How long after a stroke should dental treatment be delayed?
Abstract Objective: Current literature recommends postponing dental treatment until 6-12 months after a stroke, based on the presumed risk of recurrent stroke. The purpose of this study was to suggest that the importance of dental care during this period exceeds the risk of medical complications in this patient population.
Should antimicrobials prescribed in the dental office be reconsidered after a stroke?
Antimicrobials sometimes prescribed in the dental office may need to be reconsidered in light of potential adverse reactions with medications being used by survivors of stroke or by persons at elevated risk of stroke.
What is the role of the dental team in stroke recovery?
Collaboration among the team can identify an appropriate oral care plan for stroke survivors. The dental team must become the liaison between the health, social, and voluntary agencies to identify dental care programs within the community.
Can dental hygiene appointments cause strokes?
The perceived stressful nature of a dental hygiene appointment may potentially precipitate a stroke while the patient/client at risk (e.g., someone who has had stroke or TIA) is in the chair. Therefore, mitigating measures may include:
How long after a TIA can you have a dental cleaning?
Avoid elective care for 6 months after a stroke or TIA (“mini” stroke). Provide only urgent dental care during the first 6 months after a stroke or TIA.
How should the dental team respond if a patient is having symptoms of a stroke?
Emergency response:Place patient in an upright or semi-reclining position. Ask patient to smile. Normal: both sides of face move equally. Abnormal: one side of face does not move at all. ... If any one of the 3 signs of stroke assessment is abnormal. Notify EMS. Administer oxygen. 2 to 4 L/minute by nasal cannula.
Why can't you get your teeth cleaned after a stroke?
This is because stroke almost always results in damage to brain tissue. The most common type of stroke is ischemic stroke, which occurs when cerebral arterial blood flow is disrupted.
How do you treat a stroke in a dental office?
If the patient presents to the ER within three hours of a confirmed stroke, clot busting drugs can be used to dissolve the clot and restore blood flow in an ischemic stroke.
Which two events that can occur during a dental appointment are most commonly linked to medical emergencies?
Medical emergencies were most likely to occur during and after local anesthesia, primarily during tooth extraction and endodontics. Over 60% of the emergencies were syncope, with hyperventilation the next most frequent at 7%.
Which stroke symptom or outcome complicates the management of oral care?
Dysphagia and loss of sensation affects up to 78% of patients who have recently had a stroke and can cause stasis of saliva and food in the oral cavity.
Can dental work cause brain bleed?
Abstract. Although chronic arterial hypertension is the leading cause of intracranial hemorrhage, an abrupt rise in systemic arterial pressure in normotensive people may sometimes induce a hemorrhagic stroke. Dental treatment is rarely associated with such an event.
Can having a stroke affect your teeth?
Possible Oral Complications of Stroke People who are recovering from stroke may be more susceptible to dental problems. With facial paralysis, it's easier for food to get trapped between teeth without realizing it. Paralyzed muscles can also lead to poor-fitting dentures, which can irritate gums.
Can dental treatment cause a stroke?
An individual who undergoes dental surgery has a higher risk of developing a heart attack or stroke for a few weeks after the procedure, British researchers have revealed in an article published in the peer-reviewed journal Annals of Internal Medicine. The elevated risk is no longer there six months later.
How do you brush your teeth after a stroke?
Use just a little water and toothpaste if you have trouble swallowing. Hold or support your toothbrush with your weak hand, then apply toothpaste with your strong hand. Use your weak arm as much as you can to help it get stronger. Squeeze toothpaste on your tongue first, then take it with a toothbrush.
What is a stroke in dentistry?
Oral manifestations associated with a stroke include unilateral paralysis of the face, loss of sensory stimuli or oral tissues, a flaccid tongue with multiple folds, and dysphagia. You may also notice that patients neglect oral self-care on one side of their mouth.
What is the most common medical emergency in the dental office?
Vasodepressor syncope is the most common emergency seen in dental offices and comprises of approximately 53% of all emergencies.
