NEW INFO FOR CARDIAC PATIENTS

It is common sense that infected teeth, whether they hurt or not, or are broken down beyond repair, should be removed. We also all know by now that there are mouth-body connections and that the mouth is the “gateway” to the rest of the body. There is no disputing that a healthy mouth is better for you on many levels. However, in a recently released study, the guidelines for treatment of some types of dental problems prior to specific surgery need closer consideration.

According to a study in an issue of The Annals of Thoracic Surgery, removing an infected tooth prior to cardiac surgery may increase the risk of major adverse outcomes, including risk of death prior to surgery. This is a very specific study for a very specific group of patients. It does suggest considering postponing dental problems prior to any surgery.

Dental extraction of abscessed or infected teeth is often performed to decrease the risk of infection during surgery and endocarditis (an inflammation of the inner layer of the heart) following surgery. In this particular study, physician researchers evaluated the occurrence of major adverse outcomes in 205 patients who underwent at least one dental extraction prior to planned cardiac surgery. The median time from dental extraction to cardiac surgery was 7 days (average 35 days).

One of the researchers explained, “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%. Our results, however, documented a higher rate of major adverse outcomes, suggesting physicians should evaluate individualized risk of anesthesia and surgery in this patient population.”

In this 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. Another of the researchers went on to say, “With the information from our study we cannot make a definitive recommendation for or against dental extraction prior to cardiac surgery. We recommend an individualized analysis of the expected benefit of dental extraction prior to surgery weighed against the risk of morbidity and mortality as observed in our study.”

This study, as in many “new” studies, awakens us to consider a departure from current lines of thinking about specific situations. This paradigm shift of thinking has also been noted in the use of prophylactic antibiotics prior to dental procedures in those with cardiac conditions.

Prophylactic antibiotics have routinely been prescribed for patients undergoing dental work who also had existing heart problems because it had been accepted that there is a link between dental bacteremia and endocarditis. Individuals with pre-existing heart problems tend to have a higher incidence of endocarditis. The American Heart Association and others have withdrawn support for this practice of prophylactic antibiotics because the danger from overuse of antibiotics outweighs any other potential risks. Regular tooth brushing, flossing, and even chewing gum are now recognized to dislodge as much, if not more, bacteremia than most dental procedures.

Prevention of dental problems is the best line of defense. Regular professional maintenance, especially as we age, is important to our overall health. Talk with your dentist and physician about your specific situations.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.