context: People with heart disease have special needs when it comes to dental care. Here are some tips to consider before going to the dentist if you suffer from one of the following heart conditions. Talk to your cardiologist about undergoing any dental treatments in case he or she recommends waiting. And tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medications could result in excessive bleeding during some oral surgery procedures. Ask your dentist if oxygen and nitroglycerin are available in case a medical emergency should arise during your office visit. Some high blood pressure drugs can cause dry mouth or alter your sense of taste. Calcium channel blockers in particular can cause the gum tissue to swell and overgrow, resulting in chewing difficulties. If you do experience gum overgrowth, your dentist will give you detailed oral hygiene instructions and may ask you to make more frequent dental visits for cleanings. In some cases, gum surgery to remove excess gum tissue, called a gingivectomy, may be needed. If your dental procedure requires the use of anesthesia, ask your dentist if the anesthesia contains epinephrine. Epinephrine is a common additive in local anesthesia products. Use of epinephrine in some patients with high blood pressure may result in cardiovascular changes, including the rapid development of dangerously high blood pressure, angina, heart attack, and arrhythmias, and should be used with caution. Patients with angina treated with calcium channel blockers may have gum overgrowth. In some cases, gum surgery may be needed. Like patients with a previous heart attack, patients with angina may want to ask their dentist if oxygen and nitroglycerin are available in case a medical emergency should arise. While patients with stable angina (chest pain that occurs in a predictable pattern) can undergo any dental procedure, patients with unstable angina (new chest pain or unpredictable chest pain) should not undergo elective (nonessential) dental procedures, and emergency dental care should be performed in a hospital or office equipped with cardiac monitoring capability. If you've had a stroke in the past, tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medications could result in excessive bleeding during some oral surgery procedures. If your stroke has impaired your ability to produce an adequate amount of saliva, your dentist may recommend the use of artificial saliva. If your stroke has affected your face, tongue, or dominant hand and arm, your dentist may also recommend use of fluoride gels, modified brushing or flossing techniques, adding rinsing and strategies others can use to assist you in maintaining good oral hygiene. Some medications used to treat heart failure (such as diuretics, or water pills) can also cause dry mouth. Ask your dentist about dry mouth treatments, including the use of artificial saliva. Give your dentist a complete list of the names and dosages of all the drugs you are taking for your heart condition (as well as any other prescription or nonprescription drugs that you may be taking). This will help your dentist decide on the best treatment course for you, including the appropriate medications to use for dental procedures. Give your dentist the name and phone number of your doctor(s) in case your dentist needs to speak to him or her about your care. If you are particularly nervous about undergoing a dental procedure because of your heart condition, talk with your dentist and heart doctor. Your doctors can provide you with information and work with you on strategies for controlling dental pain and easing your fears. Various researchers and government agencies continue to investigate the possible relationship between gum (periodontal) disease and heart disease. Some researchers speculate that bacteria in the mouth that are involved in the development of gum disease move into the bloodstream and cause inflammation in the blood vessels -- changes that in turn contribute to heart disease and stroke. Numerous studies are being conducted that both support and refute the possible link between these two diseases. One study, published in Stroke: Journal of the American Heart Association, found that people who had fewer than 25 teeth at the start of the 12-year trial (teeth loss is the ultimate end result of untreated gum disease) had a 57% greater risk of stroke compared with patients who had 25 or more teeth. Another study involving over 4,000 patients and 17 years of follow-up showed no evidence of a decreased risk of coronary heart disease if chronic gum disease was eliminated. Based on these results, these researchers speculate that the relationship between gum disease and an increase in cardiovascular risk is coincidental and that gum disease does not cause coronary heart disease. The true role, if there is one, between gum disease and heart disease remains to be determined.