Dear Dr. Mishra, above paper' Dental considerations in cardiovascular patients: A practical perspective. Indian Heart Journal 2016;68:572-575′ by Chaudhary S, Jaiswal and Sachdeva has tried to focus on the interlink between cardiovascular and dental diseases.1 It has mainly emphasised on the antibiotic prophylaxis in various dental conditions/procedures associated with cardiovascular problems particularly valvular and congenital heart disease. However, one important area which needs to be emphasised both by dental surgeons and as well as internists and cardiologists is the presence of tobacco induced oro-dental lesions caused by smoking and/or smokeless tobacco in all cardiac patients. Such lesions may vary from innocuous looking tobacco stains on teeth and buccal mucosa (nicotiana stomatitis) to frank premalignant submucosal fibrosis (SMF) depending upon the frequency and duration of tobacco usage.2 Different oral symptoms such as gum bleeding, halitosis, trismus, burning sensation, ulceration and difficulty in swallowing are more common among the tobacco chewers. Different periodontal conditions such as periodontal pocket, gingivial lesion, gingivial recession are more common among gutka and paan masala chewers. Highest prevalence of oral mucosal lesions (22.7%) have been detected among tobacco chewers, compared to the smokers/non-tobacco users.3
One can often find typical nicotine stink emanating from mouth or evidence of gum infection which may be a constant source of systemic inflammation contributing to premature atherosclerosis. It is therefore extremely important to have a look at the oral cavity in each cardiovascular patient irrespective of its etiological origin, that is congenital, rheumatic, ischaemic, hypertensive, diabetic or any other aetiology. There are many instances in clinical practice where the patient tells that he does not chew tobacco or smoke but oral examination provides definite evidence of smoking or tobacco intake by way of oral SMF or presence of tobacco particles and/or dark brown tobacco stains on teeth.4 It is in such situations that oral examination is very much rewarding because one can advise the patient about tobacco cessation very emphatically to ensure relief from angina, hypertension or other comorbidites besides definitive pharmacotherapy. Thus a simple step of oral examination in all cardiovascular diseases shall help in formulating appropriate treatment strategy in a given cardiac patient.
Conflicts of interest
The authors have none to declare.
References
- 1.Chaudhary S., Jaiswal R., Sachdeva S. Dental considerations in cardiovascular patients: a practical perspective. Indian Heart J. 2016;68:572–575. doi: 10.1016/j.ihj.2015.11.034. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dwivedi S., Jhamb R. Cutaneous markers of coronary artery disease. World J Cardiol. 2010;2:262–269. doi: 10.4330/wjc.v2.i9.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Parmar G., Sangwan P., Vashi P., Kulkarni P., Kumar S. Effect of chewing a mixture of areca nut and tobacco on periodontal tissues and oral hygiene status. J Oral Sci. 2008;50:57–62. doi: 10.2334/josnusd.50.57. [DOI] [PubMed] [Google Scholar]
- 4.Dwivedi S. Another dupe-Filter tobacco causing leukoplakia and chest pain in young man. Indian J Med Spec. 2014;5:144–145. [Google Scholar]