Invasive Dental Treatment and Risk for Vascular Events
Authors: Sok-Ja Janket, Kamal Jethwani, Jukka H. Meurman
Journal: Annals of Internal Medicine (2011)

Letters15 March 2011Invasive Dental Treatment and Risk for Vascular EventsSok-Ja Janket, DMD, MPH, Kamal Jethwani, MD, MPH, and Jukka H. Meurman, MD, PhD, DDSSok-Ja Janket, DMD, MPHFrom Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118; Massachusetts General Hospital, Boston, MA 02114; and Helsinki University Central Hospital, FIN-00290 Helsinki, Finland.Search for more papers by this author, Kamal Jethwani, MD, MPHFrom Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118; Massachusetts General Hospital, Boston, MA 02114; and Helsinki University Central Hospital, FIN-00290 Helsinki, Finland.Search for more papers by this author, and Jukka H. Meurman, MD, PhD, DDSFrom Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118; Massachusetts General Hospital, Boston, MA 02114; and Helsinki University Central Hospital, FIN-00290 Helsinki, Finland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-6-201103150-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Minassian and colleagues' article (1) with great interest. The authors' use of a self-controlled case series (SCCS) to prove a causal relationship and their oversight of some important intraperson confounding factors have forced us to challenge their conclusion.Self-controlled case series can involve intraperson biases, as Minassian and colleagues' study (1) demonstrated. In addition, case series are useful only for generating hypotheses, not for demonstrating causal relationships (2). Several time-varying intraperson confounding factors that Minassian and colleagues ignored include acute upper respiratory infections that were reported to increase cardiovascular risk (3); illicit drug use that ...References1. Minassian C, D'Aiuto F, Hingorani AD, Smeeth L. Invasive dental treatment and risk for vascular events: a self-controlled case series. Ann Intern Med. 2010;153:499-506. [PMID: 20956706] LinkGoogle Scholar2. Hennekens CH, Buring JE. Epidemiology in Medicine. Hagerstown, MD: Lippincott Williams & Wilkins; 1987. Google Scholar3. Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, et al; American Heart Association. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2006;113:873-923. [PMID: 16785347] MedlineGoogle Scholar4. Sclarovsky S, Nikus KC. The role of oestrogen in the pathophysiologic process of the Tako-Tsubo cardiomyopathy [Letter]. Eur Heart J. 2010;31:377. [PMID: 19965866] CrossrefMedlineGoogle Scholar5. Janket SJ, Qvarnström M, Meurman JH, Baird AE, Nuutinen P, Jones JA. Asymptotic dental score and prevalent coronary heart disease. Circulation. 2004;109:1095-100. [PMID: 14967717] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Sok-Ja Janket, DMD, MPH; Kamal Jethwani, MD, MPH; Jukka H. Meurman, MD, PhD, DDSAffiliations: From Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118; Massachusetts General Hospital, Boston, MA 02114; and Helsinki University Central Hospital, FIN-00290 Helsinki, Finland.Disclosures: Dr. Janket is supported by grant 0635351N from the American Heart Association. Dr. Meurman is supported by grants from the Helsinki University Central Hospital and the Medical Society of Finland. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoInvasive Dental Treatment and Risk for Vascular Events Caroline Minassian , Francesco D'Aiuto , Aroon D. Hingorani , and Liam Smeeth Invasive Dental Treatment and Risk for Vascular Events Joseph D. Matthews Invasive Dental Treatment and Risk for Vascular Events Caroline Minassian , Liam Smeeth , Francesco D'Aiuto , and Aroon D. Hingorani Metrics 15 March 2011Volume 154, Issue 6Page: 441KeywordsArrhythmiaCase seriesFearHeartInfectious diseasesMenopauseRisk managementStable coronary artery diseaseThrombosisUpper respiratory tract infections ePublished: 15 March 2011 Issue Published: 15 March 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...