Mega Doctor News
By American Heart Association
Some people might consider their dentist’s office a place for talking only about the health of their teeth and gums, not their heart or brain.
But avoiding those topics would be a mistake, said Dr. Daniel Croley, vice president and chief dental officer at Delta Dental of California.
The health of all those things overlaps in ways you might not have thought about, said Croley, who helped develop Healthy Smiles, Healthy Hearts, a collaboration between Delta Dental and the American Heart Association.
So if you’ve been treated for anything related to heart disease or stroke, here are conversations worth having with your dentist.
Let your dentist know everything
If you’re wondering what heart conditions you need to bring up, “the easy answer is – all of them,” and in detail, said Croley, who lives in the Nashville, Tennessee, area.
Here’s one example why: You might not see a connection between a cavity and the cardiovascular system, but the most commonly used dental anesthetics have epinephrine in them. “Epinephrine is adrenaline,” Croley said. “They’re heart stimulators.”
That can be a concern for someone being treated for irregular heartbeats, for instance . A dentist who’s up-to-date on your heart health can assess whether another type of anesthetic might be best for you, Croley said.
If you’ve been treated for a heart attack or stroke, or had heart-related surgery, you might need to put dental care on hold. But everybody’s needs are different, and you’ll want to talk to your dentist about the timing, Croley said.
Everybody’s different, he said. “And that presents the opportunity for the cardiologist and the general dentist to consult with each other.”
Talk about medications
Be “fully transparent” with your dentist about all the medications you take, Croley said. They can have direct and indirect effects on your dental care.
Some medications, such as blood thinners, can increase the likelihood of bleeding during a routine dental cleaning. But by no means should you stop taking them on your own, Croley said. “Don’t do that. Have that conversation with the dentist,” who can work with the prescribing doctor.
Some medications given to treat high blood pressure – such as ACE inhibitors, diuretics and beta blockers – can have oral side effects such as dry mouth.
“Don’t let that frighten you,” Croley said. The prescribing doctor and your dentist might identify another way of dealing with the problem – perhaps by identifying the root cause, which might be different from what you suspect.
So make a list of medications and dosage, or have them shared electronically, or just take photos of the prescription bottles and bring them to your appointment, Croley said.
Do you need an antibiotic?
In an unhealthy mouth, bacteria can inflame the gums, Croley said. The gums become more likely to bleed, and some of that bacteria can get into the bloodstream.
Those bacteria are associated with many diseases, Croley said, including chronic kidney disease and Alzheimer’s. Bacteria that reach the heart have been associated with atrial fibrillation, a type of irregular heart rhythm.
But guidelines on the need for antibiotics before routine dental work have evolved with the research over the years. And while most people won’t need them even after intense procedures, some will, Croley said – including people who have had heart valve replacement or repairs and people who have had endocarditis (inflammation of the heart’s inner lining).
Dental care after a stroke
Croley, whose mother is a stroke survivor, understands the many issues a stroke can cause. But, he said, those issues don’t mean you should avoid regular dental care.
Stroke is a leading cause of disability in the U.S. But dental offices, Croley said, are required to be compliant with the Americans with Disabilities Act. “So access should not be a problem.” And dentists are trained in how to help people with conditions such as facial or body paralysis, he said.
After a stroke, you may not be able to brush or floss the same way as before. A dentist can help you adapt.
“It’s really important to go to your dentist and your dental hygienist and ask them, ‘How can I effectively brush and floss with adaptive devices?’” Croley said. An ultrasonic toothbrush with a fat handle might be easier to control than a thin brush. Water flossers might replace string floss.
Ask your dentist or dental hygienist to watch you brush and floss and offer advice, Croley suggested.
Caregivers play an important role in dental care for people recovering from serious conditions, Croley said, and should not be afraid to ask those they are caring for about oral health. “It’s not like cocktail party chatter,” he acknowledged. But if you’re in more of an intimate conversation with someone, ask how you can help.
Understand it’s a two-way street
Evidence is growing about links between oral and heart health, Croley said. Periodontal disease has been associated with the risk of stroke, heart attack and heart disease. So getting proper dental care might help lower the risk of problems down the road, he said.
Just don’t think of dental care and heart health as separate realms, he said. “In reality, it is all integrated.”
