Invasive Dental Treatment and Risk for Vascular Events: Have We Bitten Off More Than We Can Chew?
Authors: Howard Weitz, Geno Merli
Journal: Annals of Internal Medicine (2010)

Editorials19 October 2010Invasive Dental Treatment and Risk for Vascular Events: Have We Bitten Off More Than We Can Chew?Howard Weitz, MD and Geno Merli, MDHoward Weitz, MDFrom Jefferson Heart Institute, Thomas Jefferson University, Philadelphia, PA 19107, and Jefferson Vascular Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107.Search for more papers by this author and Geno Merli, MDFrom Jefferson Heart Institute, Thomas Jefferson University, Philadelphia, PA 19107, and Jefferson Vascular Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-8-201010190-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Our understanding of perioperative cardiac risk has unfolded slowly. Nearly 8 decades ago, White (1) described risk factors for cardiac complications of surgery. Seven years later, Master and colleagues (2) summarized their experience with general surgery patients who had fatal postoperative myocardial infarctions and speculated that infarction was the result of either spontaneous perioperative coronary thrombosis or intraplaque hemorrhage. They also proposed that “liberation of substances affecting the composition of the blood or acting directly on the arterial wall” as well as infection may have contributed to postoperative myocardial events (2).It took another 40 years until perioperative risk assessment ...References1. White PD. Heart Disease. 1st ed. New York: Macmillan; 1931. Google Scholar2. Master AM, Dack S, Jaffe HL. Postoperative coronary artery occlusion. JAMA. 1938;110:1415-8. CrossrefGoogle Scholar3. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845-50. [PMID: 904659] CrossrefMedlineGoogle Scholar4. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-9. [PMID: 10477528] CrossrefMedlineGoogle Scholar5. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50:1707-32. [PMID: 17950159] MedlineGoogle Scholar6. Minassian C, D'Aiuto F, Hingoriani AD, Smeeth L. Invasive dental treatment and risk for vascular events. A self-controlled case series. Ann Intern Med. 2010;153:499-506. LinkGoogle Scholar7. Ray WA, Griffin MR. Use of Medicaid data for pharmacoepidemiology. Am J Epidemiol. 1989;129:837-49. [PMID: 2646920] CrossrefMedlineGoogle Scholar8. Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54:2129-38. [PMID: 19942084] CrossrefMedlineGoogle Scholar9. Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. J Gen Intern Med. 2008;23:2079-86. [PMID: 18807098] CrossrefMedlineGoogle Scholar10. Helfand M, Buckley DI, Freeman M, Fu R, Rogers K, Fleming C, et al. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:496-507. [PMID: 19805772] LinkGoogle Scholar11. Joshipura K, Zevallos JC, Ritchie CS. Strength of evidence relating periodontal disease and atherosclerotic disease. Compend Contin Educ Dent. 2009;30:430-9. [PMID: 19757736] MedlineGoogle Scholar12. Persson GR, Persson RE. Cardiovascular disease and periodontitis: an update on the associations and risk. J Clin Periodontol. 2008;35:362-79. [PMID: 18724863] CrossrefMedlineGoogle Scholar13. Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007;356:911-20. CrossrefMedlineGoogle Scholar14. Ferrari E, Benhamou M, Cerboni P, Marcel B. Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol. 2005;45:456-9. [PMID: 15680728] CrossrefMedlineGoogle Scholar15. Burger W, Chemnitius JM, Kneissl GD, Rücker G. Low-dose aspirin for secondary cardiovascular prevention—cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation—review and meta-analysis. J Intern Med. 2005;257:399-414. CrossrefMedlineGoogle Scholar16. Ardekian L, Gaspar R, Peled M, Brener B, Laufer D. Does low-dose aspirin therapy complicate oral surgical procedures? J Am Dent Assoc. 2000;131:331-5. [PMID: 10715924] CrossrefMedlineGoogle Scholar17. Brennan MT, Wynn RL, Miller CS. Aspirin and bleeding in dentistry: an update and recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:316-23. [PMID: 17618144] CrossrefMedlineGoogle Scholar18. Murphy J, Twohig E, McWilliams SR. Dentists' approach to patients on anti-platelet agents and warfarin: a survey of practice. J Ir Dent Assoc. 2010;56:28-31. [PMID: 20337143] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Howard Weitz, MD; Geno Merli, MDAffiliations: From Jefferson Heart Institute, Thomas Jefferson University, Philadelphia, PA 19107, and Jefferson Vascular Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2000.Corresponding Author: Howard Weitz, MD, Jefferson Heart Institute, 925 Chestnut Street, Suite 200, Philadelphia, PA 19107; e-mail, howard.[email protected]edu.Current Author Addresses: Dr. Weitz: Jefferson Heart Institute, 925 Chestnut Street, Suite 200, Philadelphia, PA 19107.Dr. Merli: Thomas Jefferson University Hospital, Suite 2210 Gibbon, 111 South 11th Street, Philadelphia, PA 19107. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoInvasive Dental Treatment and Risk for Vascular Events Caroline Minassian , Francesco D'Aiuto , Aroon D. Hingorani , and Liam Smeeth Metrics Cited byRisk of Myocardial Infarction and Ischemic Stroke after Dental TreatmentsEvaluation of cardiac risk in dental patientsDental procedures and risk of experiencing a second vascular event in a Medicare populationUnderstanding Systemic Inflammation, Oral Hygiene, and Cardiovascular Disease 19 October 2010Volume 153, Issue 8Page: 542-543KeywordsAcute coronary syndromeAspirinCardiac surgeryCardiovascular therapyInflammationMedical risk factorsMyocardial infarctionPeriodontal diseasesPopulation statisticsSurgery ePublished: 19 October 2010 Issue Published: 19 October 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...