Should You Have a Dental Extraction Before a Cardiac Surgery?

An interesting article titled “Morbidity and Mortality Associated With Dental Extraction Before Cardiac Operation,” appears in the March 2014, journal The Annals of Thoracic Surgery (vol. 97, issue 3, pp. 838-844). The article is conducted by researchers from Mayo Clinic. They found that people who had planned dental extraction before cardiac operation are at risk for major adverse outcomes, which included a 3% risk of death before cardiac operation and included an 8% risk of a major adverse outcome including stroke or kidney failure.

In many cases problem teeth are extracted before surgery with the thought being that they will reduce the risk of an infection occurring such as endocarditis which is an infection of the inner lining of the heart. Prosthetic heart valve-related endocarditis results in about 25% of infective endocarditis cases and is fatal in up to 38% of patients who develop it. Medical guidelines demonstrate a lack of conclusive evidence for removing disease teeth before surgery as a preventative measure.

Researchers set out to determine if removing infected teeth before surgery really is the safer intervention then leaving them in. Patients in this category represent a complex patient group as many of the patients who have dental surgery right before heart surgery are not well.

The researchers studied 205 adult patients who had teeth extracted before cardiovascular surgery. The study was from January 1, 2003, through February 28, 2013. A total of 80% of the patients included were men with a median age at the time of tooth removal of 62 and the median time between dental extraction and heart surgery was 7 days.

From the study, the researchers determined the following: a total of six patients died between the tooth extraction and planned cardiac procedure and another six patients died after the heart surgery. The study also found that 10 patients had major adverse outcomes after heart surgery such as stroke and kidney failure. Further, at least 14 patients had unexpected complications from teeth removal and had to have their heart surgery delayed.

The researchers believe additional information is needed to better determine why patients died or had major adverse outcomes. Further, it is important to note that every patient is different and some had more serious heart disease or other health problems. The researchers believe that for patients who need heart surgery and have a tooth infection, each patient should be evaluated individually so that the possible benefit of tooth extraction before heart surgery is weighed against the risk of death or major adverse events.

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