Dental considerations in cardiovascular patients: A practical perspective.

Recent article, Dental considerations in cardiovascular patients by S. Chaudhary et al. has highlighted the overlap between cardiovascular and dental sciences. Most important are the issues of infective endocarditis prophylaxis and patients on anticoagulants which need further clarification from cardiac perspective. Authors have mentioned that all dental procedures require antibiotic prophylaxis. Recent guidelines recommend prophylaxis only in high risk procedures requiring manipulation of the gingival or periapical region of the teeth or perforation of the oral mucosa and only in patients with highest risk of infective endocarditis which include:

Patient with any prosthetic valve, including a transcatheter valve, or any prosthetic material was used for cardiac valve repair.

Patients with previous episode of IE.

Patients with CHD:

Any type of cyanotic CHD

Any type of CHD repaired with a prosthetic material, upto 6 months after the procedure or lifelong if residual shunt or valvular regurgitation remains.

Prophylaxis is not recommended in valvular and other forms of CHD1. These recommendations are based on studies that low level repeated bacteraemia is associated with daily living activities such as tooth brushing, chewing etc. The risk of IE may be related more to low grade bacteraemia during daily life rather than sporadic high grade bacteraemia after dental procedure, which highlights the importance of dental hygiene. Also prophylaxis may prevent small number of cases but the risk of adverse effects exceeds the benefit of prophylactic antibiotics.

In our country prevalence of rheumatic valvular disease is high, with low socioeconomic status and poor dental hygiene. But we do not have Indian data regarding the disease burden, economic burden of prophylaxis and hazards of antibiotic resistance.

Regarding, patients on anticoagulants who require dental procedure, continuation of therapy without interruption is recommended as bleeding can be easily controlled.

Conflict of interest

There are no conflicts of interest of any of the authors.