February 27th, 2014

Tooth Extraction Prior to Cardiac Surgery May Not Be a Good Idea

People with an infected or abscessed tooth are at elevated risk for cardiovascular disease. They are at particular risk for developing a serious infection during surgery, including endocarditis. Because of this risk, in order to reduce the risk of infection many patients undergo dental extraction prior to having a planned cardiac surgery. Now, however, a new paper published in The Annals of Thoracic Surgery raises the possibility that prophylactic dental extraction may be far more risky than previously thought.

Physicians from the Mayo Clinic retrospectively reviewed data from 205 patients who underwent dental extraction prior to a planned cardiac operation. They found a higher than expected (8%) rate of adverse outcomes, defined as death, acute coronary syndrome, stroke, renal failure requiring dialysis, and postoperative mechanical ventilation. A total of 3% of the subjects died after the dental extraction and before the cardiac surgery.

It seems possible, they wrote, that “preoperative dental surgical procedures may increase risk in these patients.” But they were “unable to conclude the adverse outcomes were due to dental extraction. However, the cumulative insults endured by these patients during dental extraction (additional anesthetic and surgical stresses), along with delay in definitive cardiovascular operation, may have contributed to the outcome.”

“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%,” said the first author, Mark Smith, in a press release. “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.”

The paper represents “a significant departure from current thinking,” writes Michael Jonathan Unsworth-White  in an invited commentary. It “raises the question whether we should in fact get on with our cardiac operations and deal with the dental work at some other time, if at all, or risk killing our patients with good intent!”


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