Prevalence of periodontitis and optimal timing of dental treatment in patients undergoing heart valve surgery

Abstract

We investigated the prevalence, risk factors, and optimal timing of treatment for advanced periodontitis in patients undergoing elective heart valve surgery. Dental examinations were given to 209 patients (aged 65 ± 10 years) scheduled for valve surgery. Patients with no or mild periodontitis were assigned as controls (n = 105). Patients with advanced periodontitis underwent tooth extraction and curettage (n = 104), 68 of whom underwent tooth extraction within two weeks (short wait) and 36 of whom underwent extraction longer than two weeks, before surgery. The three groups (control, short, and long wait) were similar in age, gender, diseased valve, and type of surgery received. The average number of teeth extracted was 2.3 ± 2.3. In both univariate and multivariate analysis, risk factors for advanced periodontitis were history of smoking and heart failure. No complications arose from the extractions. Length of postoperative hospital stay, intrafebrile days, white blood cell count and serum C-reactive protein (assessed at postoperative days 1, 3 and 7) were similar among the three groups. During the mean follow-up period of 60 ± 16 months, no patient developed prosthetic valve endocarditis, and there were no postoperative deaths. In conclusion, we found no evidence that receipt and timing of dental treatment affected surgical success rates and postoperative course.

Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis?

“…The complications observed in our sample were related to post-extraction hemorrhage due to continuous anticoagulation use in patients with mechanical valve prostheses. Our data were similar to previous studies that showed a low complication rate in pre-CVS patients when extractions were performed concomitant with or before CVS [14], [24]. Conversely, one study showed a high mortality rate in pre-CVS patients who underwent dental extraction [23].…”

“…Previous data from the literature, published in the United States [11], Japan [14] and Germany [12], have indicated the benefits of dental treatment before surgical valve approaches in reducing the risk of IE. In contrast, other studies conducted in the United States [23], Sweden [25] and Spain [29] did not obtain favorable results.…”

“…IE is a severe disease that affects the surface of the endocardium [5], [6], [7], occurring more frequently in the vicinity of acquired or congenital heart defects [8], [9], [10]. The pathogenesis of IE has been associated with the occurrence of bacteremia, the source of which can include periodontal infection sites [11], [12], [13], [14], [15], [16], dental and/or oral tissues manipulation [4], [8], [17], [18], [19] and even daily lifestyle habits ( e.g. , brushing and flossing) [8], [20], [21].…”

“…Surmounting evidence has indicated that dental treatment in patients at risk of developing IE could be beneficial because the elimination and/or control of acute or chronic oral infections can reduce the source of microorganisms and consequently the likelihood of bacteremia [8], [11], [12], [14]. However, the costs and benefits of dental intervention prior to cardiac valve surgery (CVS) have not been well defined.…”

Risk Factors of Periodontal Disease: Review of the Literature

“…Bacteremia from periodontitis and dental disease is known to be the primary cause of infective endocarditis [52]. In particular, patients who have undergone heart valve surgery have a significant risk of life-threatening infective endocarditis.…”