Sedation Dentist serving High Point, Greensboro, Winston-Salem and the Triad area.


My youngest sister was born with a heart defect. She had repeated visits to her physicians for monitoring and did well enough through high school and into early adulthood.”Her diagnosis was mitral valve prolapse, and the’doctors thought that heart valve replacement would give her a better quality of life. My parents wrestled with the’decision, but like most caring parents had a hard time’signing the consent form that had death as one of the possible complications of surgery.

When my sister turned sixteen and I opened my first dental office, she worked with me as a part-time dental assistant.”When she turned eighteen she was still being followed by’the cardiologist at a local hospital, and made a decision’that she would not have surgery unless it was unavoidable.

At twenty-two she was living at home and continuing her college education. On a day I will never forget, my receptionist told me my mom was on the phone.

Bertrand it’s your sister! Mom started.

What’s happening I queried.

They re working on her. Th e EMS.”

Is she alright

She’s gone, I can’t

Where are they taking her

Kings County Hospital.”

Mom, I’ll meet you there.”

My mother’s voice was in a tone that I never heard before or since. It was’sure the result was not going to be good. I rushed back and forth, told my receptionist to cancel all remaining appointments, and rushed to the hospital.”At the hospital the last sight I saw of my sister was her body passing by on a gurney as one Emergency MedicalTechnician was performing chest compressions.

Several days later my Dad and I went to identify her body in the morgue. We held onto each other for support, and in silence while being choked up we wobbled to the car together. It was over for this young child, and it was uncertainty for the young two year old child she left behind.

We could not believe it.”The death certificate stated as cause of death “Floppy mitral valve.” The rest of the family was subjected to ECG,Echocardiograms, and Stress tests. My diagnosis was functional heart murmur.” Needless to say my concern for patients with heart problems increased to the point where I took the courses given by the American HeartAssociation and became Advanced Cardiac Life SupportCertified.

The connection between the heart and the mouth has long been established, and anyone with a heart murmur or artificial joint knows that they may have to take antibiotics prior to dental treatment. Antibiotic prophylaxis is medication taken in high enough doses to treat bacteria from the mouth that gets into the bloodstream to prevent it from damaging the heart or artificial joints. The mouth, throat, and sinuses are places that are conducive’to the breeding of viruses, bacteria, and fungus that can’spread throughout your body if your immune system is compromised.

Chemotherapy can compromise your immune system’to the point where your remaining white blood cells are not enough to keep the body from coming down with a general infection. The general guidelines that your dental’team gives you for taking care of your teeth and gums’should be strictly followed to ensure that if you ever find yourself in the position where you need Chemotherapy–you will not suffer severe oral symptoms.

Radiation treatments affect the body in many ways. The bones in the jaws are particularly susceptible to radiation because the radiation compromises the blood fl ow in the bones. The salivary glands are adversely affected if they become exposed to radiation. The salivary glands are’scarred and generally reduce their production of saliva causing dry mouth. Saliva serves a protective and lubricating function in the mouth, but dry mouth leads to multiple oral problems including increased cavities and gum ulcerations.

The worse condition that can occur after radiation’treatment is osteoradionecrosis. Osteoradionecrosis is the breakdown of the bones that happens aft er radiation treatment and can be exacerbated by ongoing oral infections.”Hospitals treating this condition oft en use the hyperbaric chamber where patients are subjected pressurized oxygen over several appointments. The remaining jawbone that’survives aft er treatment, presents major problems for restoring teeth because it is hard to make a satisfactory prostheses for a compromised jawbone.

My best advice is to take prevention of gum disease and cavities seriously. Make sure your oral health is in the best of shape before doing any elective surgery, or prior to the need for chemotherapy, or radiation treatment. So let us review the April 2007 recommendations by the AmericanHeart Association.

Increased use of antibiotics also increase the risk of an allergic reaction to a specific antibiotic and that can be even more immediately life threatening than bacteria in the bloodstream. Consult your physician if you are uncertain about needing antibiotics prior to dental treatment.

The following are basic guidelines for needing antibiotics prior’to treatment.”
  • Prosthetic cardiac valve
  • Previous bouts of infective endocarditis
  • Certain congenital diseases (Unrepaired cyanoticCardiac Heart Defects (CHD ), first six months after prosthetic repair of CHD, repaired CHD with residual defects, palliative shunts and conduits, etc)
  • Cardiac transplant recipients who develop valvulitis
  • Mitral valve prolapse with associated defects that your physician thinks may put you at risk for endocarditis.

In addition to the above, certain cardiac surgical procedures may require that you wait six months prior to having a dental procedure, providing you’do not have a life-threatening dental infection. If’there is any uncertainty the best option is to see your physician prior to seeing the dentist.

Over the last few years more scientific studies have come out supporting the link between poor oral health and cardiovascular diseases. Current advances in DNA studies will allow doctors to predict the patients who are more at risk for diseases than others based on oral salivary or blood samples. Some dentists are using screening tests for C-Reactive proteins and early diabetic screening to’see which patients may require close monitoring of their’dental health.

Many studies have indicated the correlation between gum’disease and cardiovascular disease. One in office treatment involves the use of an antibiotic delivered directly into the space between tooth and gum where’severe periodontal’disease needs to be treated. The area is cleaned and irrigated before the antibiotic is administered. The protocol for using this method can be discussed with your dentist and dental hygienist. Our Registered DentalHygienists (RDHs) are trained to administer the treatment in conjunction with’the dentist’s diagnosis. Therapy can be repeated in areas of your gums that are infected, and referral to a periodontist will be made, if indicated.

 

Chapter 10: Toothpaste, Mouthwash and Fluoridated Water