Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

Abstract

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

Effects of Oral Inflammatory Diseases and Oral Hygiene on Atrial Fibrillation: A Systematic Review

“…In a retrospective cohort study [ 13 ] by Chang et al, univariate analysis suggested that PD increased the risk of new-onset atrial fibrillation (HR 1.1, 95% CI 1.02–1.20), but multivariate analysis showed no significant association between PD and atrial fibrillation. Hsu et al [ 15 ] investigated the effect of PD on stroke and found that patients with PD had a significantly increased risk of AF compared with patients without PD (OR 1.39, 95% CI 1.30–1.48), but the study did not adjust for the influence of confounding factors. After adjusting for confounding factors, the incidence of stroke in PD patients was 2.14 times that of non-PD patients.…”

“…One article analyzed the association between dental periapical abscess and atrial fibrillation. Multivariate analysis of retrospective cohort studies [ 15 ] by Hassan et al showed that dental periapical abscess was significantly associated with new-onset atrial fibrillation (HR 1.11, 95% CI 1.01–1.22).…”

“…After excluding the irrelevant literature and other types of literature, such as reviews, comment, guideline, letter, meta-analysis, animal experiment, and case reports, 16 eligible studies were obtained. After in-depth reading of the full text, 8 studies were excluded according to the data evaluation results, and 8 studies were ultimately included [12][13][14][15][16][17][18][19]. Te specifc process is shown in Figure 1.…”

“…Literature. Te eight included articles were observational studies, one of which was a large prospective cohort study [12], fve were large retrospective cohort studies based on a national population [13][14][15][16][17], one was a case-control study [18], and one was a cross-sectional study [19]. A total of 4,328,355 patients were included.…”

Screening of Atrial Fibrillation in Dental Practices: a qualitative feasibility study

“…13,14 These biomarkers are also associated with periodontitis and have been shown to reduce following professional dental cleaning and oral hygiene advice. 15,16 There are a limited number of studies showing an association with oral diseases and AF using hospital data, [17][18][19][20] however, prospective or randomised controlled trials are still lacking. A recent study that monitored patients for 17 years found an increased incidence of AF and stroke with periodontitis, 21 and another study in Hamburg assessed 5,634 participants with AF for severity of periodontitis had found an increased association before adjusting for confounders.…”