Stroke or cerebrovascular accident (CVA) - Oral Health Care Considerations

• Patients after a transient ischemic attack (TIA) or a reversible ischemic neurologic deficit (RIND) event can be treated without special precautions, but they may be at risk for developing a full-blown stroke.

• Poor oral hygiene may be associated with a person’s impaired motor functions, or depression, when regards for personal hygiene may be neglected.

• Monitor blood pressure.

• Patients with a history of a non-cardio-embolic ischemic stroke has an increased risk of a recurrence with a systolic blood pressure >150 mm Hg.

• Use antianxiety agents as needed.

• Follow anticoagulation protocol when indicated.

• Address comorbidities, such as depression, memory problems, or motor impairment.

• Address underlying diseases and conditions, such as other cardiovascular diseases, heart failure, left ventricular dysfunction, mitral and aortic stenosis, prosthetic heart valve, and atrial fibrillation.

• Recognize signs and symptoms of stroke/TIAs. These include, among others, minimal to severe motor dysfunction, sensory impairment, visual defects, speech difficulties, dysphagia, dizziness, seizures, dyspnea, sleep problems, and memory deficits. In addition, depression is a common condition affecting many patients after a stroke.

• If any of the following occur, stop all dental care and call emergency medical services:

  • sudden numbness or weakness of the face, arm or leg, especially on one side of the body;
  • sudden confusion, trouble speaking or understanding;
  • sudden trouble seeing in one or both eyes;
  • sudden trouble walking, dizziness, loss of balance or coordination;
  • sudden severe headache with no known cause.

• Encourage patients with a history of TIA and RIND to seek medical evaluation.

• Be aware that patients with a history of TIA and RIND are high risk of developing a stroke.

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Medical Complexity Status - Stroke

Stroke	MCS1C	MCS2C
Anticipated complication	Controlled/ stable	Uncontrolled/ unstable
Hemostasis	Minor	Minor
Microbial  susceptibility	None	None
Drugs/ drug  interactions	Minor	Minor
Stress/trauma	Major	Major

See Medical Complexity Status for more information.

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Related Pages

• Medical Disorder
  • Atrial Fibrillation
  • Cardiovascular Diseases
  • Heart Failure
  • Posthetic Heart Valve
  • Stroke
• Oral Health Care Considerations
  • Anticoagulation and Antiplatelet Therapy Considerations
• Medical Emergencies
  • Stroke

References/Websites

• References
  • Chen TT, et al. Risk of Myocardial Infarction and Ischemic Stroke after Dental Treatments. JDR. 2019;98(2):157-163.
  • Hankey GJ. Antithrombotic therapy for stroke prevention. Circulation. 2019;139:1131–1133.
  • Lacey B, et al. Systolic blood pressure and vascular disease in men aged 65 years and over. The HIMS (Health in Men Study. Hypertension. 2017;69:1053-1059.
  • Hankey GJ. Stroke. Lancet. 2017;389(10069):641-654
  • Ovbiagele B, et al. Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA 2011;306(19):2137-2144.
• Websites
  • National Aphasia Association.
  • Stroke. National Heart, Lung, and Blood Institute.
  • Stroke Information Page. National Heart, Lung, and Blood Institute.
  • Transient Ischemic Attack Information Page. National Heart, Lung, and Blood Institute.
  • Stroke. MedlinePlus. U.S. National Library of Medicine. June 30, 2021.