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Invasive Dentistry May Raise Short-Term Heart, Stroke Risk
Date:10/19/2010

By Alan Mozes
HealthDay Reporter

MONDAY, Oct. 18 (HealthDay News) -- Invasive dental procedures designed to treat gum inflammation may raise the risk for heart attack and stroke, researchers say.

But the increase appears to be slight and short-term, the study team noted.

"I don't want to downplay this entirely, because we saw a genuine rise in cardiovascular risk in the period just after dental work was done among patients undergoing invasive treatment," said study co-author Liam Smeeth, a professor of clinical epidemiology at the London School of Hygiene and Tropical Medicine in England. "But the overall risk is quite small and endures for only a very brief period."

Smeeth and his colleagues published their findings in the Oct. 19 issue of the Annals of Internal Medicine.

Previous research has linked common and chronic low-grade dental infections to inflammatory processes that elevate the risk for strokes and heart attacks, the authors pointed out.

But whether treatment for those infections raises a similar risk had not been explored, said the authors who set out to study the potential link between the two.

The team analyzed U.S. Medicaid records for nearly 1,200 patients who had undergone invasive dental treatments and had also experienced a stroke or a heart attack between 2002 and 2006.

The patients' median age was 67, and invasive dental procedures were characterized as those with the potential to cause an inflammatory response, such as periodontal therapy and tooth extractions.

Nearly three-quarters of the patients had undergone a single dental procedure, nearly all of them (89 percent) tooth extractions. About one-quarter had had two to four dental treatments, with 57 days, on average, between each procedure.

About 4 percent of the patients died during hospitalization.

Even after taking into consideration a history of diabetes, high blood pressure and/or coronary heart disease, the team observed a significant but slight increase in heart-related events during the month following a dental treatment, primarily because of an apparent short-term rise in heart attack risk. Stroke risk appeared to rise less significantly than heart attack risk.

However, no patient suffered a cardiovascular event on the day of treatment, and the apparent increased risk for heart problems dissipated within six months, the researchers noted.

Such "transient" cardiovascular concerns are generally minimal, do not outweigh the long-term cardiovascular benefits of invasive dental treatment, and should not deter patients from getting the dental care they need, the authors concluded.

In an editorial in the same journal, Dr. Howard Weitz of the Jefferson Heart Institute and Dr. Geno Merli of the Jefferson Vascular Center, both in Philadelphia, noted that it is too early to say that routine dental care should be altered in any way based on the current findings.

For one thing, they said the jury is still out on how clear a connection actually exists between periodontal disease and cardiovascular illness in the first place. And they theorized that much of the observed treatment-related risk might actually stem from a common pre-procedure practice, namely that patients who routinely take aspirin to lower their heart risk stop taking the medication before undergoing dental surgery.

With millions of Americans on an ongoing aspirin regimen, Weitz and Merli said this angle requires further exploration.

Anthony Iacopino a prosthodontist and dean of the University of Manitoba's school of dentistry in Canada, said he was not surprised that dental treatment may entail some cardiovascular risk. But he agreed that the benefits of treatment far exceed the risks.

"Periodontal disease is an infection, and bacteria gets into the bloodstream as a result," he noted. "This happens at a low level at rest, and even more so when a person eats and chews, and perhaps even more so when he or she has dental treatment.

"But there is a very big difference between a temporarily high level of bacterial exposure during one or two treatment sessions and years and years of walking around with untreated periodontal disease," stressed Iacopino. "Clearly, whatever exposure a patient goes through during dental treatment, it's worth it in the long run."

More information

For more on periodontal disease, visit the American Academy of Periodontology.

SOURCE: Liam Smeeth, Ph.D., M.D., professor of clinical epidemiology, department of epidemiology and population health, London School of Hygiene and Tropical Medicine, London; Anthony Iacopino, D.M.D., Ph.D., prosthodontist, and dean, University of Manitoba, school of dentistry, and director, International Center of Oral-Systemic Health, Manitoba, Canada; Oct. 19, 2010, Annals of Internal Medicine


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