Dental extraction before cardiac surgery may not be as benign a procedure as some clinicians might think, with review findings showing that it is associated with major adverse outcomes.
Researchers from the Mayo Clinic in Rochester, Minnesota, USA, found that major adverse outcomes occurred in 8% of 205 patients within 30 days of tooth removal or until the cardiac surgery was performed. Major adverse outcomes were defined as death, bleeding, acute coronary syndromes, cerebrovascular accident, transient ischaemic attack and renal failure requiring dialysis.
Guidelines issued by the American College of Cardiology and American Heart Association suggest that dental extraction is a minor procedure, but the team reports that 6% of patients died within 30 days of having a tooth removed, with 3% of these deaths occurring before and 3% after the cardiac procedure.
Poor dentition, notably abscessed or infected teeth, has been linked to an increased risk of endocarditis after prosthetic valve procedures. Although data are limited and “largely circumstantial”, removal of affected teeth is often performed before cardiac surgery, including procedures other than those involving the heart valves.
“We are always concerned with improving safety, and pulling teeth before heart surgery seemed to be the safer intervention,” senior author Kendra Grim said in a press statement. “We became interested in studying this complex patient group, as many patients that come to the operating room for dental surgery just before heart surgery are quite ill,” she added.
The team examined the medical records of patients who underwent dental extraction before cardiac surgery at their institution over a 10-year period. A total of 208 extractions were performed and there were 206 planned cardiac operations, of which 199 were actually performed. The mean age of patients was 62 years; 80% were men. The median time between tooth removal and cardiac surgery was 7 days.
“The prevalence of major adverse events should advise physicians to evaluate the individualized risk of anesthesia and surgical procedures in this population,” the researchers suggest in TheAnnals of Thoracic Surgery.
Although they cannot give a definitive recommendation for or against dental extraction based on their findings, the researchers hope that the results will spark discussion and encourage others to carry out future research.
“In the meantime, we recommend an individualized approach for these patients, to weigh their particular risk and benefit of a dental procedure before cardiac surgery with the information we have currently available,” Grim advised.
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