Running Head: SPECIAL DENTAL NEEDS OF CARDIOVASCULAR DISEASE.

Special Dental Needs of Cardiovascular Disease

Jennifer Linder

Indian Hills Community College

SPECIAL DENTAL NEEDS OF CARDIOVASCULAR DISEASE

Special Dental Needs of Cardiovascular Disease

Cardiovascular disease is the leading cause of death worldwide, taking the lives of more

than 17.7 million people every year. Cardiovascular disease (CVD) is a blanket term over many

different types of heart disease, making it a common disease in patients that dental hygienists

treat. Because of this, dental hygienists should be well aware of the disease, symptoms and oral

manifestations caused by it, common treatments, and special considerations they should take into

account when treating their patients that have cardiovascular disease.

Cardiovascular disease is “an alteration of the heart and/or blood vessels that impairs

function” (Bowen & Pieren, 2020). Risk factors for CVD include family history, race, stress,

Type-A personality, gender, obesity, diet, environment, tobacco usage, diabetes, oral

contraceptives, and age. “Research suggests that the systemic inflammatory or immune response

to periodontal infection may increase cardiovascular risk.” The direct correlation between

periodontal disease and cardiovascular disease is important for the dental hygienist to understand

because it is detrimental to those patients’ health that their periodontal disease is thoroughly

addressed and treated.

Hypertension is a common clinical finding in a patient with CVD and a symptom a dental

hygienist can easily find by taking a patient’s blood pressure prior to starting any dental

procedures. “Dental care is one of few medical services to which a considerable proportion of the

general population comes for regular check-ups” (Engström, Berne, Gahnberg, &

Svärdsudd, 2011). Because of this, a patient’s BP and pulse should be taken at the beginning of

every appointment. Hypertension is the “persistent elevation of the blood pressures greater than

130-139 Hg systolic or greater than 80-89 Hg diastolic. Hypertension can be controlled with

medications and patients with uncontrolled hypertension should have their dental treatments
SPECIAL DENTAL NEEDS OF CARDIOVASCULAR DISEASE

delayed until it is under control. Modifications for patients with hypertension include reducing

stress and anxiety for the patient during the appointment and using local anesthetic without

vasopressors.

Coronary Artery Disease is the result of insufficient blood flow to the heart from the

coronary arteries. CAD includes arteriosclerotic heart disease (narrowing of the arteries), angina

pectoris (chest pain), coronary insufficiency, and MI (heart attack). “Research has shown that

atherosclerosis is more common in patients with periodontitis” (Rose, Mealey, Minsk, &

Cohen, 2002). Patients with CAD are usually on Aspirin and antiplatelet drugs, making

excessive bleeding a concern. Sudden heart attack in the dental office is also a major concern

that a dental hygienist should be prepared for. Patients should be treated in a stress-free

environment. Before starting treatment, the hygienist should check with the patient’s physician to

ensure the patient can endure dental treatment in their current condition and on their current

medications. Office staff should be prepared if the patient needs assistance with taking

nitroglycerin for chest pain, or needs advanced life support. Patients should not receive dental

treatment within 30 days of a MI.

Cardiac dysrhythmias and arrhythmias are disfunctions in the heart rate and rhythm.

Different types include bradycardia (slow heartbeat), tachycardia (increased heartbeat), atrial

fibrillation, ventricular fibrillation, premature ventricular contractions, and heart block. Patients

with these conditions may have a pacemaker or implanted cardioverter defibrillator that can be

affected by electrical interference from treatment devices. Dental hygienists should consult the

patient’s cardiologist before providing treatment to discuss if the patients pacemaker is protected

of if it needs special considerations.

SPECIAL DENTAL NEEDS OF CARDIOVASCULAR DISEASE

Congestive heart failure (CHF) can cause fluid buildup in the patient’s lungs, causing

difficulty breathing. Patients should be treated in a stress-free environment and positioned

upright to help with breathing.

Congenital heart disease (CHD) is caused by an abnormality in the heart’s structure or

function. These may include septal defects or patent ductus arteriosus. Patients with CHD should

be given a prophylactic antibiotic before treatment to help prevent infectious endocarditis.

Valvular heart defects can cause irregular blood flow within the heart. Patients with VHD

are usually on anticoagulants, creating a risk for excessive bleeding. Hygienists should consult a

patient’s physician before completing treatment to discuss the patient’s current condition and

medications. Patients that have had corrective surgery for VHD are at risk for infection and need

meticulous oral biofilm control and frequent care appointments to reduce their infection risk.

The best dental hygiene consideration for patients with cardiovascular disease is

consulting a patient’s cardiologist or primary care physician prior to giving treatment. Their

cardiologist can inform the hygienist if precautions should be made related to medications or

medical equipment. Hygienists can best serve their patients suffering from cardiovascular disease

by reviewing their medical history and medications, obtaining their vitals, having them rinse

with a preprocedural antimicrobial mouth rinse, ensuring they have optimal oral health, and

providing their cares in a stress-free environment.

SPECIAL DENTAL NEEDS OF CARDIOVASCULAR DISEASE

Works Cited

Bowen, D. M., & Pieren, J. A. (2020). Pp. 785-802.s Darby and Walsh Dental Hygiene: Theory

and Practice (5th ed.). Maryland Heights, MO: Elsevier.

Engström, S., Berne, C., Gahnberg, L., & Svärdsudd, K. (2011). Efficacy of screening for

high blood pressure in dental health care. BMC Public Health, 11(1). doi:10.1186/1471-

2458-11-194

Rose, L. F., Mealey, B., Minsk, L., & Cohen, D. W. (2002). Oral care for patients with

cardiovascular disease and stroke. The Journal of the American Dental Association, 133.

doi:10.14219/jada.archive.2002.0378