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

ho had teeth pulled before cardiovascular surgery. The study covered January 1, 2003, through Feb. 28, 2013; 80 percent of the patients were men, the median age at the time of tooth extraction was 62, and the median time lapse between dental extraction and heart surgery was seven days. The research found:

Six patients, or 3 percent, died in the period between their tooth extraction and the planned cardiac procedure.

Another six died after heart surgery, all while still hospitalized.

Ten patients, or roughly 5 percent, had other major adverse outcomes after heart surgery, such as bleeding, stroke, kidney failure requiring dialysis, acute coronary syndrome or stroke-like transient ischemic attacks.

Due to unexpected complications or findings from dental surgery, at least 14 patients, or 7 percent, had to have heart surgery delayed.

More information is needed to understand why patients died or had other major adverse outcomes, the researchers say. In addition to the stress placed on the body by dental extraction and heart surgery themselves, potential factors include the severity of individual patients' heart disease, other serious health problems they may have had, and how they reacted to anesthesia.

The bottom line for patients and physicians, the researchers conclude: Rather than following a rule of thumb, physicians should evaluate each patient individually to weigh the possible benefit of tooth extraction before heart surgery against the risk of death and other major adverse events.

"We hope this study sparks future discussion and research," Dr. Grim says. "In the meantime, we recommend an individualized approach for these patients, to weigh their particular risk and benefit of a dental procedure before cardiac surgery with the information we have currently available."


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Contact: Sharon Theimer
newsbureau@mayo.edu
507-284-5005
Mayo Clinic
Source:Eurekalert

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