From the Guidelines
I strongly advise informing your dentist about your patient's stroke history before any dental treatment, as this information is crucial for modifying treatment plans and ensuring the patient's safety during procedures. The dentist should know about all medications the patient is taking, particularly anticoagulants like warfarin, clopidogrel, or direct oral anticoagulants, as these affect bleeding risk during procedures 1. Provide details about when the stroke occurred, any residual deficits (such as weakness, speech difficulties, or swallowing problems), and current mobility limitations. The dentist may need to modify the treatment position if the patient has difficulty lying flat or has one-sided weakness. For patients with communication difficulties, bringing a family member or caregiver to appointments can help ensure clear understanding of instructions.
Some key considerations for dental treatment in stroke patients include:
- Ensuring good oral and dental hygiene, particularly for those with dysphagia, through assistance and/or education 1
- Using strategies to address specific barriers to physical activity related to patients, health care providers, family, and/or the environment 1
- Providing advice on prescribed medications for people after stroke, including anticoagulants and their potential impact on bleeding risk during dental procedures 1
- Supporting and educating people after stroke and their families and carers, in relation to emotional adjustments to stroke, recognizing that psychological needs may change over time and in different settings 1
The dentist should also be aware that stroke patients may have difficulty maintaining oral hygiene and might need simplified home care routines or adaptive tools like electric toothbrushes or floss holders. This information is crucial because stroke patients often have underlying cardiovascular conditions that can affect dental treatment decisions, including medication interactions, stress management during procedures, and appointment duration considerations 1.
From the Research
Dental Treatment Considerations
- When considering dental treatment for a patient who has had a stroke, it is essential to weigh the risks and benefits of treatment, as well as the timing of treatment 2.
- Current literature recommends postponing dental treatment until 6-12 months after a stroke, based on the presumed risk of recurrent stroke, but a study suggests that dental treatment may be safely administered in patients a few weeks after the cerebrovascular event as long as these patients are kept under optimal medical surveillance 2.
Medication Considerations
- Dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin is a well-established practice after a minor stroke or transient ischemic attack (TIA), but ticagrelor plus aspirin may be an alternative 3, 4.
- Ticagrelor plus aspirin was found to be superior to aspirin in preventing stroke recurrence in overall analysis, and may be a considerable option for patients after a minor stroke or TIA 3.
- However, ticagrelor was not associated with an increased risk of all-cause mortality, major bleeding, hemorrhagic strokes, and intracranial hemorrhage, but was associated with an increased risk of major or minor bleeding compared to the control group 5.
Patient Management
- Patients who have had a stroke should be closely monitored during and after dental treatment, and treatment parameters and outcomes should be compared to ensure safe and effective care 2.
- The use of ticagrelor was found to be superior to the use of clopidogrel or aspirin in reducing the risk of subsequent stroke in patients with a history of acute ischemic stroke (AIS) or transient ischemic attack (TIA) 5.
- Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA), but is associated with a higher risk of major hemorrhage 6.