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September JADA examines effect of dental treatment before heart surgery

August 19, 2019

By Mary Beth Versaci

It is unclear if post-operative outcomes differ in patients who receive dental treatment before cardiac valve surgery compared with those who do not, according to a systematic review published in the September issue of The Journal of the American Dental Association.

JADA September 2019 cover
The cover story, titled "Effect of Dental Treatment Before Cardiac Valve Surgery: Systematic Review and Meta-analysis," is the result of Resolution 86H-2016 from the ADA House of Delegates that instructed the ADA Council on Scientific Affairs to work with other ADA agencies and external stakeholders to develop proposed policy and evidence-based resources to optimize oral health before performing complex medical and surgical procedures.

Under this directive, the council assembled an expert panel of dentists and physicians to review the literature surrounding the effect of dental interventions on morbidity and mortality when performed as preparation for cardiac valve surgery. Six studies met the inclusion criteria.

"Given what we know about the nature and frequency of bacteremia from the mouth and the potential for oral bacterial species to cause infective endocarditis, some dentists and cardiac surgeons emphasize the importance of a thorough dental evaluation for patients about to undergo cardiac valve surgery," said Dr. Peter B. Lockhart, the article's lead author and a research professor in the Department of Oral Medicine at Carolinas Medical Center in Charlotte, North Carolina. "Findings from this systematic review, however, demonstrate a lack of data to show a protective effect."

While the authors could not determine an effect based on the evidence currently available, they advised that dentists and medical professionals should collaborate on an appropriate course of action for each patient, weighing any potentially relevant care considerations.  

"Importantly, this review does not demonstrate a lack of patient benefit but simply a lack of scientific evidence to support or reject this practice of presurgical dental evaluations," Dr. Lockhart said. "It clearly points to the need for a well-designed and conducted clinical study. In the meantime, this systematic review does not suggest we should abandon this practice, but that dentists and cardiac surgeons should take several factors into consideration in order to arrive at the most appropriate decision on which presurgical patients to screen and treat for dental disease."

Patients with cardiac valves are the first of several medically complex or immunocompromised patient populations to be examined under the resolution. The next group is patients with head and neck cancer.

To read the article, visit JADA.ADA.org.

Other articles in the September issue of JADA examine the oral health care experiences of transgender adolescents and young adults, the efficacy of LED light-polymerization units and the oral manifestation of a possible eating disorder in a minor patient.

Every month, JADA articles are published online at JADA.ADA.org in advance of the print publication.