Coronary ischaemic syndromes: dental considerations

For the medical management of coronary ischaemic syndromes, see here.

In dental practice, first-aid management of angina or an acute coronary syndrome is outlined here.

Check if the patient is taking antithrombotic drugs (see Antithrombotic drugs: considerations for oral and dental procedures).

In the 12 months after myocardial infarction, stent placement or coronary artery bypass surgery, patients are at increased risk of a major adverse cardiac event (eg sudden death). Defer elective dental treatment for 6 months after myocardial infarction, stent placement or coronary artery bypass surgery. If dental pain or infection occurs within the 6-month period following the event, provide adequate emergency treatment in order to defer definitive treatment, and consider seeking specialist advice.

Patients with a history of a coronary ischaemic syndrome can undergo dental treatment as long as their condition is stable and they are following their preventive or rehabilitation program.

The presence of a pre-existing coronary stent is not an indication for surgical antibiotic prophylaxis for dental procedures (see Antibiotic prophylaxis for dental procedures).

Instruct patients with angina to bring their medication (eg glyceryl trinitrate spray or tablets) when attending for dental treatment, and have it in a readily accessible place. Limit the duration of dental procedures. Use relaxation techniques and consider anxiolysis. Ensure effective analgesia during dental procedures using a local anaesthetic—the use of a vasoconstrictor with local anaesthetic is not contraindicated in these patients (see Local anaesthetics in dentistry).