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Pulling problem teeth before heart surgery to prevent infection may be catch-22
Date:2/26/2014

Rochester, Minn. Feb. 27, 2014 To pull or not to pull? That is a common question when patients have the potentially dangerous combination of abscessed or infected teeth and the need for heart surgery. In such cases, problem teeth often are removed before surgery, to reduce the risk of infections including endocarditis, an infection of the inner lining of the heart that can prove deadly. But Mayo Clinic research suggests it may not be as simple as pulling teeth: The study found that roughly 1 in 10 heart surgery patients who had troublesome teeth extracted before surgery died or had adverse outcomes such as a stroke or kidney failure.

The findings are published in The Annals of Thoracic Surgery.

Prosthetic heart valve-related endocarditis accounts for up to one-fourth of infective endocarditis cases and proves fatal for up to 38 percent of patients who develop it. In light of that high mortality rate, physicians try to address risk factors such as poor dental health before cardiac surgery. Removing diseased teeth at some point before surgery as a preventive measure is common, but research on whether that helps has been limited. Medical guidelines acknowledge a lack of conclusive evidence, the Mayo researchers noted.

The new study shows that the risk for patients who do have teeth removed before heart surgery "may be higher than we thought," says senior author Kendra Grim, M.D., a Mayo Clinic anesthesiologist.

"We are always concerned with improving safety, and pulling infected teeth before heart surgery seemed to be the safer intervention. But we became interested in studying this complex patient group, as many patients that come to the operating room for dental surgery just before heart surgery are quite ill," Dr. Grim says.

The study is believed to be the largest so far evaluating adverse outcomes after pre-cardiac surgery dental extractions. The researchers studied outcomes in 205 adult Mayo patients w
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Contact: Sharon Theimer
newsbureau@mayo.edu
507-284-5005
Mayo Clinic
Source:Eurekalert

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