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Invasive dental treatments may be associated with an increase in the risk for vascular events, researchers reported.
To investigate whether invasive dental treatment transiently increases the risk for vascular events, researchers conducted a self-controlled case series of 9.9 million people in a Medicaid claims database. Included in the study were patients who had a first hospitalization for ischemic stroke or myocardial infarction at least 24 weeks after their enrollment period began.
Researchers tracked all persons exposed to invasive dental treatment, defined as those that could result in bacteremia and induce an inflammatory response, including periodontal therapy or tooth extractions, who also had a discharge diagnosis of ischemic stroke or myocardial infarction from 2002 to 2006. The incidence of ischemic stroke and myocardial infarction in periods immediately after invasive dental treatment was compared with the incidence in all other observed time periods. Results appeared in the Annals of Internal Medicine.
The study identified 1,152 vascular events. The rate of myocardial infarction (n=525) was higher in the first 4 weeks after an invasive dental treatment compared with baseline (incidence ratio, 1.56 [95% CI, 0.98 to 2.47]) and decreased over 24 weeks. For ischemic stroke (n=650), a slightly elevated risk was seen during the first four weeks after an invasive dental treatment (incidence ratio, 1.39 [95% CI, 0.89 to 2.15]), although this was less marked and the pattern wasn't as clear. No events occurred on the same day as an invasive dental procedure and the incidence rates decreased to the baseline rate within six months.
The positive association remained after exclusion of persons with diabetes, hypertension, or coronary artery disease or persons with prescriptions for antiplatelet or salicylate drugs before treatment.
The authors concluded, “… invasive dental treatment may be associated with a transient increase in the risk for stroke and myocardial infarction in adults. The short-lived adverse effects are nevertheless likely to be outweighed by long-term benefits of invasive dental treatment to vascular health.”
An accompanying editorial raised the point that patients undergoing dental surgery often discontinue aspirin before their procedures, a potential trigger for a subsequent coronary event. The editorialists advised against routinely discontinuing aspirin before invasive dental procedures.