Dental extractions and cardiovascular health: exploring the connections

The dental extraction of abscessed or infected teeth is sometimes performed to reduce the risk of infection during surgery and endocarditis following surgery. A recent study titled “Morbidity and Mortality Associated With Dental Extraction Before Cardiac Operation,” published in the March 2014 issue of The Annals of Thoracic Surgery, (1) suggests that removing an infected tooth before cardiac surgery exposes patients to a greater risk of negative outcomes, even the risk of death.You can read the abstract here. According to an article from ScienceDaily, 205 patients who had at least one dental extraction prior to a planned cardiac surgery from 2003 to 2013 were evaluated for the occurrence of major adverse outcomes. … For the study, patients who underwent dental extraction prior to cardiac surgery experienced an 8% incidence of major adverse outcomes, including new heart attack, stroke, kidney failure, and death. Overall, 3% of patients died after dental extraction and before the planned cardiac surgery could be performed. (2)

I spoke with Dr. Richard Nagelberg, who has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations, and he lectures on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Dr. Nagelberg is a monthly columnist for Dental Economics and a contributor to DentistryIQ.com.

I wanted to get his thoughts on the study, and here’s what he had to say …

“This study has some startling findings, but perhaps the biggest takeaway is found near the end. Dr. Ann Bolger, a professor of medicine at the University of California, San Francisco, and a spokeswoman for the American Heart Association stated: ‘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.’ Dr. Bolger further indicated that additional studies are needed to clarify these findings. (3)

"If a patient presents for dental clearance prior to cardiac surgery, any treatment recommendations involving invasive procedures, including tooth extraction, should be made with the patient’s attending physician. Communication between the dentist and the patient’s physicians should be in writing, especially those involving any and all recommendations to defer or proceed with any invasive dental procedures.”

Additional reading …
The most important perio-systemic facts
Enough talk about the oral-systemic link: It's time to bridge the gap between dentistry and medicine
Connecting the oral and systemic gap: what's it going to take?

More resources ...
American Health Association

References...
1. Smith MM, Barbara DW, Mauermann WJ, Viozzi CF, Dearani JA, Grim KJ. Morbidity and mortality associated with dental extraction before cardiac operation. The Annals of Thoracic Surgery, 2014; 97(3):838-844. DOI: 10.1016/j.athoracsur.2013.10.034.
2. Tooth extraction prior to cardiac surgery may increase risk of adverse outcomes. Society of Thoracic Surgeons. ScienceDaily. Feb. 27, 2014.
3. Dotinga R. Getting teeth pulled before heart surgery may pose serious risks. 2014. HealthDay.

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