Dentists are required daily to advise their patients regarding their oral hygiene and how that impacts on their general health. Patients should be aware how their general health and medication impacts on their oral environment and vice versa. Selecting just the female population of our practice, one should discuss problems from the mundane to the potentially life-threatening. We should take into account the diversity of this group of patients regarding their habits, lifestyle and medication.
The risk factors we need to discuss would involve smoking, oral contraception hypertension and the age of the patient. This is always in the domain of the patient’s medical general practitioner but the dental profession should be aware of how these factors impact on their patients’ lives.
Patients who smoke often consult the dentist about the colour of their teeth and are concerned with the loss of the bright white straight smile that they used to have. Certainly, orthodontics can remedy the crooked smile and a good scale and polish and bleaching can improve the colour of the teeth giving the patient back that Hollywood smile.
Smoking and other modifying factors such as oral contraception, obesity and hypertension can impact heavily on the patient’s health. While the cardiovascular risks are low in young woman, this risk is often modified by the patient’s lifestyle and medicinal drug intake. The three areas of main concern for women are Venous Thromboembolism or clot formation in the veins, stroke and myocardial infarction or heart attack.
The risk of venous thromboembolism in women taking oral contraception is low in the range of 7 to 18 events for every hundred thousand women and is related to the oestrogen dose of the contraceptive but again this risk can be modified by the patients’ blood factors and obesity which will increase her risk.
A stroke Is less common than a venous thromboembolism at 1.5 events per hundred thousand women but will be increased if that woman is a smoker or suffers from hypertension (high blood pressure).
A Myocardial Infarction or heart attack is rare in young woman at less than 0.2 heart attacks for every hundred thousand women but again high blood pressure or hypertension, smoking and increased age will increase her risk.
Armed with the above information a woman of childbearing age who is taking an oral contraceptive should have some idea of the risks involved with respect to her age, smoking habit, weight and hypertension. The ideal situation would be for her to discuss the types of oral contraceptive with her medical practitioner, be treated for any hypertension present, lose weight if necessary and give up smoking.