Dental treatment for patients with cardiac diseases

For children with certain cardiological diseases, oral cavity sanitation – that is, the treatment of diseased teeth – is a direct indication. Dental…

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Dental treatment for patients with cardiac diseases

For children with certain cardiological diseases, oral cavity sanitation – that is, the treatment of diseased teeth – is a direct indication. It helps prevent infection from a diseased tooth into the heart, which is especially important if the baby is indicated for cardiac surgery. However, why do such patients often find themselves without proper attention from dentists and do not always receive timely assistance?

The refusal of dentists in most conventional clinics to treat patients with cardiac diseases is primarily due to the fear of the doctor himself that something might happen to the patient during treatment. Secondly, local anesthesia drugs used in dentistry contain substances that affect the heart, which is even more alarming and discourages the dentist from taking up dental treatment in such patients. Thirdly, a number of dental manipulations require the abolition of a number of serious drugs that these patients need in connection with the main diagnosis. And besides, in an ordinary dental clinic there is no way to control the current state of the heart (carry out cardiac monitoring, control blood pressure, etc.) and there are no anesthesiologists who could provide the necessary assistance in case of complications from the heart …

It is for these reasons that if cardiac patients are provided with dental care, but not on an outpatient basis, but in a hospital. Of course, in severe cases, this is the only way, and it is absolutely justified. But after all, a number of diseases, in particular, some heart defects, are of a formal nature and do not pose a threat to life.

In children, heart diseases are divided into two most important categories: congenital, that is, those that appeared in utero as a result of improper laying of internal organs, and acquired, resulting from the impact of any other factors after the baby was born. Parents of such children often have to hear the diagnosis of heart disease. What it is? Heart disease is the presence of its structural anomalies. Congenital heart defects (CHDs) may include disorders of the heart tissue (particularly muscle tissue) and disorders of the conduction system.

In turn, CHD with a violation of the development of muscle tissue are divided into pale and blue. In simple terms, with violations of the development of muscle tissue for one reason or another, the blood flows “in the wrong direction.” In pallidum, for example, a lot of blood flows to the lungs, where there is high pressure, called pulmonary hypertension. At the same time, the higher the pressure, the more dangerous any dental intervention is for patients. But it may also be that the pressure in the lungs is normal or only slightly elevated. In this case, the dentist can safely take up treatment – both under anesthesia (for children under 3 years old) and without it (for children over 3 years old who sit quietly in a chair, and the volume of treatment is not too large) . If the dentist or parents are afraid for the condition of a small patient, then an anesthesiologist will monitor his current condition. Depending on the degree of heart damage and the amount of treatment, intravenous sedation and LACS are also possible.

With blue defects, the blood bypasses the lungs, and the pulmonary blood flow, on the contrary, is depleted. Consequently, there is little oxygen in the blood (the so-called arterial blood). In such children, cyanosis of the skin is observed – a very specific symptom for them. They cannot run and move actively, like their other peers, because the body does not have enough oxygen, and they simply begin to suffocate. Depending on the severity of the defect and cyanosis, such children, however, still need to have their teeth treated. Of course, the situation with them is more complicated. As a rule, they require further resuscitation observation, which means a hospital.

A separate group of CHD are those that have congenital arrhythmias. The most common heart rhythm disorder is a change in heart rate. It can be either very slow or very fast. With these patients, anesthesiologists practicing in dental clinics work quite confidently and recommend dentists to take them for treatment.

But in any case, before deciding whether to take treatment or not, whether anesthesia or sedation is necessary, whether cardiomonitoring is required during treatment even without anesthesia, it is necessary to consult an anesthesiologist. Of course, the dentist cannot take on such responsibility.

As we said, there are also a number of diagnoses that in some cases are either formal or often not even detected by specialists: that is, people live their whole lives without even knowing that they have a cardiac diagnosis. This is due to the fact that these ailments do not cause pulmonary hypertension and, in general, do not affect the state and well-being of a person and his quality of life. These diagnoses include an open foramen ovale and a small atrial septal defect. They are not an absolute contraindication for dental treatment.

There are two more fairly common diagnoses that most often do not cause concern among anesthesiologists in outpatient practice – mitral valve prolapse at a certain stage and patent ductus arteriosus in the absence of pulmonary hypertension. But before deciding whether to take such a patient for treatment on an outpatient basis, it is important to provide the anesthetist with the results of a number of studies: echography and ultrasound of the heart.

Acquired heart defects

Most often, PPS occurs at a young age. The main and most famous of them is rheumatism. This is a systemic disease that is bacterial in nature. In addition, for its occurrence there must be a genetic predisposition. After the body is damaged by a microbe that causes rheumatism, it can take years before the disease manifests itself in the heart. That is why most often adults suffering from rheumatism get to dentists, and much less often children.

However, regardless of the age of the patient, sanitation of the oral cavity – that is, treatment and, if necessary, removal of diseased teeth – is a prerequisite for patients with rheumatism. And the first rule in the treatment of teeth in such patients is the obligatory consultation of a dentist, and in fact, joint work with the attending cardiologist: only he can decide whether it is possible to carry out sanitation of the oral cavity right now. Indeed, it depends on the stage at which the rheumatic process is located, whether the removed (or even treated) tooth will become the reason for its aggravation and aggravation of the situation. And of course, tooth extraction (like any surgical intervention) should be accompanied by the appointment of two drugs – an antibiotic and an anti-inflammatory, which should also be prescribed by the attending cardiologist. The anesthesiologist, for his part, determines how possible dental treatment is on an outpatient basis with the current state of the heart.

Examination before treatment

For our patients suffering from heart disease, before dental treatment – regardless of whether it will take place under anesthesia, sedation or under normal conditions – we without fail prescribe a number of necessary studies that will help us assess the current state of the heart and protect the patient as much as possible . So, if there is a heart disease, Rudent anesthesiologists most often prescribe the following examinations:

• analysis of the blood coagulation system;
• ECG;
• Ultrasound of the heart;
• general blood analysis.

Also, according to the indications and at the discretion of the anesthesiologist, additional studies may be prescribed. For example, a biochemical blood test that reflects the function of the liver and kidneys. Indeed, with rheumatism, impaired blood circulation leads to impaired renal function. And in some cases there is stagnation in the systemic circulation, then the liver takes on the role of a buffer. This causes a violation of the blood coagulation system. To avoid complications, the doctor needs to understand how certain drugs will be excreted from the body.

Firstly, the presence in the clinic of experienced anesthesiologists with experience in cardiac surgery and cardiac resuscitation (including in children’s departments), as well as the necessary equipment and drugs, makes it possible in many cases to treat cardiac patients on an outpatient basis. This allows the dentist and the patient to feel comfortable. In addition, the anesthesiologist is faced with a task in the event of a complication during dental treatment – pain, rhythm disturbances, increased blood pressure, etc. to deal with this condition. Our clinic has everything you need for any resuscitation. Depending on the degree of heart damage, the volume of treatment, the general physical and psychological condition of the patient, the anesthesiologist may apply intravenous sedation and LACS.

Thirdly, we have introduced a standard (by the way, this is the European standard that all dental clinics in the Old World adhere to): before starting dental treatment, we measure blood pressure for each of our patients (regardless of age and underlying diagnosis)! This is not only an elementary concern, but also a logical and simple way to avoid even minimal risks of complications. It is by blood pressure indicators that we can judge whether the patient is nervous, afraid to treat his teeth, etc. If the doctor deems it necessary, we can either cancel the treatment and reschedule it to another day, or carry it out under cardiac monitoring and control of the anesthesiologist.

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