THURSDAY, Feb. 27, 2014 (HealthDay News) -- If you're a heart
patient, you might be wise to wait to have any infected teeth
pulled if you're about to have cardiac surgery, a new study
In a small, retrospective study, Mayo Clinic researchers found
that 8 percent of heart patients who did not wait to have teeth
pulled suffered major adverse health outcomes, such as a heart
attack, stroke, kidney failure or death.
"Guidelines from the American College of Cardiology and American Heart Association label dental extraction as a minor procedure, with the risk of death or non-fatal heart attack estimated to be less than 1 percent," study co-author Dr. Mark Smith said in a statement. "Our results, however, documented a higher rate of major adverse outcomes [with the extractions]."
Such extractions are commonly done ahead of some types of heart
surgery to lower the chances of infection during the procedure or
avoid inflammation of the inner layer of the heart after the
operation, the researchers noted.
However, the study didn't pinpoint what risks might be posed by
postponing major dental care until after heart surgery. The study
also didn't prove a cause-and-effect relationship.
Still, the finding "does help us to understand the risk we're
exposing patients to when they get their teeth extracted before
their heart surgery," said study co-author Dr. Kendra Grim, an
anesthesiologist at the Mayo Clinic in Rochester, Minn. "It opens
up a lot of different avenues for research and discussion."
At issue is what to do with patients who have both dental
problems and heart issues. A combination of these two conditions
isn't uncommon, explained Dr. Ann Bolger, a professor of medicine
at the University of California, San Francisco, and a spokeswoman
for the American Heart Association.
"Given the frequency of risk factors that poor oral health and cardiovascular disease share, such as age, smoking and diabetes, the fact that they overlap is not a surprise," Bolger said.
But the combination can be dangerous.
"We know that patients with poor dental health are at higher risk of having bacteria in the bloodstream, which can cause infections in the heart valve," Grim explained.
Previous research suggests that patients with infected
artificial heart valves have a 38 percent higher risk of dying,
according to background information in the study.
Surgeons may recommend dental care before heart valve surgery
and other kinds of cardiac surgery, such as coronary artery bypass
procedures and heart transplants.
But the authors of the new study write that it's not clear
whether it's a good idea to get dental treatment before heart
surgery. To try to get closer to an answer, they examined the
medical records of 205 patients who had teeth removed before
undergoing cardiac surgery.
Of those patients, a total of 8 percent (16 people) experienced
a heart attack, stroke, kidney failure or death. Twelve patients
died within 30 days after their teeth were removed -- including six
people who died before their cardiac operation and six who died
after heart surgery, the investigators found.
What's going on?
The condition of the patients may have been so poor that they
had trouble tolerating anesthesia during a dental procedure, Grim
said. As to whether things would have been different if patients
hadn't undergone dental treatment, Grim said it's unclear.
Still, the risk of death and other medical problems was higher
than the study authors expected, she noted.
"If a tooth is painful and obviously infected, it must be dealt with," Grim said. "The dental procedures discussed here, and that are most common, are prophylactic [preventive]. That is, the extraction of an infected tooth may not be an urgent dental issue, but when the patient has [scheduled] heart surgery -- particularly valve replacement surgery -- pre-emptive dental imaging and extractions are often performed."
For now, the study isn't prompting any new guidelines or rules.
For one, researchers don't know exactly where the increased risk
may originate. It's not easy to figure out what to do except
carefully control pain or high blood pressure resulting from a
dental procedure, Bolger said.
"This is an interesting study that identifies a gap in our understanding of the risks of this practice. But it does not prove that doing the opposite would improve outcomes," Bolger said. "This work will need to be followed by additional studies before we know with more certainty."
The study appears in the March issue of
The Annals of Thoracic Surgery.
For more about dental and heart health, try the
American Heart Association.
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