By Amy Salonek, RDH, RCS

As a registered dental hygienist who has also worked in cardiac rehabilitation (CR), I’m always asking myself the same question: How can we make oral health education a practical part of helping people care for themselves after a cardiac event?

More than a decade of expertise in the dentistry field tells me that oral health deserves a place in the CR conversation. A patient may be learning to manage medications, change eating habits, and regain confidence while also struggling with bleeding gums and dental pain — concerns that deserve attention in light of the connection between oral and cardiovascular health.

Asking about those concerns gives CR teams another way to understand what recovery looks like beyond the exercise session, particularly in far-flung communities where access to health care — including CR — is a persistent barrier.

During my time in a rural rehabilitation setting, our team introduced oral health education using American Heart Association (AHA) resources. The ensuing conversations brought attention to dental concerns and highlighted gaps in patients’ understanding of the mouth–heart connection. This was clinical experience, not a formal study, but it strengthened my interest in helping rehabilitation teams make room for the subject.

Explain the connection carefully

An AHA scientific statement published in December 2025 describes growing evidence of an association between periodontal disease and atherosclerotic cardiovascular disease. It discusses shared risk factors and possible biological pathways, including bacteria entering the bloodstream and systemic inflammation. A cause-and-effect relationship has not been established, and periodontal treatment has not been proven to prevent cardiovascular events.¹

That distinction belongs in patient education. CR professionals can explain why oral health matters without promising that treating gum disease will prevent another heart attack. Patients deserve both useful information and an honest account of what remains uncertain.

For rehabilitation teams, the immediate opportunity is straightforward: help patients recognize oral concerns, understand everyday care, and connect with dental professionals. These are useful goals even while researchers continue to investigate cardiovascular outcomes.

Begin with a few questions

Adding a brief conversation to an existing education visit is a good starting point. Does the patient have a dentist? When did they last receive dental care? Are they experiencing bleeding gums, mouth pain, dryness, or difficulty chewing? Is anything making it hard to arrange an appointment?

The purpose is to identify concerns and barriers that need follow-up. Diagnosing periodontal disease requires a dental evaluation; a conversation in rehabilitation cannot establish whether someone has it.

How we ask matters. The question “What has made dental care difficult for you?” leaves room for a patient to discuss cost, transportation, fear, or competing responsibilities. It also gives the team a more useful starting point than a reminder to schedule an appointment.

Make education fit daily life

• A brief discussion can reinforce brushing twice daily for two minutes, cleaning between teeth daily, and receiving regular dental care tailored to individual needs. Floss, interdental brushes, and water flossers offer different options for cleaning between teeth; patients can ask their dental professional which approach suits them.²
• Ask what the patient can realistically manage at home. Would a caregiver’s help make oral care easier? Does the patient need a demonstration from a dental professional? Choose one achievable next step together and revisit it at a later session.
• Dry mouth also deserves attention. Medications can contribute to oral dryness, and reduced saliva can increase tooth decay risk. Persistent dryness may affect comfort and eating. Encourage patients to discuss symptoms with their dental and prescribing teams.³ Any discussion of fluid intake must respect the patient’s prescribed fluid limits.
• Medication questions are another opportunity to support communication. Patients taking anticoagulants or antiplatelet medications should not stop them on their own before dental treatment. The American Dental Association notes that most patients do not need these medications altered for dental procedures; any proposed change requires coordination with the prescribing clinician.⁴ Rehabilitation staff can reinforce that message and encourage patients to bring an updated medication list to dental appointments.

Help patients reach dental care

Education should come with a realistic next step. Before recommending a dental care provider, a CR program can check whether that practice is accepting patients, what services it provides, and whether affordable options are available. A community health center with dental services, a local dental practice, or a dental school clinic may be worth exploring, depending on location and eligibility.

A CR program could invite a local dental hygienist or dentist to review its educational materials and help develop a referral process. That relationship would also give staff a place to direct questions that fall outside their role.

At follow-up, ask whether the patient was able to make contact and what happened next. If transportation or cost prevented an appointment, documenting that barrier helps explain why a referral did not lead to care.

Start small and learn from it

It may benefit programs to test whether a brief oral health conversation and referral pathway can fit into routine rehabilitation. A small pilot could track staff time, patient understanding, referrals offered, and appointments completed. It should also ask patients whether the conversation was useful and staff whether the approach was workable. These measures would help assess feasibility before attempting to study longer-term outcomes.

For now, a team can begin by reviewing its education materials and choosing where an oral health question belongs. Give someone responsibility for maintaining referral information, then revisit what patients and staff are telling you.

My message is simple: Don’t forget the mouth. The next time a patient talks about the challenges of recovery, ask whether oral health is one of them. Their answer may reveal a need your team can help them address.

References

1. Tran, A. H., Zaidi, A. H., Bolger, A. F., Del Brutto, O. H., Hegde, R., Patton, L. L., Rausch, J., & Zachariah, J. P. (2026). Periodontal disease and atherosclerotic cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 153(6), e73–e88. https://doi.org/10.1161/CIR.0000000000001390

2. American Dental Association. (n.d.). Home oral care. https://www.ada.org/resources/ada-library/oral-health-topics/home-care

3. American Dental Association. (2026, March 4). Xerostomia (dry mouth). https://www.ada.org/resources/ada-library/oral-health-topics/xerostomia

4. American Dental Association. (2022, September 28). Oral anticoagulant and antiplatelet medications and dental procedures. https://www.ada.org/resources/ada-library/oral-health-topics/oral-anticoagulant-and-antiplatelet-medications-and-dental-procedures

About the author

Amy Salonek, RDH, RCS, is a registered dental hygienist, registered cardiac sonographer, and patient education advocate in rural West Texas. Her background includes more than a decade in dental hygiene and previous experience working in cardiac and pulmonary rehabilitation, where she recognized a need for oral health education. She is interested in practical ways to connect oral health education with cardiovascular care and improve access in rural communities.