Christine Rekash: Oral Health and Heart Health - Why does it matter?
If you have ever experienced tooth pain, and survived open heart surgery, you quickly flash back to your recovery and realize that while there was pain from open heart surgery, there's nothing quite like tooth pain. I recently found that I had a fractured molar, both vertically and horizontally. Little did I know that this was something that had "just happened" over the course of a few months without decay or trauma. It could have even been caused by eating one too many heart healthy almonds!
My pain began on a Friday evening with plans to celebrate my birthday weekend with an overnight stay in downtown Chicago. By the time Saturday morning came, I had not been able to sleep for a single minute throughout the evening. Any movement of attempting to lie down or put my head slightly in a reclined position, would increase the throbbing sensation that I felt in my lower jaw. I began to feel frequent heart palpitations due to the pain and lack of sleep. When morning struck, I immediately called my dentist to get an ER Saturday morning appointment. Much to my dismay, he was on vacation and I needed to be seen by his backup. It was determined that after poking and prodding, that my molar was fractured vertically. I was prescribed a treatment of antibiotics to begin immediately as to prevent any infection. I knew of the importance of antibiotics and infection, as I was used to taking antibiotics prior to teeth cleaning due to my heart valve disease. Once the antibiotics kicked in, that seemed to help relieve the pain a bit, however, I needed to make it until Monday morning when my dentist and the backup would connect about the final diagnosis. Still unable to fully sleep, I was suffering.
Waiting another full day, I was not able to be seen until Tuesday afternoon by my dentist and by this time, the pain level had jumped off the 1-10 pain scale. When Tuesday arrived, my dentist took further x-trays only to find that the molar was also cracked horizontally and the tooth could not be saved. As a result, he told me to see a recommended oral surgeon. Getting closer to a resolution, but yet, another delay and day in agonizing pain.
This is where my journey became worse than open heart surgery because I was not given any pain medication to manage the tremendous amount of pain I was in. I was told to continue taking Extra Strength Tylenol for pain, which did absolutely nothing to relieve the pain. Upon seeing an oral surgeon, I was advised that I would need to stop my aspirin therapy for 3 days and the soonest I could get in would be on Friday. An alarm went off when I heard the possibility of having to stop aspirin therapy. Knowing what I went through during my recovery from heart surgery and the speed bumps that I encountered, I certainly did not want to stop my aspirin therapy at the recommendation of a oral surgeon without knowing my cardiac history. However, I needed to get relief from the excruciating and debilitating tooth pain. It was then, that I began to search for an oral surgeon that could take me as soon as possible with the understanding that I was a post repair valve patient. After many calls and researching facilities, I was finally able to schedule an appointment for an extraction. However, what should be noted here, is that I was not able to confirm the appointment for extraction without receiving clearance from my cardiologist to have the tooth extracted. I was advised by my cardiologist to continue aspirin therapy. The oral surgeon however, would not accept my answer and needed the directive to be communicated from the cardiologist to the oral surgeon's office. Upon countless calls between my cardiologist's nurse and the oral surgeon staff, I was finally able to secure the appointment. Yet, I could not go through the next 3 days enduring the tremendous amount of pain. I returned to the dentist to ask for a pain medication, other than extra strength Tylenol that would not interfere with baby aspirin therapy. That said, my dentist would not prescribe me any pain medication due to the fact that he wanted to take the lead from the cardiologist as to what was acceptable. I found myself yet again, in the middle of another round of dentist/oral surgeon vs cardiologist. I finally was able to receive a prescription for Tylenol with codeine.
Who would have ever thought that a simple tooth extraction would lead to so many precautions that need to be adhered to by heart valve patients? From this experience, I have learned in greater detail, that oral health greatly impacts heart health. My takeaway is that the heart valve patient needs to be proactive in communicating to a dentist or oral surgeon their heart history from the onset. Conversely, it is imperative that your cardiologist is aware of what is occurring with your oral health. As a result of my tooth experience, I was experiencing so many palpations, that I was asked to wear a heart monitor for 14 days post tooth extraction, to ensure I did not throw myself in A-Fib from all the pain, stress, anxiety and lack of sleep I was in for almost a week. In addition, without prompt antibiotics from the onset of pain, bacteria from a tooth infection can enter your bloodstream and directly affect your heart health.
Below is a checklist from my experience that one should be aware of, if you ever find yourself experiencing tooth pain.
Interactions with Baby Aspirin:
If you are on daily baby aspirin therapy, you may need to stop prior to your tooth extraction to minimize the bleeding. Reach out to your cardiologist if you are advised by oral surgeon or dentist to stop before your procedure!
If you are on any blood thinners, there could be a minimum of 3 days before the extraction can be performed and thinners may need to be held. Again, reach out to your cardiologist to corroborate directives.
As a general rule of thumb, Ibuprofen should not be used when taking baby aspirin. What is important to know is that taking ibuprofen can reduce the heart-protective effect of aspirin. The reason is that ibuprofen latches on to platelets in the blood at the same spots where aspirin attaches to platelets, thereby decreasing the anti-clotting effects of aspirin. Depending on what mg of baby aspirin you are on, this may or may not be applicable to your regime, so keeping your cardiologist informed is a must!
Communication is key with your cardiologist in order to determine the best route the oral surgeon can take with the tooth extraction.
It is important to note that most class II pain medications that are commonly used for tooth pain, i.e. those from the morphine, opium, codeine and hydrocondone famlies, could also contain ibuprofen, which can interfere with baby aspirin therapy. It is always best to double check with the pharmacist once your prescription has been issued.
Communication is key with your dentist in order to determine the correct pain management in conjunction with your heart medications.
Don't ignore tooth pain. Get to the root of the matter ASAP.
Don't risk your tooth infection getting to your heart.