Heart disease, blood pressure medication and implants

In dentistry, the information most often left out is the list of medications. Patients do not think it worth mentioning their blood pressure tablet because 'everyone takes one anyway'; yet that information changes the time of the appointment, the anaesthetic used, how bleeding is managed and, for some patients, the decision about antibiotics before surgery. Planning implant surgery without this information means accepting an unnecessary risk.

With blood pressure, the real issue is not whether you have the condition but whether it is under control. In a patient whose high blood pressure is under control, implant surgery goes ahead as normal. When readings are high and unstable, two risks come into play: more bleeding during surgery, and the stress of the procedure pushing blood pressure up even further. That is why blood pressure is measured before the appointment and, if necessary, the procedure is postponed.

Fear of the dentist has a particular place in this group. Anxiety raises blood pressure and speeds up the heart rate; the reading taken in the dental chair can be higher than the one you get at home. The answer is not to ignore the reading but to manage the anxiety: a morning appointment, explaining the procedure from the start and, if needed, sedation. In a calm patient, the reading reflects reality and the procedure is also safer.

Local anaesthetics often contain a small amount of adrenaline. It narrows the blood vessels in the area, which makes the anaesthetic last longer and reduces bleeding; in other words, its presence is not a drawback but an advantage. In patients whose heart disease is under control, it is considered safe at the doses used in dentistry. In situations such as unstable angina, a recent heart attack or an irregular heartbeat that has not been brought under control, the dose and whether it is needed at all are assessed separately.

A little-known issue, but one you can see directly in the mouth, is that some blood pressure medications cause the gums to overgrow. This effect has been reported with the group known as calcium channel blockers; the gums swell, grow over the teeth and form pockets that are hard to clean. This can also develop around implants and make them harder to look after. The answer is not to stop the medication on your own; it is to tell your doctor and, if necessary, discuss an alternative with your cardiologist.

Finally, timing. For patients who have recently had a heart attack, had a stent fitted or had heart surgery, a certain waiting period is required before planned surgery. How long that period should be is not decided by the dentist alone; the decision is made together with your cardiologist. Waiting does not mean the treatment is cancelled; it means it is carried out on a safe footing.

The breakdown below is the framework for the assessment made at the examination; the final decision is made together with your list of medications and, if needed, your cardiologist's opinion.

For this group, most of the safety comes from preparation. The steps below are standard.

1. 1

   Bring a written list of your medications

   Names, doses and the times you take them. Written down, not from memory. Photos of the boxes are fine too. Include vitamins, herbal products and supplements as well; some of them can affect bleeding.

2. 2

   Give us your full heart history

   Stents, bypass surgery, valve surgery, a pacemaker, any previous heart attack, an irregular heartbeat and, if you have it, heart failure. With dates. These determine both the timing and the decision about antibiotics.

3. 3

   A cardiologist's opinion is sought if needed

   If you have had a new cardiac event, if your condition is unstable or if a decision about antibiotics is needed, the dentist contacts your cardiologist. This opinion is part of the plan, not a delay.

4. 4

   Your appointment is booked for the morning and your blood pressure is measured

   The morning is when you are less tired, and it leaves the rest of the day for you to keep an eye on how you feel. Blood pressure is measured before the procedure; if it is high, the cause is looked into and, if necessary, the procedure is postponed.

5. 5

   Do not skip your medications

   Unless you have been told otherwise, take your blood pressure and heart medications at the usual time. Skipping these medications because you are having surgery is the most common and the most dangerous mistake. If a change is needed, your doctor will tell you.

6. 6

   Managing anxiety is planned in

   For patients who are afraid, the procedure is explained from the start, breaks are agreed in advance and, if needed, sedation is considered. A calm patient is safer, and the procedure takes less time.

How the plan is put together for patients with heart disease has a direct effect on the surgical burden and the number of repeat procedures.

These are known, manageable issues. None of them is inevitable; all of them are brought under control through preparation.

Healing does not progress any differently from other patients; the difference is that you are followed up a little more closely.

1. The first few hours

   Controlling bleeding and resting. If you check your blood pressure at home, check it once more that day. Strenuous activity and hot showers are put off for the first few hours; both can increase bleeding.

2. The first few days

   The choice of painkiller is based on your medications; do not add any medication on your own. Some painkillers can interact with blood pressure medications, which is why you are told in writing which one to take.

3. The first week

   The swelling goes down and you get back to your normal routine. Your blood pressure medication routine should not be disrupted; because your diet changes, you may be asked to watch your salt and fluid intake.

4. The long term

   If you take a medication that causes gum overgrowth, check-ups are scheduled more often. If you have a dry mouth, your care routine is set up accordingly. In both cases, the area around the implants is assessed regularly.

Heart disease and blood pressure do not directly change the price of treatment; what they affect is the preparation and the session plan. The items are:

Preliminary assessment and consultation

If a cardiologist's opinion is needed, this is a separate appointment. It may look like a delay, but it is the step that determines how safe the plan is.

Choosing sedation

In very anxious patients, sedation increases comfort and, in some cases, supports safety. It should be discussed from the start as a separate item.

Number of sessions

If the procedure needs to be split, the number of sessions may go up. On the other hand, in plans where the surgical burden is reduced, the total number of sessions goes down.

How often long-term maintenance is needed

For patients taking a medication that causes gum overgrowth, or who have a dry mouth, check-ups are more frequent. This makes the maintenance item bigger, but it protects the life of the implants.