ABSTRACT
The authors describe how oral disease, particularly periodontal disease, may place certain patients at increased risk of developing cardiovascular disease and stroke.
CARDIOVASCULAR DISEASE
Cardiovascular diseases make up the most prevalent category of systemic disease in the United States and in many other countries, and increase in prevalence with age.
DENTAL MANAGEMENT OF PATIENTS WITH CARDIOVASCULAR DISEASE
The primary management goal for the patient with cardiovascular disease during dental therapy is to ensure that any hemodynamic change produced by dental treatment does not exceed the cardiovascular reserve of the patient.
CONCLUSION
In May 2000, the public health community was alerted to the need to promote oral health by the first surgeon general's report on oral health.
Figures
Figure 1 A 45-year-old man with coronary artery disease who smokes two packs of cigarettes per day. He has not responded well to periodontal treatment and does not practice good oral hygiene.
How to maintain oral hygiene after stroke?
Good oral hygiene is difficult to maintain in stroke patients because they may not have the necessary dexterity and caregivers may not be trained in oral hygiene techniques. 4 Dietary adjustments to manage food consistency include thickening fluids and dietary food supplements, which increase plaque formation. 4 Adequate nutritional intake is extremely important for recovery and to avoid malnutrition. Food supplements and recommendations to consume food throughout the day to maintain sufficient calories can increase the risk of dental caries, especially if medications are causing xerostomia. 3 Facial palsy and loss of sensation can cause pooling of food debris on the side affected by the stroke, allowing for bacterial accumulation. Impaired swallowing and facial paralysis can increase the amount of time when teeth and oral tissues are exposed to cariogenic food debris, increasing the risk of tooth decay. 3,4
How does stroke affect the mouth?
Stroke patients are at risk of aspiration pneumonia, which is caused by inhaling food debris and bacterial biofilm into the airway . Aspiration results when the swallowing reflex is damaged. The first stage of swallowing starts when food is introduced into the mouth and the lips seal. Sealing the lips is a crucial step to the facial muscles working successfully together in the mastication process. During the second stage, the tongue sweeps the food into the buccal and labial vestibules, where broken-down food or bolus is collected. Food debris is left in the buccal and labial vestibules when there is damage from stroke.3 The bolus is collected at the back of the mouth, where it is rapidly propelled into the pharynx. In the third stage, breathing stops when food enters the pharynx, the soft palate rises to seal the nasopharynx, the glottis (opening of the larynx) closes, and the larynx is pulled up while the epiglottis tilts back to cover it.3 If the nasopharynx is unable to seal, food and debris will enter the nasal area and create the potential for infection and aspiration.
How common is xerostomia in stroke patients?
Xerostomia is very common among stroke survivors due to their medication use. Xerostomia can cause dysgeusia, difficulty in chewing and swallowing, and improper denture fit. 3,5 Poor clearance of food from the mouth in the presence of xerostomia reduces the protective influence of saliva. 6,7 Reduced saliva can be addressed with daily oral hygiene, hydration (at least eight 8-oz glasses of water per day), sugarless mints and gum, use of a humidifier, alcohol-free mouthrinses (alcohol is drying to tissues), and saliva substitutes containing carboxy – methycellulose (used in foods to thicken and coat). Caries is more prevalent among those with dry mouth, thus preventive measures should be implemented, such as fluoride therapy. Dehydration contributes to dry mouth and should be monitored in stroke survivors. 7
What is the difference between thrombotic and embolic stroke?
Thrombotic stroke occurs when a clot forms in an artery that is already narrow. Embolic stroke (cerebral embolism) happens when an artery is blocked by a blood clot (arterial embolus) that originates from some other area of the body.
What is a three headed toothbrush?
Three-headed toothbrushes can clean more of the tooth surface with each movement of the brush. Special oral hygiene instructions for stroke survivors and their caregivers are essential to maintaining good oral health. 2,3 There are many oral hygiene devices made especially for special needs patients. Three headed toothbrushes clean more of the ...
