Which of the following is NOT recommended for patients with cardiovascular disease?

The use of a gingival retraction cord with epinephrine is not recommended for patients with cardiovascular disease because epinephrine can cause an increase in heart rate and blood pressure, which can be particularly risky for patients with existing heart conditions. These individuals often have compromised cardiovascular systems, and the introduction of epinephrine can exacerbate their condition, leading to potentially serious complications such as arrhythmias or hypertensive crises.

In contrast, fluoride is generally safe for patients with cardiovascular disease as it helps prevent dental caries without affecting cardiovascular health. Nitrous oxide, when used appropriately, can provide anxiety relief and sedation without significant cardiovascular effects, making it safer for use in many patients, including those with heart conditions. Local anesthesia, while it can have cardiovascular considerations, is usually manageable when dosages are kept within safe limits and the specific agents used are selected with caution.