Medical History and Dental Treatment
Many patients are surprised to find out how important a medical history is for dental care. There are many interrelationships between general health and oral health, and there are also many interactions of drugs that affect dental care. Below are some explanations of why we need to know about health conditions.
Keep in mind, however, that this is by no means a complete list of health conditions or medication that affect dental care. Patients should always tell us about any medical treatments they are receiving and all medications they are taking.
Antibiotic Prophylaxis/Bacterial Endocarditis
When dental work is performed that could involve bleeding, such as teeth cleaning, periodontal treatment, extractions, or fillings around the gum area, bacteria that is present in the mouth may be introduced into the bloodstream. This is not a problem for most people, but if someone has a certain condition, it could cause serious problems if precautions are not taken. In these special medical cases, antibiotics will need to be taken before having dental work performed. The conditions for which this pre-treatment course is recommended can vary based on guidelines based on current scientific evidence, but at present include some heart conditions that involve some prosthetic devices and some congenital heart conditions, along with some orthopedic implants, and for patients who have additional problems compromising their immune system. Generally, the decision for use of antibiotics would be a joint decision in consult with the patient’s physician, taking into account an individual’s total medical profile.
Periodontal disease is a risk factor in heart disease. With heart conditions, extra care must be taken to monitor periodontal conditions. Some heart conditions may also affect the type of anesthetic used, and some medicines taken for heart conditions affect dental treatment.
Radiation therapy can cause reduced saliva flow, which in turn can cause rampant decay. If a patient is undergoing radiation therapy, a prescription for artificial saliva and a fluoride rinse may be necessary, along with close monitoring at the dentist's office.
Nutrition concerns while undergoing cancer treatment may also affect oral hygiene, and vomiting from chemotherapy can cause erosion of teeth.
This condition would cause concern about the type of anesthetic to use for local anesthesia. We would need to use an anesthetic without epinephrine.
High Blood Pressure
Epinephrine, added to dental anesthetics to provide a longer lasting effect, causes a rise in blood pressure. If a patient has high blood pressure, we would need to use a different kind of anesthetic, without epinephrine.
Diabetics have a much higher risk of developing periodontal disease, and periodontal disease aggravates diabetic problems. Diabetics also have a harder time healing from oral surgery, so special precautions may be needed. Close monitoring of gum problems, with more frequent cleanings and check-ups may also be indicated.
Bulimia can cause severe erosion of teeth. Acid regurgitated from the stomach repeatedly eats away at tooth enamel. Anorexia or overall poor nutrition can cause gum or soft tissue problems.
Head or Jaw Injury, Arthritis, Chronic Headaches
Injuries to head or jaw can cause TMJ (jaw joint) problems and should be monitored. Arthritis can also affect the jaw joint, and chronic headaches may be caused by dental problems such as bruxism (clenching of teeth).
Anemia or Blood Clotting Problems
These can both cause complications with periodontal treatment or other dental surgery.
Chronic Sinus Problems
Pressure from this condition can cause tooth pain, and can mimic an abscessed tooth.
Medicines and Dental Care
Blood Thinners and Aspirin
These drugs can affect clotting times and cause complications from dental surgery. A patient may need to discontinue these medicines temporarily when dental surgery is scheduled. Anyone taking blood thinners should consult with his or her physician before scheduling dental procedures that could involve bleeding.
Some contraceptives can cause change in periodontal condition, and may have interactions with other medications.
Fosamax, Actonil, Boniva – are a class of drugs called Bisphosphonates are used to treat osteoperosis and osteopenia. These drugs affect the bone modeling cells called osteoclasts and have been associated in rare cases with an increased risk of bone osteonecrosis of the jaw. In this condition jaw bone dies from a combination of factors and is associated with dental treatment affecting the bone such as extractions or jaw surgery.