Pulling Teeth Before Heart Surgery May Pose Severe Risks

Teeth extraction before heart surgery increased risk of death and heart failure

(RxWiki News) Before going through heart surgery, patients often have infected teeth pulled to avoid infection after surgery. However, this preventive measure may actually be causing more problems than preventing them.

A recent study found that patients who had an infected tooth pulled before undergoing heart surgery were at increased risk for major adverse outcomes, including death, stroke and heart attack, compared to patients who did not get teeth pulled prior to heart surgery.

The researchers recommended that health professionals should consider each individual patient's risks and benefits of tooth extraction before heart surgery.

"Discuss the risks of having teeth pulled before heart surgery with your doctor."

This study was conducted by Kendra J. Grim, MD, from the Department of Anesthesiology at the Mayo Clinic College of Medicine in Rochester, Minnesota, and colleagues.

Extraction of abscessed or infected teeth is often done with the intention of decreasing the risk of infection during surgery, as well as decreasing the risk of endocarditis (an inflammation of the inner layer of the heart) following surgery.

The study included 205 people who had abscessed or infected teeth pulled before a planned heart surgery at the Mayo Clinic between January 1, 2013 and February 28, 2013.

All of the participants were 18 years old and older when they had their teeth pulled, 80 percent were male, and the average age was 62 years old.

The researchers looked for any cases of death, bleeding, acute coronary syndrome (the heart's blood supply is blocked), stroke, transient ischemic attack (blood supply to the brain is temporarily blocked) and kidney failure within 30 days of dental extraction.

Heart surgery patients often have any infected teeth pulled before their operation in order to prevent endocarditits — the inflammation of the inside lining of the heart chambers and heart valves.

In this study, the average time between getting teeth pulled and heart surgery was 35 days.

The findings showed that 16 of the participants experienced negative outcomes within 30 days of getting their teeth pulled, but before the heart surgery.

Six of these participants died between getting their teeth pulled and heart surgery, four participants developed acute coronary syndrome and four participants had a stroke.

The researchers determined that patients with a planned tooth extraction before heart surgery had an 8 percent total risk for a major adverse outcome, and a 3 percent total risk of death.

“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,” said study co-author Mark M. Smith, MD, in a press statement. “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.”

Dr. Grim and team mentioned a few limitations of their study. First, there was no control group to use for comparison. Second, the researchers used past data, so they did not know about any specific, undocumneted decisions made at the time of surgery and potential missing information in a patient's chart.

Furthermore, data on complications after being discharged from the hospital were not available. Lastly, the researchers could not definitively link deaths to complications from the tooth extractions or from the heart surgery.

This study was published on February 27 in The Annals of Thoracic Surgery.

Review Date: 
February 27, 2014