Dentists and medicines
Published in Medicinewise Living
Date published: About this date
Your general heath and medicines can affect your oral health. To help your dentist make the best treatment decisions for you, they will need to know about all the medicines you are taking, and any medical conditions you have.
Heart health matters
Tell your dentist if you have a heart condition, or had any heart problems or heart surgery in the past. People with certain heart conditions (e.g. artificial heart valves) may need a course of antibiotics before their dental procedure. This is to prevent infective endocarditis — a rare but serious infection of the heart valves or lining of the heart.
Infective endocarditis can occur if bacteria from your mouth get into your bloodstream then settle and grow on the heart valves.
In the past, people with heart conditions were routinely prescribed antibiotics before undergoing dental work as a precaution to prevent infective endocarditis. However, it is now thought that this is not always necessary.
Your dentist will assess whether or not you need antibiotics before undergoing some types of dental work (e.g. a tooth extraction) or dental surgery.
You may be prescribed antibiotics if you have:
- repaired or artificial heart valves
- had infective endocarditis previously
- certain congenital heart conditions
- heart valve damage following a heart transplant
- rheumatic heart disease, if you are an Aboriginal or Torres Strait Islander person.
Even if your heart condition isn't in the list above, your dentist still needs to know about it, because it may affect other aspects of your dental treatment.
Make your medicines known
In addition to your medical conditions, be sure to tell your dentist about all your prescription and non-prescription medicines, including complementary medicines like herbs and vitamins.
In particular, they will need to know if you're taking:
- anticoagulant medicines (e.g. warfarin)
- antiplatelet medicines (e.g. aspirin, clopidogrel, prasugrel)
- bisphosphonate medicines (e.g. alendronate, zoledronic acid, tiludronate)
Medicines such as anticoagulants and antiplatelets affect blood clotting and increase your chances of bleeding. Complementary medicines like fish oil can also affect blood clotting, so it's important to tell your dentist about these medicines.
It is also vital that you don't stop taking your anticoagulant or antiplatelet medicine, or change the dose, without talking to your health professional.
Your doctor or dentist will weigh up your risk of bleeding (from the mouth) during dental surgery against the risk of having a blood clot or a stroke if you stop taking your medicine before dental surgery. They will advise if you need to do anything.
If you take warfarin, you will need to have an INR test before your procedure. To reduce your risk of bleeding, surgery may be delayed until your INR is below 4. Any decision about changing your dose would be done only in consultation with your doctor.
It's a good idea to keep track of your recent INR results. You can do this using the NPS MedicineWise Warfarin Dose Tracker.
If you are taking an anticoagulant, bleeding from your mouth caused by a dental procedure can be managed, but, if you stop taking your anticoagulant, you are at risk of a blood clot or stroke, which can be fatal.
Biphosphonates and denosumab
Biphosphonates and denosumab are prescription medicines used to treat a range of bone disorders including osteoporosis, Paget's disease, cancer that has spread to the bone (e.g. from breast, prostate, liver, lung or kidney cancer) and multiple myeloma.
Bisphosphonate medicines and denosumab can, in rare cases, cause a condition known as osteonecrosis of the jaw. This involves break down of the jaw bone, and can result in severe damage to the bone.
Osteonecrosis of the jaw can occur spontaneously, but most commonly occurs following a dental procedure, such as a tooth extraction. If you're taking a bisphosphonate or denosumab, your dentist can advise the best dental treatment for you and what signs of osteonecrosis of the jaw to watch out for.
It is also very important to have a thorough dental examination before you start taking any bisphosphonate or denosumab, and to have regular dental check-ups while you are taking any of these medicines.
Keep a medicines list
The more medicines you take, the more difficult it can be to remember important information about them. A medicines list can be a useful way to keep all the information about your medicines together.
Find out more about free medicines lists from NPS MedicineWise, and choose one that suits you.
- Use the paper Medicines List if you would like to print the form and write on it.
- Create your own Medicines eList using your computer's internet browser. You can print it out, save it as a PDF and email or print it. Keep the list in your browser and edit it when your medicines or doses change.
- The free MedicineList+ smartphone app allows you to enter your medicines, set alarms for taking your medicines, save your medicines list and email it.