Dental surgery patients had an increased risk of heart attack or stroke for a few weeks after the procedure, according to British researchers who published a report in the peer-reviewed journal Annals of Internal Medicine. Six months later, the higher risk is no longer there. Periodontal disease treatment, according to the scientists, may reduce cardiovascular risk in the long run. However, no research has previously looked into the link between dental procedures and acute inflammation in the short term.
Inflammation, the researchers believe, is the link, with germs leaking into the bloodstream from a dental infection (periodontal infection). Bacteria may accumulate in blood arteries, causing inflammation — this sort of inflammation raises the risk of stroke or heart attack.
Caroline Minassian, MSc, of the London School of Hygiene and Tropical Medicine, who led the study, said the findings add to the growing body of evidence associating acute inflammation to cardiovascular events (e.g. heart attack or stroke).
The researchers emphasise that the long-term advantages of dental treatment outweigh the risk of transient side effects.
They used data from the Medicaid claims database in the United States, which included 32,060 persons who had suffered a stroke or heart attack. They next looked into their medical histories to see how many of them had had extensive dental surgery. After dental surgery, 525 people had a heart attack and 650 people had a stroke. They took into account factors like hypertension (high blood pressure), diabetes, coronary artery disease, and patients who had prescriptions for antiplatelet or salicylate medicines before treatment, all of which might increase stroke and heart attack risk on their own or in combination.
The researchers discovered that during the month following their dental work, there was a considerably higher risk of heart attack or stroke (incidence ratio 1.50; 95 percent CI 1.09-2.06). A third of the vascular incidents occurred in patients under the age of fifty. After around six months, the risk was shown to gradually diminish to baseline (normal).
The London School of Hygiene and Tropical Medicine’s Dr Liam Smeeth said:
Many people who are only moderately at risk most of the time will have periods of very high risk as a result of surgery owing to inflammatory or viral triggers, and those people may benefit from short periods of prophylactic (preventive) therapy that they don’t need most of the time.
Finally, the writers stated:
A transitory increase in the risk of vascular events may be linked to invasive dental treatment. However, the absolute risks are low, and the long-term advantages to vascular health are likely to outweigh any short-term negative effects.
Editorial Supplement
The association between inflammatory markers and atherosclerosis, according to Dr. Howard Weitz and Dr. Geno Merli of Jefferson University in Philadelphia, is still tenuous. They go on to say that Minassian et al. lacked sufficient data to link vascular event risk to inflammation.
According to Weitz and Merli, the study contains a significant flaw: the Medicaid data did not include information on patients’ aspirin therapy or cessation prior to dental surgery. The discontinuation of aspirin has been linked to an increased risk of cardiovascular events. A small percentage of individuals (15%) discontinue taking aspirin before dental surgery and then have a heart attack or stroke.
A cardiovascular event, such as a heart attack, is a collection of outcomes involving blood vessels and/or the heart.
A vascular event is a collection of events involving blood vessels, such as a stroke (formerly known as a cerebrovascular accident).
