Cardiovascular disease, particularly hypertension and ischemic heart disease are the most common causes of death globally.

Dental procedures or drugs used in dentistry (e.g. local anesthetics) sometimes can aggravate heart disease or possibly even provoke a heart attack. It can also precipitate bacterial endocarditis (Bacteria reaches into the heart from the mouth via the blood stream and causes heart infection), specially when it is done without antibiotic coverage and other prophylactic measures. Myocardial infarction is one of the most serious emergencies that can also happen in the dental surgery.

Dental aspects of hypertension
There are no recognised oral manifestations of hypertension, but anti hypertensive drugs can sometimes cause side-effects like

*Xerostomia (Dryness of the mouth)

*Salivary gland swelling

*Pain in oro-facial region

*Lichenoid reactions (white mucosal ulceration)

*Gingival hyperplasia (gum swelling)

*Sore mouth (oral ulcers)

*Disturbance of oral sensation

*Paraesthesia of oro-facial region

*Facial palsy (Facial paralysis, specially in malignant hypertension)

In this circumstances, hypotensive drugs should not, however, be stopped, as rebound hypertension can result.

Dental aspect of coronary heart disease
Myocardial infarction is the most severe and lethal form of coronary heart disease, as between 30-50 per cent of the patients die within the first hour of attack and other 10-20 per cent within the few days, which eventually may occur during any dental surgical procedures.

Angina pectoris is another acute manifestation of ischemic heart disease, which may be mis-diagnosed as pain on jaws, teeth, tongue or palate due to dental infections.

Dental aspect of cadiac pacemakers
Dental surgical procedures should be done very cautiously in patients who use cardiac pacemaker. High frequency external electromagnetic energy can interfere with the sensing function of pacemaker when following instruments are used

*Electro surgical equipments (diathermy)

*Ultrasonic scales

*Pulp testes

*Dental induction casting machine

*Belt-driven motors in dental chairs

*Microwave ovens

*Television transmitters

*Faulty or badly earthed equipments etc.

Dental aspects of congenital heart disease
Oral abnormalities associated with cyanotic congenital heart disease include --

*Delayed eruption of teeth

*Enamel hypoplasia

*Malocclusion

*Bluish-white or skimmed milk teeth

*Gross vasodilatation in pulps

* Increased incidence of caries and periodontal disease

*Small-white non-ulcerated mucosal lesions

*Bleeding gum (due to defective platelate function and increased fibrinolytic activity in cyanotic congenital hearth disease)

*Cleft lip & palate.

Other associated problems such as brain abscess, infective endocarditis, Down's syndrome, Turner's syndrome or idiopathic hypercalcaemia may affect dental management.

Dental aspects of hearth surgery
Dental infections may be a threat to patients having cardiac surgery as infective endocarditis can nullify any benefits from the operation and frequently cost the patient's life. Therefore, following factors in relation of dental aspect should be considered before surgery --

*A meticulous pre-operative oral assessment (dental clearance)

* Optimal oral hygiene

*Eradication of potential source of infection (removal of dental plaque and calculus by scaling)

*Dental treatment should be completed before surgery (at least two weeks).

Dental procedures require antibiotic prophylaxis
*Tooth extraction

*Scaling

*Oral surgery involving the periodontal tissues

*Periodontal surgery

*Endodontic (Root canal) manipulation through apex of tooth

*Endodontic surgery

*Sub gingival procedures

*Re-implantation of avulsed teeth (accidental falling & re-positioning)

*Re-posiitoning of teeth after trauma

*Use of orthodontic bands (not brackets)

*Dental implants & other invasive prosthesis etc.

Dr Md Mujibur R Howlader is an Assistant Professor of Department of Conservative Dentistry and Endodontics, Faculty of Dentistry BSMMU, Dhaka