• Tooth extraction prior to heart surgery carries many risks

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    DR. JOSEPH D. LIM

    DR. JOSEPH D. LIM

    Are you undergoing heart surgery soon? If so, it’s best not to have your bad tooth removed. A study published in The Annals of Thoracic Surgery showed that the routine practice of removing an infected tooth prior to cardiac surgery carries a lot of risks, including death prior to surgery itself.

    This news will probably shock many dentists and change the way they look at patients with heart disease. However, the authors of the study said that further research is needed before they can make any recommendations.

    “Dental extraction of abscessed or infected teeth is often performed to decrease the risk of infection during surgery and endocarditis (an inflammation of the inner layer of the heart) following surgery,” according to a report in Science Daily.

    However, this is one good example where the end doesn’t justify the means. After studying 205 patients who underwent at least one dental extraction before undergoing heart surgery, cardiac surgeon Dr. Joseph A. Dearani and his colleagues from the Mayo Clinic in Rochester, Minnesota, found that many patients suffered from adverse effects.

    “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 percent. 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,” according to anesthesiologist Dr. Mark M. Smith.

    The authors found an 8 percent incidence of major adverse reactions, including heart attack, stroke, kidney failure, and death. Three percent of patients died following tooth extraction and before the planned surgery could be performed. However, the authors of the study admit that their review was limited and more research is needed to confirm this.

    “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,” said Dearani.

    Commenting on the study, Dr. Michael Jonathan Unsworth-White, a fellow of the Royal College of Srugeons from Derriford Hospital in Plymouth, United Kingdom, said his colleagues should seriously consider the repercussions of the new study.

    “Accepted ‘wisdom’ leads surgeons to request dental reviews prior to cardiac surgery in many thousands of patients annually around the world. Dr. Smith’s group asks us to question this philosophy. It is a significant departure from current thinking,” he concluded.

    Dr. Joseph D. Lim is the dean of the National University College of Dentistry, president & CEO of Dr. Smile Dental Care & Laser Center and honorary fellow of the Asian Oral Implant Academy and the Japan College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.

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