Summary

Familiarity with the top 300 prescription drugs dispensed by U.S. community pharmacies provides an insight into prevailing disease trends in the U.S. population. In 2020, 20% of the top 300 drugs dispensed in the United States were prescribed to address cardiovascular diseases such as HTN, IHC (i.e., chronic CAD and ACS), cardiac arrhythmias, heart failure, and thromboembolic complications.

The risk of a major adverse cardiac event (MACE), defined as myocardial infarction, heart failure, or sudden cardiac death, occurring in the dental treatment scenario is predicated on multiple factors such as the cardiovascular / overall health of the patient and the extent of dental procedural stress. The stress associated with an outpatient dental procedure under local anesthesia is typically not associated with an increased risk of MACE. Presenting medical conditions such as advanced age, atrial fibrillation, stroke, uncontrolled HTN, chronic stable angina pectoris, previous MI (>60 days), compensated HF, diabetes mellitus, and renal insufficiency are generally not associated with an increased risk of MACE.

The risk of MACE is significantly increased in a patient presenting with one of the following conditions: unstable angina pectoris, recent MI (<60 days), decompensated HF, severe valvular disease, or significant arrhythmia. The risk is independent of the level of dental procedural stress.

It is important to always estimate the patient’s perioperative risk for MACE. If the combined procedure- and patient-specific variables predict a low-risk for MACE and the patient’s FC is ≥4 METs no further preoperative evaluation may be needed. If the FC is <4 METs and/or the risk for MACE is elevated, the practitioner should refer the patient for appropriate medical evaluation, before undergoing elective dental care.