By Anna M. Avola, D.M.D., M.S.

Many diseases associated with aging have symptoms that appear in the oral cavity.  Through regular geriatric dental care, a dentist can find evidence of conditions such as anemia, diabetes, osteoporosis or arthritis.  However, people with heart disease have special needs when it comes to dental care.

If someone has suffered from a heart attack, it is recommended that they wait six months after such an episode before undergoing any dental treatments.  Before dental treatments begin, be sure to tell your dentist what medications have been prescribed such as anticoagulants (blood-thinning) drugs.  A geriatric dental care dentist should have oxygen and nitroglycerin available in case of a medical emergency.

Another consideration for heart patients if a dental procedure requires anesthesia, is that some types of anesthesia contain epinephrine.  Epinephrine is a common additive in local anesthesia products.  In some patients with high blood pressure the use of epinephrine may result in cardiovascular changes including the rapid development of dangerously high blood pressure, angina, heart attack and arrhythmias.   Geriatric dental care will include blood pressure monitoring and a though review of your past medical history including all prescribed medications.  Some medications used to treat heart failure such as diuretics, or water pills can also cause dry mouth.

According to the American Academy of Periodontology, people with periodontal disease are almost twice as likely to have coronary artery disease.  In fact, one study found that the presence of common problems in the mouth, including gum disease (gingivitis), cavities, and missing teeth were as good at predicting heart disease as cholesterol levels.

Most people do not make the connection between periodontal disease and heart disease.  However, a study published by the Journal of the American Heart Association found that people, who had higher blood levels of certain disease causing bacteria in the mouth, were more likely to have atherosclerosis in the carotid artery.  Clogging of the carotid arteries can lead to stroke!

But there is also good news for dental patients from the American Heart Association!  For decades it has been recommended that patients with certain heart conditions take antibiotics shortly before dental treatment.  However, the latest guidelines recommend that most patients no longer need short-term antibiotics as a preventive measure before their dental treatment.

These guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients.  The risks include adverse reactions to antibiotics and the possibility that may lead to the development of drug-resistant bacteria.

However, antibiotics prior to a dental procedure are advised for patients with artificial heart values, a history of infective endocarditis, certain specific congenital heart conditions and cardiac transplant patients that develop problems in the heart valve.  The new recommendations also apply to many dental procedures including teeth cleaning and extractions.

But antibiotics are generally not required for routine anesthetic injections through non- infected tissue, x-rays, placement of dentures and adjustments of removable orthodontic appliances.  If there is any question as to what pre-medication prescription is necessary before a dental treatment, patients should first check with their cardiologist before going to a dentist.

During a dental visit the dentist will discuss the medication that the patient is currently taking such as anticoagulants (blood thinning) and will consult with the patient’s physician to determine if such medication canbe interrupted if necessary for a particular dental procedure. Comprehensive dental treatment may also include taking blood pressure readings two or three times to establish a base line for the patient.

Oral health holds clues to overall health.  Geriatric dental care can provide warning signs for other diseases or conditions including heart disease.  As with many things today, prevention is the best medicine.  Regular dental exams and cleanings including a oral cancer exam will keep your teeth and smile in good condition and will have a great influence in your overall health.
Anna M. Avola
Dental Solutions for Seniors, LLC

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