Heart conditions and dental care

Reviewed by Dr. Samar Fadavi, DDS

Short answer: Most people with a heart condition can have routine dental care safely. Tell your dentist about every heart condition and medication, keep taking blood thinners unless your physician tells you otherwise, and take antibiotics before treatment only if your doctor says you belong to a high-risk group.

Heart conditions, medications and dental care: how do they fit together?

A dental visit touches several things that matter to the heart and circulation: bleeding from cleanings and extractions, mouth bacteria entering the bloodstream, the small amount of adrenaline (epinephrine) in many local anaesthetics, and the stress some people feel in the chair. For most patients none of these is a problem. For a smaller group, each one needs a little planning between you, your dentist and your physician.

This guide explains what to tell us, which questions to ask your doctor, and what to avoid. It is general information. Your own physician or cardiologist knows your heart and makes the medical decisions.

Why your heart history matters at the dental office

Bleeding. Many people with heart disease take medicine that thins the blood or stops platelets from clumping. Common examples include warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, clopidogrel, ticagrelor and low-dose ASA. These drugs are prescribed to prevent clots, strokes and heart attacks. Stopping them, even for a few days, can raise the risk of a clot, which is far more dangerous than some extra oozing from a tooth socket. Dentists manage bleeding in the mouth with firm pressure, stitches, packing materials placed in the socket and, when suitable, a special mouth rinse.

Bacteria in the bloodstream. Everyday chewing and brushing let small numbers of mouth bacteria into the blood. Dental treatment that works on the gums or near the tip of a root does the same. A healthy heart clears them without trouble. In a few heart conditions, these bacteria can settle on a damaged or artificial valve and cause infective endocarditis, a serious infection of the heart’s inner lining. That small group is the reason some patients take antibiotics before certain dental treatment.

Local anaesthetic and stress. Epinephrine keeps the numbing in place longer and reduces bleeding. In the amounts used for dental work, it is well tolerated by most people whose heart disease is under control. With some conditions, such as very high blood pressure on the day, certain heart rhythm problems or a recent heart attack, the dentist may limit the dose, choose another anaesthetic or postpone non-urgent work. A calm, unhurried visit also helps, because anxiety can raise heart rate and blood pressure.

Effects of heart medicines on the mouth. Some blood pressure medicines, including certain calcium channel blockers, can make the gums grow over the teeth. Diuretics and several other medicines contribute to a dry mouth, which raises the risk of decay. Some people notice taste changes. Knowing your medication list helps us spot these effects early.

Gum disease and heart disease. People with gum disease are more likely to have heart disease. Part of this link is explained by shared risk factors such as smoking, diabetes and age, and long-term inflammation may also play a role. So far, research has not proven that gum disease causes heart disease, or that treating gum disease prevents heart attacks or strokes. Healthy gums are still worth having for their own sake: they mean less bleeding, less infection, fewer lost teeth and a more comfortable mouth.

Common heart conditions and what they mean in the dental chair

• High blood pressure. Take your pills as usual on the day. If your reading is very high, non-urgent treatment may wait while you check in with your doctor. Some blood pressure medicines cause dry mouth or gum overgrowth, which we watch for at check-ups.
• Coronary artery disease, angina and stents. Bring your nitroglycerin spray. Most people with stents take one or two antiplatelet medicines; these usually continue through dental care.
• Heart failure. Lying flat can make breathing harder. Tell us if you need the chair more upright, shorter appointments or extra breaks.
• Atrial fibrillation and other rhythm problems. Many people with atrial fibrillation take a blood thinner to lower stroke risk. Tell us about palpitations or dizziness, and about any recent change in rhythm medicine.
• Valve disease and valve replacement. People with an artificial valve, or valve repair using artificial material, are in the group most often advised to take antibiotics before certain treatment. Many also take a blood thinner. Both need planning with your physician.
• Pacemakers and implanted defibrillators. Most dental care goes ahead normally. Let us know about the device so we can choose instruments accordingly.
• Congenital heart disease. Needs vary widely. Some people with congenital heart conditions are in the high-risk group for antibiotics, and many are not. Your cardiologist will tell you which applies.
• Recent heart attack, stroke or heart surgery. Routine work is usually delayed for a period your cardiologist advises. A painful or infected tooth can still be managed, with your physician’s input.

