This term includes a wide range of conditions that affects heart and blood vessels. Atherosclerosis is diseases of blood vessels that are changed in structure, since the medium and internal layer known as mesothelium and endothelium are covered with atherosclerotic plaque. The plaque consists of lipids, cholesterol and calcium, in other words- calcified collection of fat and cholesterol. These changes leads to loss of elasticity in vessels, they become more rigid. The named changes can lead to other serious conditions in other systems and organs, such as heart attack, ischemic conditions and stroke. Depending on the affected vessels, different complications may develop: coronary heart disease, angina pectoris, stroke, carotid artery disease, peripheral artery disease. Main causes for heart disease are high blood pressure, unhealthy diet (rich in fat, carbs, salt and sugar), lack of physical activity, diabetes, stress and smoking. Patients suffering from any of these conditions needs to discuss their medical history with their dentist who may contact your physician in order to collect additional information or recommendation for future dental treatments.
Dental interventions are usually stressful for everyone. Stress in dental office needs close attention in patients with any form of cardiovascular disease, especially those with unstable angina pectoris. In these patients, stress can be a trigger for worsening their condition. Therefore, in order to reduce stress during the procedure, patients may be advised to take oral sedatives prior to the intervention. Earlier considerations suggested that anaesthetic solutions with adrenalin should be avoided in patients with cardiovascular diseases since they may negatively affect patients’ health. Nowadays, attitudes towards anaesthetics with adrenalin indorse their application in patients with cardiovascular conditions, but with caution regarding the dosage that should not exceed 0.04 mg of adrenalin.
Many patients suffering from cardiovascular diseases are taking anticoagulant medications that are preventing clot formation. The problem with these patients may appear during surgical treatments since the clotting time is increased and bleeding is longer than normal. Oral surgical interventions are usually less invasive, with small wounds and healing is possible without interrupting medication therapy. If anticoagulant therapy would be stopped prior to surgical treatment, that could negatively affect primer health condition and lead to complication of cardiovascular disease with fatal outcome. With these patients, important thing is to be familiar with INR value on the day of surgical intervention. INR value is clotting time in patients taking anticoagulants. This factor should be in the range of 2.0-4.0 in order to conduct a safe surgical procedure. As a part of a regular protocol, local hemostasis should be provided for these patients. Whether it is an absorbable gelatin sponge that could be placed into the wound in order to help hemostasis, hemostatic gauze impregnated with iodoform or simply surgical suturing of a wound, your dental surgeon will know which is the right additional treatment to prevent any prolonged bleeding after the procedure.
If patients have implanted a pacemaker, that should be seriously considered since dentist often use electronic devices in everyday practice for additional diagnoses. There are many different pacemakers nowadays, and its interferential with dental electronic devices is not uniform. Usually, the manufacturer in their instruction for use will suggest how to handle patients with a pacemaker. The safest procedure is your dentist consulting your cardiologist since he will know the exact type of pacemaker implanted and how your dentist can proceed in order to avoid interaction between these two appliances.
Infective endocarditis is an infection of the inner layer of the heart known as the endothelium. The causes of this infection are bacteria known as Streptococcus and Staphylococcus. This condition, if it is not treated, has manifestations similar to any fever, with high body temperature, chills, general fatigue, sweating, aching of muscles and joints etc. Complication of infective endocarditis can have a fatal outcome. Thanks to antibiotics, this condition can be easily treated. Many other heart conditions can be accompanied with infective endocarditis, such as rheumatic heart disease, different congenital heart diseases, mitral valve prolapse, artificial valves.