______________________ The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition
cause increased swelling. This condition increases the risk for infection and inflammatory complications and may cause dif- ficulty with eating and a disfigured appearance (Georgieva & Yordanova, 2020). Although gingival enlargement is a common side effect of most calcium channel blockers, it is reported with the most frequency with nifedipine use (Castelino et al., 2021). Diuretics and other antihypertensive drugs can result in hyposalivation (dry mouth) (Ramirez et al., 2023; Ito et al., 2023; Fernandes et al., 2021). Decreased saliva exacerbates tooth decay and periodontal disease. Hyposalivation can also result in speech difficulties, a burning sensation in the mouth, tongue pain, impaired taste, bad breath, and difficulties when swallowing (Khalil & Zeltser, 2022). ACE inhibitors expand the blood vessels, allowing blood to flow more easily and reducing the work of the heart (AHA, 2023). However, these agents can cause recurrent aphthous stomatitis (oral ulcers) in addition to intraoral lesions with a lichen planus-like appearance (Boch et al., 2021). Potassium channel blockers can cause oral manifestations. For example, adverse effects of amiodarone include bluish discol- oration of the oral mucosa, bitter taste, and hypersalivation (Binmadi et al., 2021). ORAL MANIFESTATIONS IN CONGENITAL AND OTHER VASCULAR DISEASES In addition to acquired cardiovascular diseases, congenital and other cardiovascular diseases may also present with oral manifestations, some of which are pathognomonic. CONGENITAL CARDIOVASCULAR DEFECTS Congenital cardiovascular defects (CCDs) , also known as congenital heart defects , are the most common type of birth defect and the leading cause of infant death due to birth defects (CDC, 2023b). CCDs affect approximately 40,000 births annually in the United States. The defects occur when a part of the heart does not form properly before birth. Examples of simple CCDs are septal defects (holes in the heart), patent ductus arteriosus, and narrowed veins. The most common cyanotic congenital heart defect in children is tetralogy of Fallot (Shahnawaz et al., 2021). One study reported that children with CCDs had significantly more gingivitis, plaque, recession, and calculus than the control group. The researchers concluded that, compared with children without heart defects, children with congenital cardiovascular disease had a higher prevalence of periodontal disease. Children born with the tetralogy of Fallot have a higher rate of caries, poor oral hygiene and are more suscep- tible to infections and bacterial endocarditis. Frequent dental check-ups for which antibiotic prophylaxis may be needed are essential to maintain the patient’s oral and systemic health (Shahnawaz et al., 2021).
Although some patients with CCDs do not have obvious signs or symptoms, some may present with rapid breathing, cyanosis (i.e., bluish tint to skin, lips, and fingernails), fatigue, and poor blood circulation. If the CCD leads to heart failure, the patient may have shortness of breath, fatigue with physical activity, an accumulation of blood or fluid in the lungs, and swelling in the ankles, feet, legs, abdomen, and veins in the neck (AHA, 2022a). Other oral findings associated with congenital heart disease, particularly ventricular septal defects, include midline abnor- malities, cleft palate, and growth abnormalities such as delayed eruption of permanent teeth and hypoplastic primary denti- tion (Azadgoli et al., 2020). Although not pathognomonic of CCD, the gingival tissues and those of the hard and soft palate can appear cyanotic, with a greater risk of periodontal disease and dental caries and a higher susceptibility to bacte- rial endocarditis. The patient’s physician or cardiologist must be consulted to determine if antibiotic prophylaxis is required before dental treatment (van Melle et al., 2023). OSLER-RENDU-WEBER DISEASE (HEREDITARY HEMORRHAGIC TELANGIECTASIA) Osler-Rendu-Weber disease , also known as hereditary hemorrhagic telangiectasia , Babington disease , or Goldstein syndrome , is an auto- somal dominant condition resulting from aberrant vascular development. The diagnostic criteria of the disease include spontaneous recurrent nosebleeds, multiple telangiectasias (dilated blood vessels under the skin), visceral arteriovenous fistulas (abnor- mal connections between arteries and veins), and a first-degree family member who has the condition (Mayo Clinic, 2022a). Symptoms include multiple telangiectases of the skin as well as of the oral, nasal, conjunctival, and gastrointestinal mucous membranes. These often ulcerate and bleed, making nosebleeds and hemorrhages common. Bleeding risk increases with age, potentially causing anemia (Yunus et al., 2022). Blood transfusions are necessary in about 30% of patients (Hammill et al., 2021). Other recurrent complications include stroke and hypertension (Farooqui et al., 2021). GIANT CELL ARTERITIS (TEMPORAL ARTERITIS) Giant cell arteritis , also known as temporal arteritis , is a systemic necrotizing vasculitis and an important cause of secondary headaches. The most feared complication of giant cell arteritis is blindness. The common presentations of this medium- and large-vessel vasculitis are a patient age 50 years or older at onset, new headache, clinical temporal artery abnormality, elevated erythrocyte sedimentation rate, and abnormal temporal artery biopsy (Farina et al., 2023).
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