Angina - Oral Health Care Considerations

Stable Angina

• Arrange for necessary medical attention.
• Have oxygen and nitroglycerin available.
• Use additional pain and anxiety control as indicated.
• Schedule late-morning or early-afternoon appointments.
• Schedule short appointments.
• Use local anesthetics judiciously.
• Use adjunct measures to reduce stress.
• No contraindication for using epinephrine.
• Be aware that chronic use of non-steroidal anti-inflammatory drugs may increase the risk of cardiovascular events in elderly patients with hypertension.
• Address patient’s anticoagulation therapy, if indicated.

Unstable Angina

For emergency care:

• Use analgesics and antibiotics as indicated.
• Be aware that chronic use of non-steroidal anti-inflammatory drugs may increase the risk of cardiovascular events in elderly patients with hypertension.
• For invasive procedures, consult with patient’s cardiologist and be prepared to use continuous cardiac monitoring.

⚠️ Defer all elective dental care. Unstable angina is a predictor for developing a heart attack.

Complications associated with angina

• Arrythmias
• Cardiomyopathy (see below: Websites - Cardiomyopathy)
• Sudden cardiac arrest (SCA) (see below: Websites - Sudden Cardiac Arrest)

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Medical Complexity Status - Angina

Angina	MCS1B	MCS3
Anticipated complication	Controlled/ stable	Uncontrolled/ unstable
Hemostasis	Minor	Minor
Microbial  susceptibility	None	None
Drugs/ drug  interactions	Minor	Minor
Stress/trauma	Minor	Major

See Medical Complexity Status for more information.

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Related Pages

• Medical Disorders
  • Angina
  • Arrhythmias
  • Cardiovascular Disorders
  • Heart Attack
  • Hypertension
• Oral Health Care Considerations
  • Anticoagulation and Antiplatelet Therapy Considerations
• Classification and Definitions
  • Angina

References/Websites

• References

  • Balla C, et al. Treatment of Angina: Where Are We? Cardiology. 2018;140(1):52-67.
  • Blumenthal DM. Prevalence of angina among primary care patients with coronary artery disease. JAMA Netw Open. 2021;4(6):e2112800.
  • Ford TJ, et al. Angina: contemporary diagnosis and management. Heart 2020;106:387–398.
  • Kloner RA, et al. Angina and its management. J Cardiovasc Pharmacol Ther. 2017 May;22(3):199-209.
  • Levy BI, et al. The many faces of myocardial ischaemia and angina. Cardiovasc Res. 2019 Aug 1;115(10):1460-1470.

• Websites

  • Coronary Heart Disease. National Heart, Lung, and Blood Institute
  • Angina. American Heart Association. July 31, 2015.
  • Angina. MedlinePlus. U.S. National Library of Medicine. April 9, 2021.
  • Angina. National Heart, Lung, and Blood Institute
  • Arrythmias. National Heart, Lung and Blood Institute.
  • Cardiomyopathy. National Heart, Lung and Blood Institute.
  • Sudden cardiac arrest (SCA). National Heart, Lung, and Blood Institute.