The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition _ _____________________
CARDIAC ARRHYTHMIAS Cardiac arrhythmias encompass issues related to the rhythm or rate of the heartbeat. The heart may skip beats, beat too fast, or cease beating at all. A common symptom of cardiac arrhythmias is palpitations, a fluttering feeling in the chest (NIH, 2022d). Most oral manifestations of arrhythmias are related to side effects of antiarrhythmic drugs such as quini- dine, procainamide, and amiodarone (Jeske 2018). (See the discussion in the section on oral presentations and symptoms resulting from the use of common cardiovascular agents.) HEART FAILURE Heart failure occurs when the heart cannot pump enough blood to meet the body’s needs. Heart failure does not mean the heart has actually stopped. A buildup of fluid causes such symptoms as shortness of breath, fatigue, and swelling of the ankles, feet, legs, stomach, and veins in the neck (NIH, 2022e). Healthcare professionals should also look for signs of jugular vein distention, hepatojugular reflux, pulmonary rales, and pitting peripheral edema, which all indicate fluid volume overload and increase the chances for heart failure (Thibodeau & Drazner, 2018). Patients with heart failure can also develop compensatory polycythemia (and attendant thrombocytopenia), which can manifest as ruddy complexion and bleeding tendency. Abnor- mal production of clotting factors can also result from passive congestion of the liver. Other oral manifestations of heart failure may be related to pharmacotherapy such as angiotensin- converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-adrenergic blockers (“beta blockers”), diuretics, and hydralazine/nitrates. (See the discussion in the section on oral presentations and symptoms resulting from the use of common cardiovascular agents.) About 6.2 million adults in the United States have heart fail- ure. Patients with coronary heart disease, high blood pressure, and diabetes have a higher likelihood of heart failure. People who smoke, do not exercise enough, are overweight, or eat foods high in fat, cholesterol, and sodium are also at greater risk for heart failure (CDC, 2023b).
CASE SCENARIO Glen is a 75-year-old male who has recently moved to live closer to his children after the death of his wife. His health has declined over recent years, and his dental care has been sporadic. Glen was a tobacco smoker for about 50 years and quit smoking at the age of 68 after suffering a myocardial infarction. At that time, he had coronary bypass surgery and has had no further episodes of myocar- dial infarction or angina. Over the past several months, Glen has experienced increasing fatigue, shortness of breath with mild exertion, and swelling in his feet and ankles. A medical evaluation resulted in a diagnosis of mitral valve stenosis. His cardiologist advised that Glen undergo surgery to replace the mitral valve. In preparation for the surgery and to reduce risk of postoperative complications, Glen was instructed to find a dentist and obtain treatment for urgent conditions, if any. Glen, who has not seen a dentist for several years, set an appoint- ment with his son’s dentist, Dr. Richardson. In reviewing Glen’s medical history, Dr. Richardson learns of his history of cardiovascu- lar disease and his planned surgery. He learns that Glen is currently taking aspirin (81 mg) and simvastatin. Glen has listed no other medications except for nitroglycerin, which he carries with him but has not used for many years. Dr. Richardson’s intraoral examination reveals generally poor oral hygiene, with heavy plaque coating Glen’s teeth and multiple areas of root surface decay. Tooth 2 is extensively decayed, with pus draining from a fistula on the buccal gingiva. In addition, Glen has generalized moderate periodontal disease. Although there are multiple areas of probing depths between 4 and 7 mm, there is not a large amount of bleeding on probing, and it does not appear that any teeth are at immediate risk of extraction due to bone loss. Points to Consider 1. Without dental treatment, what are some specific risks posed by Glen’s oral health to his cardiovascular health? Glen’s history of cardiovascular disease and current mitral valve stenosis place him at a much higher risk of developing infective endocarditis, which could be fatal. Periodontal and other oral pathogens can enter the bloodstream and infect the inner lining of the heart and valves. This risk may be higher after surgery with an artificial or donor mitral valve replacement. continued ►
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