Step by step: preparing for a dental visit with a heart condition

1. Write down your heart history. Include diagnoses, heart surgery, valve repairs or replacements, stents, a pacemaker or defibrillator, any past episode of endocarditis, and the dates of any heart attack or stroke. Add your cardiologist’s and family doctor’s names and phone numbers.
2. List every medication with its dose. Include blood thinners, antiplatelet medicines, blood pressure pills, heart rhythm medicines and nitroglycerin spray. Add over-the-counter painkillers and supplements too. Fish oil, ginkgo, garlic tablets and high-dose vitamin E can add to bleeding.
3. Ask your physician whether you need antibiotics. Current guidance limits antibiotics before dental treatment to a high-risk group. It generally includes people with an artificial heart valve or artificial material used to repair a valve, people who have had infective endocarditis before, some people with congenital heart disease, and heart transplant recipients who develop a valve problem. Your physician or cardiologist decides whether you are in that group. If you are, the usual approach is a single dose taken shortly before treatment that involves the gums or the area around a root tip.
4. Keep taking blood thinners as prescribed. For most check-ups, cleanings, fillings and simple extractions, blood thinners continue as normal. If you take warfarin, we usually ask for a recent INR blood test result, taken close to the appointment. For more involved surgery, your dentist and physician may agree on timing together. Never skip or reduce a dose on your own.
5. Choose a convenient appointment. Many people feel more relaxed with an appointment that leaves time to rest afterwards. If you are having an extraction while on a blood thinner, an appointment earlier in the week leaves time for a follow-up call if bleeding is slow to settle.
6. Take your usual medicines on the day. Unless your physician says otherwise, take blood pressure pills and other heart medicines as normal, eat your usual meals and bring your nitroglycerin spray if you have one.
7. Speak up in the chair. Tell us straight away if you feel chest pain, pressure, shortness of breath, a racing or irregular heartbeat or dizziness. We stop, check on you and call for help if needed.
8. Follow the aftercare instructions closely. After an extraction, bite firmly on gauze, avoid hard rinsing and hot drinks on the first day, and use any rinse we prescribe. Ask your doctor or pharmacist which painkiller suits you. Anti-inflammatory painkillers such as ibuprofen and naproxen can add to bleeding and are not suitable for everyone with heart disease.

What to avoid

• Stopping blood thinners on your own. The risk of a clot is the bigger danger. Changes to timing are made only by your prescriber.
• Taking leftover antibiotics “just in case”. Antibiotics carry real risks, including allergic reactions, severe bowel infections and resistance. Take them only when your physician or dentist prescribes them for this visit.
• Assuming we already know about a change. Medications often change after a hospital stay or a visit to another doctor. Update us at every visit.
• Putting off a tooth infection. An abscess is a source of bacteria and inflammation. Getting it treated promptly is safer than living with it.
• Booking elective work soon after a heart attack, stroke or heart surgery without first asking your cardiologist how long to wait. Urgent dental problems can still be managed with your physician’s input.
• Skipping cleanings because your gums bleed. Bleeding gums usually point to inflammation that a cleaning helps settle, even if you take a blood thinner.

When to see a dentist

Keep up regular check-ups at the interval your dentist recommends. Book a visit sooner if you notice:

• Swelling in the face or gums, a bad taste or a tooth that throbs. This can be an abscess and should be seen the same day. Our emergency dentist page explains same-day visits.
• Bleeding from a socket that does not slow after 20 to 30 minutes of firm pressure on gauze. Call us. If bleeding is heavy or you feel faint, go to the nearest emergency department.
• Gums that are growing over the teeth, or a dry mouth that will not go away.
• Planned heart surgery, especially valve surgery. Cardiac teams often ask for a dental check beforehand so any infection can be treated first. Bring the request with you.

Chest pain, pressure or sudden shortness of breath is a medical emergency. Call 911.

For routine care, our check-ups and cleanings page explains what a regular visit includes, and our dental care for seniors page covers older adults managing several medicines.

Questions about heart conditions and dental care

Do I need antibiotics before a cleaning if I have a stent?

Usually not. Coronary stents, bypass grafts, pacemakers, heart murmurs and mitral valve prolapse are generally not in the high-risk group for dental antibiotics. Your cardiologist has the final word, so ask them if you are unsure.

I had a hip or knee replacement. Do I need antibiotics?

Most people with joint replacements do not need antibiotics before routine dental care. If your surgeon has given you different advice, follow it and let us know.

Can I have a tooth removed while taking apixaban or rivaroxaban?

Often yes, with planning. Simple extractions are commonly done without stopping these medicines, using local measures to control bleeding. For more involved surgery, your physician may adjust the timing of a dose. Never change it yourself.

Is dental freezing safe if I have high blood pressure?

For most people whose blood pressure is controlled, yes. We may check your blood pressure before treatment. If it is very high on the day, we may postpone non-urgent work and suggest you speak with your doctor.

I have a pacemaker. Is dental equipment safe?

Most dental equipment is fine for people with pacemakers and defibrillators. A few devices carry cautions, so tell us about your implant and we will choose instruments accordingly.

Will treating my gum disease protect my heart?

That has not been proven. Treating gum disease protects your teeth and gums and reduces infection in the mouth, which is reason enough. It does not replace any heart treatment your doctor recommends.

Can I get urgent dental care if I have a heart condition?

Yes. We offer same-day emergency visits and you do not need to be an existing patient. Bring your medication list so we can plan safely.

Should I mention a past stroke or mini-stroke?

Yes. A past stroke or transient ischemic attack often means you take a blood thinner or antiplatelet medicine, and it can affect swallowing, grip and the ability to clean your teeth. We plan treatment and home care around it.

Related guides

• Antibiotics before dental work
• Risks of dental treatment explained
• Dry mouth and medications after 60