If possible, elective dental treatment should be avoided in the first 6 months after infarction. If treatment is required, local anaesthetics which contain adrenaline should be avoided as, coupled with the patient's anxiety, adrenaline may provoke an arrhythmia. A full medical history should be obtained and, if needed, advice should be sought from the doctor managing the post-infarct patient. Complex dental procedures should take place in hospital or practices where patients can be monitored with an electrocardiogram and oximetry. Giving oxygen may reduce the risk of minor arrhythmias.
Post-infarction patients should not be exposed to prolonged dental procedures. It is preferable to divide large procedures into several shorter appointments. The patients should be treated in a comfortable position; the popular, almost horizontal, position is in most cases likely to cause needless stress and respiratory difficulty.
Where oral surgery is needed, including the removal of teeth, another concern is the use of anticoagulants. Advice should be sought from the medical practitioner managing the anticoagulant therapy. If antibiotics are employed, dentists should be aware that some antibiotics may inhibit the action of warfarin.1
To minimise complex dental treatment, the treatment plan for these patients should include a regular preventive dentistry program. This would most likely consist of regular cleaning and scaling of the teeth with a topical fluoride application.
- Buckley NA, Dawson AH. Drug interactions with warfarin. Med J Aust 1992;157:479-83.