What is hand over hand in stroke?
The “hand-over-hand” technique is another way of assisting with oral hygiene if patients want to participate in their own oral hygiene. Prescription fluoride toothpaste can be used but stroke patients must expectorate to minimize aspiration.
What is a TIA stroke?
TIA, often called a mini stroke, results when blood flow stops to a part of the brain for a short time. A TIA is different from a stroke because the blockage breaks up quickly and dissolves without infarction (tissue death).
Does dental treatment help with heart disease?
Abstract. Patients who have suffered a heart attack often require dental treatment. The inflammation of the oral cavity not only reduces the quality of life , but also negatively affects the course of ischemic heart disease. Dental treatment in patients with a history of myocardial infarction seems complicated, since these patients require special ...
Can you get dental treatment for myocardial infarction?
Dental treatment in patients with a history of myocardial infarction seems complicated, since these patients require special consideration with regard to the timing and form of dental treatment as well as to the precautions required. Patients at risk of cardiac complications that are greater than the benefits of dental treatment should be ...
When does the oral health course expire?
The oral health consequences of these common conditions warrant special care strategies. This course was published in the June 2018 issue and expires June 2021. The authors have no commercial conflicts of interest to disclose. This 2 credit hour self-study activity is electronically mediated.
Why is it important to update medical history?
With older adults, it is imperative to update medical histories at every visit, as medications and medical conditions can change frequently. Dental professionals should inform caregivers that it is important to report any change in health status or medications because it can affect dental treatment plans.
What is the cause of a stroke?
Stroke is most often caused by chronic hypertension, but risk factors include atrial fibrillation, diabetes, family history of stroke, high cholesterol and advanced age.
Is it safe to do a debridement procedure on a patient with a blood pressure of 180
The 2017 American Heart Association/American College of Cardiology guidelines state that it is generally unsafe to perform elective procedures on patients with blood pressure readings greater than 180/110 mm Hg. 25.
When was Pradaxa approved?
FDA approved in October 2010 and is a direct thrombin inhibitor. Pradaxa was the first NOAC on the market and is currently the only NOAC to have a reversal agent. The reversal agent is idarucizumab and was FDA approved in October 2015. Pradaxa has a half-life of about 12 to 17 hours and is eliminated in the kidneys.
What is secondary stroke?
Secondary means the patient has had a prior stroke. As with most every condition, there are modifiable and nonmodifiable risk factors, and that's where dental hygienists come in-changing the modifiable risk factors.
What are the undiagnosed conditions that dental hygienists treat?
Patients often present with undiagnosed conditions such as high blood pressure, diabetes mellitus, and/or obstructive sleep apnea. Dental hygienists are in a position to intervene and start the process of assessment, education, and then referral every time the patient comes into our treatment room.
What are the two types of strokes?
What is a stroke? According to the American Stroke Association (ASA) and the American Heart Association (AHA), the two types of strokes are ischemic and hemorrhagic. Ischemic stroke has a number of subtypes, including a cryptogenic stroke, which is one that has "no definitive causes.".
How long does a factor XA inhibitor last?
No known reversal agent. Half-life is 6 to 9 hours for individuals who are healthy and 20-45 years of age and 11-13 hours average in the elderly. Eliminated through kidneys.
Can you prescribe NSAIDS in dental office?
Additionally, no NSAIDS or aspirin should be dispensed in office to any patient on blood thinners .
Is low birth weight a risk factor for stroke?
3 Patients born with a low birth weight may always have a higher risk for a stroke, even in absence of other risk factors.
How long after myocardial infarction can I resume dental care?
However, emerging evidence suggests that a shorter time (e.g., 4 to 6 weeks) may be appropriate for many patients/clients post-MI, with individualization according to the patient/client’s functional capacity.
Can a myocardial infarction cause stomatitis?
None specific to myocardial infarction or coronary atherosclerotic heart disease; however, medications used in post-MI care and its complications can result in oral changes such as stomatitis (e.g., from antiarrhythmic use).