Dental treatment with heart disease: stents, heart valves, bypass, pacemakers and blood thinners

• Any heart attack, stent or bypass, and when
• A prosthetic or repaired heart valve, or previous infective endocarditis
• Congenital heart disease
• A pacemaker or defibrillator (ICD)
• All your medicines: anticoagulants, antiplatelets, blood pressure and rhythm medicines
• Any recent chest pain, breathlessness or palpitations

This determines which procedure is done, when and how. Other conditions such as diabetes and high blood pressure are covered in dental treatment with chronic conditions.

During procedures that make the gums or root tip area bleed, mouth bacteria can briefly enter the bloodstream. For most people this causes no problem. But for those at high risk of infective endocarditis, a single preventive dose of antibiotic is recommended beforehand. According to current guidelines this group mainly includes:

• People with a prosthetic heart valve or prosthetic material used in valve repair
• People who have had endocarditis before
• Some congenital heart conditions (particularly unrepaired ones or those recently repaired with prosthetic material)

A stent, bypass or pacemaker alone usually doesn't require antibiotic cover. Your doctor decides which medicine and dose; don't take antibiotics on your own.

Antiplatelet medicines after a stent and anticoagulants shouldn't be stopped without your cardiologist's approval, as stopping them can raise the risk of clots. Fillings, root canal treatment and most extractions can be done while you continue them, with local measures to control bleeding. For more extensive surgery, blood tests and the medicine schedule are planned with your cardiologist or prescribing doctor.

• Recent heart attack or stent: non-urgent treatment is usually postponed for a while; your cardiologist decides how long. Urgent problems such as pain and infection aren't postponed.
• Local anaesthetic: the small amount of adrenaline in dental anaesthetics is used safely in most heart patients; the dose is adjusted to your condition.
• Pacemakers: your dentist may take precautions with some electrical instruments, so always mention it.
• Position: people with heart failure may struggle to lie flat; treatment can be done semi-upright.
• Short, calm visits: stress and long sessions can strain the heart, so treatment can be split into shorter visits.

Studies have shown links between gum disease and cardiovascular disease. Regular scaling and gum treatment lower the inflammatory load in the mouth. For heart patients, keeping the mouth healthy is also one of the surest ways to avoid infections that need urgent treatment. See gum treatment.

Bring your medicine list and any cardiology report to the appointment. After the examination we give you the plan and, where needed, questions to ask your cardiologist in writing, and carry out treatment at a time that suits your medicines and heart condition.

Dent32 Ağız ve Diş Sağlığı Polikliniği (Dent32 Dental Polyclinic) is at Barış Mah., Ginza Lavinya, E-5 Yanyolu No:30 D:179, 34520 Beylikdüzü, Istanbul and is open seven days a week. To book, call or WhatsApp +90 555 011 33 68, or use our contact page. At the examination we share the findings, the options and the approximate cost in writing; you are under no obligation to start treatment afterwards.

For clinic details, our dentists and the full list of treatments, visit Dent32, dental polyclinic in Beylikdüzü.