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Are dental procedures safe after a stroke or heart attack?

Robin Wulffson MD's picture
stroke, heart attack, dental care, cardiovascular event, bacteremia

Patients who suffer a cardiovascular event such as a heart attack or stroke are generally older individuals who also may be in need of dental care. Historically, stroke or heart patients have been cautioned to postpone dental procedures after a cardiovascular event; researchers affiliated with the University of Minneapolis conducted a study to evaluate whether postponement of needed dental procedures was necessary in this situation. They published their findings in the November edition of the Journal of the American Dental Association.

Dental procedures, particularly more invasive ones, can result in bacteremia: the release of oral cavity bacteria in to the bloodstream. The American College of Cardiology/American Heart Association guidelines on preoperative care assign risk for invasive surgical procedures.

The guidelines do not specifically mention dental procedures; however, most clinicians have assumed that dental procedures can be treated in the same way as other outpatient procedures and considered them to carry a low risk for complications. However, many authorities have advised postponing non-emergent elective dental care in patients who have recently had vascular events. Some have recommended postponing the procedures for only a few weeks; however, others recommend waiting six months.

The goal of the study was to determine whether dental procedures increased a patients’ risk of experiencing a second vascular event if performed within six months of the event. The researchers reviewed data on 50,329 seniors who were participants in the Medicare Current Beneficiary Survey to identify those who had had a vascular event and a second event while in the survey. A total of 2,035 patients suffered a vascular event and 445 suffered a second event. The evaluated the associations between dental procedures performed within 30, 60, 90, or 180 days after a first event and the risk of experiencing a second vascular event.

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The researchers found that both dental procedures of any kind, and invasive procedures considered separately were not associated with a patients’ risk of experiencing second vascular events across all periods examined. They determined hazard ratios, which measure increased risk, and found that most hazard ratios associated with dental procedures were less than 1.0, although none differed significantly from 1.0.

The authors concluded that community-dwelling Medicare beneficiaries who underwent dental procedures within 30 to 180 days after an ischemic vascular event, including those that produce a bacteremia consistently, were not at an increased risk of experiencing a second event. They noted that their results suggested that clinicians should reassess historical recommendations that dental care in this population be postponed for as long as six months after an ischemic vascular event.

Take home message:
This study is reassuring for individuals who have suffered a cardiovascular event and are in need of a dental procedure. However, more invasive procedures, which are more likely to cause bacteremia, should be assessed in regard to their urgency. It may be prudent to postpone the less urgent and more invasive procedures for up to six months.

Reference: Journal of the American Dental Association

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