Unique to You

About cardiovascular disease

Cardiovascular disease (CVD) describes multiple conditions that can affect your heart and blood vessels. CVD includes coronary heart disease, stroke, high blood pressure, heart failure, artery diseases, and more. In people with CVD, plaque builds up in arteries, causing them to harden or thicken. This restricts blood flow and can eventually trigger a heart attack or stroke.

Nearly half of American adults have some form of CVD, but it's becoming more prevalent in younger people as well.¹ It is the number one cause of death in America, claiming more lives than cancer and chronic respiratory disease combined.¹

Key risk factors and lifestyle choices contributing to CVD include:

• High blood pressure
• High cholesterol
• Obesity
• Physical inactivity
• Diabetes
• An unhealthy diet
• Tobacco and excessive alcohol use
• Poor oral health²

It may surprise you that poor oral health is not only a CVD risk factor but is considered to be as relevant as virtually any other risk factor listed above. Consider that an estimated 50% of U.S. adults have some degree of periodontal disease.³ If you are among this group, you must take action to ensure that your oral health is not contributing to your risk for cardiovascular disease.

Oral health and your heart

Recent research has demonstrated the following:

• People with gum disease have two to three times the risk of having a heart attack, stroke, or other serious cardiovascular events.⁴
• People with tooth decay can have a 4.5 times higher risk of brain bleed strokes (intracerebral hemorrhages) than those without decay. While brain bleed strokes account for only 10% to 20% of all strokes, they have a higher mortality rate than the more common ischemic strokes.⁵

While the connection between oral disease and CVD is not fully understood, it appears to relate to bacterial infection from your mouth entering your bloodstream.

• Bacteria found in heart disease and gum disease are similar and could be related.⁶
• C-reactive protein (CRP) levels, which are inflammation markers used to assess the risk of heart attack, have been found to be higher in people with moderate to severe periodontal disease.⁷

CVD and its treatment can produce effects that can complicate dental treatment. This is why it is important to alert your dentist if you have been diagnosed with CVD.

Inform your dentist:

• Prior to arriving for your appointment, inform your dentist that you have been diagnosed with CVD or have suffered a heart attack or stroke. It is important for your dentist to know before you arrive at the office because they may require special accommodations or equipment to safely treat you. Without proper planning, appointment delays could result. In some cases, your dentist may wish to refer you to a specialist.
• Be sure to provide your dentist and physician with each other's contact information. This is important as they should discuss your physical stability, oral health status, and medications you take prior to beginning any dental treatment. For example, they may decide that certain procedures (especially non-essential procedures) should be postponed until they agree you are stable enough to receive treatment.⁸
• At your dentist appointment, be certain to tell your dentist or hygienist about any medications (prescription, over-the-counter, or supplements) and the dosages you take when you discuss your health history and current health status. Certain CVD medications may cause increased bleeding that can affect your treatment options. They may also cause oral side effects like dry mouth that you and your dentist can address during your appointment. You may want to prepare a list of medications and dosages before your appointment. There is more information on CVD medications in the "Other considerations" section below.
• Before starting treatment, your dentist will assess your risk for complications, including the severity of your disease, the type of dental procedure, and your overall stability.⁸
• Let your dentist know if you've noticed any of the symptoms of periodontal disease or tooth decay, such as bleeding, swollen gums, tooth sensitivity, rashes, or sores.

Make oral health a priority:

Don't wait until you are diagnosed with CVD or have a heart attack or stroke to address your oral health.

• Make sure you are brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If you have symptoms of dry mouth or tooth sensitivity, special toothpastes are available to help reduce these symptoms. Some may require a prescription.
• Don't stop brushing your teeth if your gums bleed. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day helps remove plaque from between teeth where brushes do not reach.
• Your dentist may suggest fluoride supplements if they feel you are not getting enough fluoride from your water sources.
• To prevent and treat tooth decay, gingivitis, and periodontal disease, visit your dentist regularly for exams and professional teeth cleanings on the schedule your dentist recommends.
• Let your dentist know if you have any loose teeth. Loose or missing teeth can have profound effects on your oral and overall health.
• You and your dentist should let your physician know about any treatment your dentist recommends. Ask if any of the medications you are or may be taking have oral side effects.
• Eat a healthy, well-balanced diet. Your doctor may also suggest you take supplements.
• Avoid tobacco and excessive alcohol use.

Antibiotics:

If you have a heart condition, your dentist may recommend you take antibiotics prior to invasive procedures to avoid inflammation or other conditions that could result from bacteria in your mouth entering your bloodstream and reaching your heart.

Heart attack: If you have suffered a recent heart attack, you are at an increased risk of complications from invasive dental care. You and your dentist should discuss these risks and determine if delaying dental care is appropriate.

Medications: Some CVD medications may produce inflammation in your mouth and lips, bleeding gums, mouth lesions, and changes in taste.⁸, and some medications used in support of dental treatment can have implications for people with CVD. Always speak with your dentist and physician prior to stopping, changing, or taking medication. Here are some examples:

• Statins: Statin drugs and other medications are often prescribed to treat heart disease, high cholesterol, and high blood pressure. Dry mouth (xerostomia) is a possible side-effect, which can lead to other oral conditions.⁹
• Blood thinners: Warfarin and other blood thinners may delay how long it takes your blood to clot, which can be a factor for some invasive procedures. For treatment that is expected to cause bleeding, you may need to temporarily suspend your medication. Only do this on the recommendation of your dentist and physician.¹⁰
• Calcium blockers: Calcium channel blockers used to lower your blood pressure have been shown to increase the growth of gums surrounding your teeth (gingival overgrowth), which can make oral hygiene more difficult.¹⁰
• NSAIDs: If you have an elevated risk or history of heart attack, check with your physician or dentist about the safety of taking NSAIDs (aspirin, ibuprofen, naproxen, etc.) to manage pain following dental treatment.¹⁰

Diabetes: People with diabetes are at greater risk for CVD. There is also evidence that people with diabetes can better control their disease by improving their oral health.¹¹ So when you focus on your oral health, you can directly impact two significant CVD risk factors.

Anesthesia: If you have CVD, you should talk to your dentist and/or physician before getting dental treatment that requires anesthesia. Some types of anesthesia include epinephrine, which can increase blood pressure and heart rate, especially in older adults.¹²

Artificial heart valves: Oral bacteria in the bloodstream can have particularly negative effects on artificial heart valves, making it even more important to maintain good oral health.¹¹