Is dental care prior to advanced heart surgeries safe?

2017 05 26 14 08 22 160 Heart 400

Patients who receive dental care prior to advanced cardiac interventions, including heart transplants, may not be at greater risk of death or adverse events, according to a study published June 4 in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.

Dental infections can be treated safely to help optimize cardiac interventions for end-stage heart failure patients, the authors wrote.

"As advanced cardiac therapies are becoming more commonplace, it is important that oral health care providers understand that these patients can be managed safely pre-operatively in order reduce post-operative morbidity," wrote the authors, led by Dr. Reeva Mincer of the University of California, Los Angeles (UCLA) School of Dentistry in California.

In the U.S., heart failure affects about 6 million people. About 5,000 people in the U.S. are diagnosed with end-stage heart failure, but only 2,500 patients receive cardiac transplants annually. Those who don't receive transplants often receive mechanical circulatory support, such as ventricular assist devices.

Because infection is one of the major adverse events linked to mechanical circulatory support, preventive strategies often include patients undergoing presurgery dental exams to eliminate any potential oral infections. Though studies have concluded that dental treatment prior to heart surgeries, such as coronary artery bypass grafts, can be done safely and does not increase the risk of morbidity and mortality, the research is limited in more complex patients, they wrote.

To explore the effects of preoperative surgical dental treatment prior to orthotopic heart transplant or mechanical circulatory support placement, a retrospective chart review was conducted. The review included 305 end-stage heart failure patients evaluated by the hospital dentistry service at UCLA Ronald Reagan Medical Center. Patients who underwent nonsurgical care, including caries excavation or placement of a restoration, were not included in the study.

Between the dental and nondental groups, the number of medical and dental complications and deaths did not differ significantly. Additionally, the only dental complication experienced was intraoral bleeding, the authors wrote.

Comparison of complications and deaths experienced by dental and nondental heart patients
  Dental patients Nondental patients
Patients with dental complications within 31 days of dental treatment 8 (7%) 1 (0.5%)
Patients with medical complications within 31 days of dental treatment 6 (5.3%) 6 (3.1%)
Patients with medical complications within 31 days of cardiac surgery 15 (13.2%) 24 (12.6%)
Deaths within 31 days of dental treatment 5 (4.4%) 5 (2.6%)
Deaths within 31 days of cardiac surgery 6 (5.3%) 10 (5.2%)

The study was limited due to its nature as a retrospective record review. The study's authors acknowledge that adverse events may have been overlooked due to omissions from medical charts.

Though the study suggests that dental intervention can be performed safely in end-stage heart failure patients, more research should be conducted to examine whether presurgical treatment is warranted, they wrote.

"Elimination of oral infection prior to advanced cardiac interventions does not increase the risk of morbidity or mortality," Mincer and colleagues concluded.

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