Science in the News
Dental Treatment before Cardiac Surgery Studied
May 28, 2014
Physicians and dentists often work hand in hand to optimize the oral health of patients prior to cardiac surgery. To that end, tooth extraction is not uncommon for these patients. A recent study1 from the Mayo Clinic investigated potential risks that may be associated with pre-surgical extractions.
Infective endocarditis is associated with a high mortality rate, and therefore preventing these infections is critical. Because oral infections have been implicated in the pathogenesis of infective endocarditis,2 dental procedures are often performed before cardiac surgery as a preventive measure.
Smith and colleagues investigated the morbidity and mortality associated with this practice.1 In this retrospective study, the authors reviewed the medical records of patients who had been scheduled for heart surgery and had pre-surgical dental extractions. Specifically, the authors looked for occurrences of major adverse events following tooth extraction, which they defined as death, acute coronary syndrome, stroke, renal failure requiring dialysis or the need for postoperative mechanical ventilation.
Out of 205 patients, eight percent (n=16) suffered an adverse event — a rate that was higher than expected. Six percent (12 patients) died — three percent before cardiac surgery and three percent after cardiac surgery. The authors concluded that the prevalence of major adverse events documented by their study should "alert physicians to evaluate the individualized risk of anesthesia and operation in this patient population."
The authors noted that the limitations of the study (for instance, the use of a retrospective chart review and lack of a control group for comparison) did not allow them to draw firm conclusions about their findings. The findings do not establish, nor do the authors suggest, that the tooth extraction(s) caused the adverse events. It's possible that multiple procedures in this patient population put the patients at risk for adverse events. Therefore, the risk associated with additional procedures (like tooth extractions) may outweigh the benefits. Acknowledging that more research is needed, the authors suggest that doctors consider the risk of adverse events on a case-by-case basis in this population before prescribing pre-operative dental extractions.
This study was originally published in the Annals of Thoracic Surgery, and summaries have appeared on various online outlets, including Forbes.com and U.S. News & World Report.
1 Smith MM, Barbara DW, Mauermann WJ, Viozzi CF, Dearani JA, Grim KJ. Morbidity and mortality associated with dental extraction before cardiac surgery. Ann Thorac Surg. 2014;97(3):838-44.
2 Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. JADA 2008;139:3S-24S.
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