It has always been standard practice to remove abscessed or infected teeth before heart surgery to lower the risk of infection during the surgery as well as the risk of inflammation of the inner layer of the heart, or endocarditis, after surgery. However, the evidence for this practice is quite limited and a new study published in The Annals of Thoracic Surgery investigated possible adverse effects from having infected teeth removed prior to heart 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 1%,” according to Dr. Mark M. Smith, study author and anesthesiologist from the Mayo Clinic in Rochester, MN. “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.”
New Data on Dental Extractions
Dr. Smith and his team of researchers discovered that 8 percent of patients who have had dental extractions before heart surgery have had adverse outcomes such as heart attacks, stroke, kidney failure, and even death. A total of 3 percent of patients died after having their teeth extracted but before their heart surgery.
Dr. Joseph A. Dearani, cardiac surgeon and co-author of the study, explains the limitations of this study, “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.”
Change in Current Thinking
The current thinking within the dental industry is changing in regard to the practice of dental extractions prior to heart surgery and the results of this study contribute to this change in philosophy.
“Accepted wisdom leads surgeons to request dental reviews prior to cardiac surgery in many thousands of patients annually around the world,” according to Dr. Michael Jonathan Unsworth-White of Derriford Hospital Plymouth, UK. “Dr. Smith’s group asks us to question this philosophy. It is a significant departure from current thinking.”
Dr. Unsworth-White also relates this study to another change in established thinking regarding the prescription of prophylactic antibiotics to patients with heart problems having dental work done. This has been standard practice because of the link between dental bacteremia and endocarditis but newer studies suggest that the possible side effects of prophylactic antibiotics could exceed the benefits.
“Regular tooth brushing, flossing, and even chewing gum are now recognized to dislodge as much, if not more, bacteremia than most dental procedures,” says Dr. Unsworth-White. Regular tooth care as well as visiting your dentist every six months will ensure a healthy mouth both before and after any surgery.