Morning Drills Best for Heart Patients

Dentist visits early in day reduce cardiovascular stress

TUESDAY, April 23, 2002 (HealthDayNews) -- If you have heart disease and an aching tooth to boot, consider getting to the dentist first thing in the morning -- not for your tooth's sake, but for your ticker's.

Getting a tooth pulled can put serious stress on your heart. However, the risks are smaller if a patient schedules a dental appointment early in the day, a new Italian study says.

For people without heart disease, this extra stress really isn't a problem. However, if you've got severe heart disease, you'd better talk to your doctor before having any dental work done, advise researchers from the University of Bologna.

The study, which appears in the current issue of the Journal of the American Dental Association, found that people with severe heart disease were at an increased risk of heart failure during dental procedures.

The authors recommend that patients with severe heart disease consider scheduling short dental appointments and making them for early in the morning.

"It is well known that both blood pressure level and cardiovascular reaction to any stress are reduced early in the morning," says study author Dr. Lucio Montebugnoli, a dentist in the department of oral sciences at the University of Bologna.

The researchers recruited 80 volunteers who needed to have a tooth pulled. They split them into four groups of 20: normal heart function, mild heart disease, transplant patients and severe heart disease.

They measured the patients' blood pressure and heart rate at rest, just after the local anesthesia was given, and while the tooth was being pulled.

Patients with normal heart function, as well as those with mild heart disease, showed similar increases in their blood pressure and heart rate, which Montebugnoli explains means their bodies adapted well to the emotional stress. Most of the transplant patients also did well, but the authors suggest that transplant patients be evaluated on a case-by-case basis.

People with severe heart disease had more circulatory impairment during the dental procedure, according to the authors. And they point out that even slight changes in heart rate or blood pressure can put a patient with severe heart disease at risk.

Montebugnoli recommends that heart disease patients first consult their doctors before having any dental work done, and to let the dentist know about if you have heart disease. Pre-appointment antibiotics may be recommended for some patients, he says. He also suggests patients schedule early morning appointments, ask for short visits, and request relaxation exercises.

Cardiologist Dr. Emerson Walden, from Mercy Medical Center in Baltimore, says the study makes a lot of sense, but he'd like to see it duplicated on a larger group of patients.

"I don't know if they've actually done enough patients to statistically say that it's true," he says.

Dr. Matthew Messina, a spokesman for the American Dental Association, says an early morning appointment could be helpful because patients won't be worrying about it the whole day, though he says there's little to be afraid of in modern dentistry.

"People still have previous perceptions from what happened 20 to 30 years ago," he says.

What To Do

"One of the most vital things is to be very aware of the fact that the mouth and the body are very connected," Messina says.

For that reason, Walden says, "anyone who has had a heart attack, an enlarged heart or an irregular heartbeat should definitely talk with their doctor before they have any dental or surgical procedure."

To learn more about dental work and heart disease, go to the American Heart Association, which also says good oral health can prevent heart disease. Meanwhile, the American Dental Association has a page on how your oral health reflects your overall health.

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