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There are important considerations that need to be kept in mind for a cardiac patient before undergoing dental treatment. Not following these precautions could even be life threatening. We list them out.

If you are suffering from one of many cardiac diseases, you must already be bombarded with a litany of things to do, not to do, and precautions to take. One among these, however, one thing that often gets overlooked is the precautions you need to take when you are going in for a dental check-up.

To be fair, the onus of knowledge lies on the dentists in this case, but the quality of care may vary from place to place and so arming yourself with the latest scientific recommendations is essential.

High Blood Pressure And Dental Treatment

High blood pressure (hypertension) is one of the most common cardiac diseases around the globe. Its rapid and continuous rise has been attributed to the growth of fast food, excessive salt usage and falling levels of physical activity.

Patients on treatment for high blood pressure should take their medication as they usually do and not alter or skip it because they are about to undergo dental treatment. They should mention that they are under hypertension treatment and provide the dentist a list of drugs if required.

A blood-pressure checkup will be performed on every visit by the dentist.

A well-controlled hypertension patient can be treated like any other patient, however, if you have a history of poor blood pressure control then the dentist might require a recent check-up, blood pressure reading and go-ahead from your physician.

Ibuprofen, naproxen, and Indomethacin (common types of pain medication) can interact with hypertension medication, and should not be prescribed to hypertensive patients [1]. 

If you start feeling dizzy or overly anxious during the treatment, let the dentist know so that adequate pre-medication can be given. Sometimes the dentist may also choose to abort a procedure and delay it to a more appropriate time [2].

In the case of a hypertensive emergency where the blood pressure rises to dangerous levels, emergency services may need to be called in along with an administration of furosemide 40mg. Your doctor may choose to observe your blood pressure for 30 minutes before referring you to the nearest hospital if no improvement is seen.

Myocardial Infarction And Dental Treatment

If you have had a myocardial infarction (also known as a heart attack), then you are at a very high risk of a second incident within one month of the first [3]. Doctors are advised not to carry out any non-emergency dental treatment on a patient who has suffered a myocardial infarction for at least six months, after which they can be treated like any other patient [4].

If any emergency procedure has to be carried out like an extraction or root canal treatment, then it should be carried out in a hospital setting where any unexpected medical emergency can be promptly dealt with.

Angina And Dental Treatment

Angina or chest pain is felt in patients that are suffering from coronary heart disease. This is again very common in the general population. One of the most common areas where angina is referred to is the lower jaw.

Patients often mistake their pain to be of dental origin when it could be cardiac in nature. If you have suffered from angina in the recent past or are known to be a risk for it, inform your dentist about it beforehand.

Patients are advised to schedule appointments in the morning, when they are most relaxed. They should also request that the dentist keeps the appointments short, as stress-free as possible, and even prescribe some anti-anxiety pre-medication if necessary [5].

It is advisable to always carry your own nitroglycerine spray when you are going in for a dental appointment in case an angina attack is precipitated on the chair itself.

Infective Endocarditis And Dental Treatment

The American Heart Association recommends that antibiotic prophylaxis be undertaken when patients at high risk of developing infective endocarditis are undergoing dental treatment. These include patients who have prosthetic heart valves, heart transplant patients, and those who have a previous history of infective endocarditis or are suffering from a congenital heart disorder [6].

This antibiotic prophylaxis should be given before any kind of gingival treatment, ranging from simple scaling to other more invasive procedures. Patients will be administered a 2-gram dose of oral penicillin 30-60 minutes before their scheduled procedure or a substitute drug if they are allergic to penicillin.  

Patients should also know that the maintenance of good oral hygiene assumes a whole different level of seriousness in their cases [7,8].

Dental Treatment For Patients On Anticoagulant Therapy

A lot of patients that have a history of cardiac disease are put on low dose anticoagulants to prevent further episodes. These patients are at risk for uncontrolled bleeding if proper precautions are not taken [9].

Patients are advised to inform the dentist of the exact dose of anticoagulant they are on, get an INR test done prior to treatment or on the advice of their dentist, and not discontinue the anticoagulant medication before dental treatment.

There was a school of thought that recommended interrupting the anticoagulant therapy during dental treatment, however, that is no longer the case [10].

An INR of 2-4 indicated the patient is within the safe zone to undergo dental treatment.

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