The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition _ _____________________
therapy is the nature and the extent of the morbidity of the cardiovascular or cerebrovascular disease for which these medi- cations are prescribed. Co-morbidities such as hepatic disease which could adversely impact the production of coagulation factors produced in the liver, as well as platelet disorders such as thrombocytopenia or other coagulopathies which can impair the ability to obtain hemostasis, must be considered before oral surgery is considered on any patient, but with greater import for patients on an anticoagulant or antiplatelet regimen. Options for dental patients who require oral surgery and who use anticoagulants include the continued use of the anticoagulant, timing the daily dose of the anticoagulant to be as many hours away from the surgical procedure as possible, or a temporary interruption of 24-48 hours of the anticoagulant prior to the surgery (ADA, 2022). The dentist must consult with the patient’s physician or cardiologist to determine the regimen that is appropriate for the patient. It is important that the dentist informs the physician of the nature and extent of surgery as hemostasis concerns are different for a single tooth extraction compared to multiple or full-mouth extractions. When anticoagulant therapy cannot be interrupted, dental clinicians must be skilled in their ability to obtain hemostasis via local measures if intraoperative or post-operative bleeding ensues. Neither the dentist or the patient via single or joint decision can make the decision to modify the anticoagulant therapy in any fashion. After completing an extensive literature review, one group of researchers concluded that the level of evidence for which patients taking anticoagulant medicines had safe and successful dental treatment was insufficient. Until results from random- ized clinical trials are available, these researchers recommend that the dental professional and physician together develop an individualized medical treatment plan for each patient. The results of large studies do not replace the collaboration of the dentist and physician in developing a treatment plan that protects the patient’s cardiovascular or cerebrovascular health and provides for obtaining hemostasis after oral sur- gery. More recently, the ADA has said that there is strong evidence for patients on older antiplatelet medications and anticoagulants—and some limited evidence concerning newer medications—indicating that there is no need for patients to alter their antiplatelet or anticoagulant regimens before having dental treatments (ADA, 2022).
CONCLUSION The oral cavity plays an important role in many critical physi- ologic processes, such as digestion, respiration, and speech. Vascular and cardiovascular diseases often have orofacial pre- sentations, which in some cases appear before the emergence of symptoms or lesions at other locations. Additionally, there is evidence implicating periodontal disease as a potential risk factor for some types of cardiovascular disease. Exposure to a number of pharmacotherapies used in the treatment of cardiovascular disease may also produce orofacial presentations and symptoms. To aid in diagnosis and guide the approach to dental treatment, oral healthcare professionals must recognize oral manifestations of these conditions and other systemic or multiorgan diseases with a cardiovascular component. Given the prevalence of cardiovascular disease in the United States, dental professionals must be aware of its effect on oral health in order to optimize management of this large population.
WORKS CITED https://qr2.mobi/Diseases-Oral
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