Removing infected teeth prior to cardiovascular surgery may not be advisable, according to a study published in The Annals of Thoracic Surgery.
The removal of abscessed or infected teeth before heart surgery is commonly practiced, given that it decreases infection and inflammation risks during and after the operation.
But a new Mayo Clinic study found that eight percent of patients who had their teeth removed before heart surgery had negative results, including stroke, heart attack, kidney failure and death. Three percent of patients died after dental extraction and prior to the beginning of cardiovascular surgery.
"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 one percent," study co-author Dr. Mark Smith said. "Our results, however, documented a higher rate of major adverse outcomes [with the extractions]."
The study has its limitations. It doesn't indicate potential risks of postponing dental care until after heart surgery. It also doesn't prove a cause-and-effect relationship.
Still, the study marks what may be seen as a contribution to an ongoing departure from conventional thinking on dental treatment and cardiovascular surgery.
"Accepted wisdom leads surgeons to request dental reviews prior to cardiac surgery in many thousands of patients annually around the world," said Dr. Michael Jonathan Unsworth-White of Derriford Hospital in Plymouth, UK. "Dr. Smith's group asks us to question this philosophy. It is a significant departure from current thinking."
It is not uncommon for patients to have both dental and heart problems.
As to what occurred with patients in this particular study, the patients' condition may have been so poor that they had difficulty tolerating anesthesia during a dental procedure. It's unclear whether there would have been a different result if the patients hadn't undergone dental treatment.
The study isn't yet prompting new rules or guidelines. Researchers are unsure as to where the increased risk may originate. They also are unsure exactly what to do for patients except carefully control pain or high blood pressure that comes as a result of a dental procedure.
"This is an interesting study that identifies a gap in our understanding of the risks of this practice," Dr. Ann Bolger, professor of medicine at the University of California, San Francisco, and a spokeswoman for the American Heart Association, told HealthDay. "But it does not prove that doing the opposite would improve outcomes. This work will need to be followed by additional studies before we know with more certainty."
