Article Accessed August 1st 2014
Article published by the American Dental Association on 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.
Footnotes
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.
Article published by the American Dental Association on 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.
Footnotes
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.