In the management of congestive heart failure, which dental equipment should be avoided?

• A. Air polisher or ultrasonic
• B. Hand scalers only
• C. Laser
• D. Drill with water spray

Answer: (A)

When a patient has congestive heart failure, protecting the airway and minimizing respiratory stress during dental care is especially important. Procedures that generate large aerosols can worsen breathing, increase coughing, and raise the risk of pulmonary irritation or infection in someone whose pulmonary reserve may be limited.

An air-polishing device uses compressed air to propel a fine abrasive powder, creating a widespread aerosol and powder plume. In someone with heart failure, this inhaled material and the associated aerosol exposure can be problematic for the lungs and overall respiratory status. Ultrasonic scalers also produce substantial aerosols through their vibrating tip combined with a water spray, which can spread bacteria and irritants and potentially trigger bronchospasm or hypoxia in susceptible patients.

Because of these aerosol-related risks, air polishing and ultrasonic scaling are best avoided in the management of congestive heart failure. Hand instrumentation avoids aerosol generation, and lasers or drilling with water spray can be used with appropriate suction and precautions to minimize exposure.