Dental Care

Since the most common route for entry of bacteria into the blood stream is from the gingivae (gums), it is very important to inform your dentist that you have HHT before any dental work including dental cleaning. If pulmonary arteriovenous malformations are present, the bacteria once in the bloodstream can pass through them may lodge in the brain and cause a brain abscess. A brain abscess is an extremely serious medical emergency and could be life threatening. If you have HHT and have not been specifically screened for lung AVMs, to prevent a brain abscess antibiotics must be taken prior to any dental procedure. It is essential that patients with HHT receive antibiotics using the American Heart Association Guidelines before dental cleaning or dental work of any kind.

You should also discuss with your dentist and dental hygienist any home care procedure or device that has been recommended, such as oral irrigation or any procedure that could introduce bacteria into the bloodstream.

After you have been to an HHT Center and confirmed you do not have lung AVMs, you will not require antibiotics. If you do have lung AVMs, even if they have been treated, you will always need to take antibiotics before dental work. If you have not been screened for lung AVMs, simply take your dentist's choice of antiobiotics 1 hour before dental work.

Also, there are medications that should not be routinely prescribed for HHT patients. Dental professionals should be aware of these. Any anti-inflammatory agent such as Advil, Motrin, Naprosyn, Aleve, and Aspirin should generally not be taken by individuals with HHT, because these medications can increase bleeding. Many times these medications are prescribed following dental procedures.

Telangiectases of the gums, lips, and tongue are often mistakenly called red spots or some other abnormality upon oral examination. They can vary in size from pinpoint to pea size. Procedures involving minor tissue manipulation such as getting your teeth cleaned, brushing your teeth, and using dental floss at home can cause bleeding. The dental professional should pay attention to the bleeding and rule out gingivitis or bacterial infection. Telangiectases related to HHT in the mouth and lips can be acquired in adulthood. The dental health professional is thus in a position to identify telangiectases.

We recommend that your dentist work with your physician if your dentist is unfamiliar with HHT. If your primary physician is not familiar with HHT, you must provide for his/her education. Give them the HHT Foundation number or website address as a first step. Together, they can ensure that you receive the care you need.

To obtain information from the AMERICAN HEART ASSOCIATION on the recommended standard prophylactic regimen for dental, oral, or upper respiratory tract procedures in all adult patients who are at risk, please call: 1 - 800 - 242 - 8721

References:
# Guttmacher AE, Marchuk DA, White RI: " Current Concepts: Hereditary Hemorrhagic Telangiectasia" the New England Journal of Medicine, Volume 333, Number 14, pp. 918-924. October 3, 1995.
# Shovlin CL, Letarte M: "Hereditary Haemorrhagic Telangiectasia and Pulmonary Arteriovenous Malformations: Issues in Clinical Management and Review of Pathogenic Mechanisms". THORAX, Vol 54, No. 8, pp 714-729, August 1999.
# Christensen G J: "Nosebleeds May Mean Something Much More Serious: An Introduction to HHT", Journal of the American Dental Association, Vol. 129, May 1998, pp 635-637