Should Dental Extractions Be Done Prior to Heart Surgery?

Dr. Kendra J. Grim Department of Anesthesiology Mayo Clinic, Rochester, MN Interview with:
Dr. Kendra J. Grim
Department of Anesthesiology
Mayo Clinic, Rochester, MN 55905
: What are the main findings of the study?

Dr. Grim: “The current guidelines say that if possible, treating the dental problems that patients have before heart surgery is best, to try to prevent both early and late heart infections. But the data is very unclear, because it’s very difficult to study. We found in our study that their risk of serious complications after having teeth removed may be higher than we thought. We were primarily looking at stroke, heart attack, renal failure and death. We found that actually the incidence of having one of those major morbidities was 8 percent.  Of that 8 percent, we had six patients, or 3 percent, of the total group who died between their dental surgery and scheduled heart surgery, so these patients never made it to their heart surgery. An additional 3 percent of patients died after heart surgery. “ Were any of the findings unexpected?

Dr. Grim: “Yes. The risk of having a serious complication after tooth extraction before heart surgery was higher than we expected, at 8%.  Current ACC/AHA guidelines that rate dental extraction a low-risk procedure (<1% risk of major complication or death) may not apply to this patient population.”

Dr. Grim:  “Our take-home message is that discussion among the specialists – the cardiologist, cardiac surgery, the oral surgeon and the anesthesiologist –  would be in the best interest of the patient, to try to ascertain the risk for this particular patient. If we think the risk from taking the teeth out is low, but the benefit is perceived to be high, then we would proceed with the tooth extraction. But if we think the risk of having the teeth extracted before heart surgery is too high, then we would consider not proceeding with the tooth extraction. We really feel that it’s important, because the data is unclear, that rather than following a general rule of thumb, physicians assess each patient’s individual risk. What recommendations do you have for future research as a result of this study?

Dr. Grim:  “Our hope is that this will spark further conversation that will lead to further research. It’s difficult to study, because the incidence of the infection in the new artificial heart valve is very low. Infection rates have not been studied in patients for bypass grafts, for the ventricular assist devices, total artificial hearts, and there has been minimal research in heart transplantation. So there are a lot of additional avenues open for research in this area to better understand the risk/benefit.”


Morbidity and Mortality Associated With Dental Extraction Before Cardiac Operation

Mark M. Smith, David W. Barbara, William J. Mauermann, Christopher F. Viozzi, et al

The Annals of Thoracic Surgery Vol. 97, Issue 3, Pages 838-844

Last Updated on March 19, 2014 by Marie Benz MD FAAD