The perioperative dental screening and management of patients undergoing cardiothoracic, vascular surgery and other cardiovascular invasive procedures: A systematic review

Abstract

Background One controversial issue in the relationship between oral care and cardiovascular diseases is how and whether to manage oral infections prior to cardiovascular surgery or other cardiovascular invasive procedures. Design We designed a systematic review to assess the information available on three main questions. Is there an agreement on the need for dental evaluation and treatment before cardiovascular interventions? Are consistent clinical recommendations or protocols available? Is dental treatment prior to cardiovascular interventions effective? Methods A systematic electronic search of MEDLINE, Scopus and Web of Science was performed from the database inceptions up to 31 April 2016. Searches were performed using Boolean operators to combine medical subject headings and free text words. Because this review included a large, heterogeneous group of study designs and sources, the results were synthesised in a narrative approach. Results In total, 2447 studies were identified: 2099 (+241 duplicates) were excluded after screening; 107 were included for full-text assessment; 55 were excluded for not meeting the inclusion criteria; and 11 were not available. Thus, 44 studies meeting the inclusion criteria were analysed. We found that, for patients undergoing cardiovascular surgery, there is a general agreement on the need for screening and treatment of dental infections, but not on the protocols. We also found that there are conflicting indications on when and to what extent to perform the treatment and that the risk-to-benefit ratios for these treatments are controversial. Conclusion No satisfactory answers regarding dental care before cardiovascular invasive procedures are available.

Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: A nationwide population-based cohort study

“…25 A systematic review suggested that there is a general consensus for preventive screening and treatment for dental infections in the patients undergoing cardiothoracic and cardiovascular intervention. 28 Previously, one study has proposed that periodontitis is an independent factor of arrhythmic events in patients with AF and AF highly occurs in patients with severe periodontitis. 29 Considering HF, performing tooth scaling is associated with decreased risk of myocardial infarction.…”

Surgical treatment of heart valve disease: Considerations for the dental management

“…On the other hand, one study reported a higher incidence of IE in treated patients compared to patients who did not receive dental treatment prior to heart valve surgery 29 . Meta‐analysis studies have shown that there are no differences in all‐cause mortality in patients who did and did not receive dental treatment before surgery 30,31 . Dental infection should not be neglected prior to heart surgery, and the extent of dental treatment should be tailored to the patient's clinical status and performed by a dental/medical team.…”

Bacteriological examination of stomach mucosa and periodontal pocket in patients with gastric cancer: A study protocol

“…In recent studies, the multidisciplinary approach has attracted attention for reducing the rate of postoperative complications after gastrointestinal surgery, including via patient nutrition management, chemical bowel preparation and early-phase rehabilitation [1][2][3] . To this end, some studies have shown the effectiveness of managing the oral function in order to prevent aspiration pneumonia [4][5][6] , infectious endocarditis [7][8][9] or postoperative complications in head and neck surgery 10) and esophageal surgery 6) . It is easy to understand how these efforts can help reduce aspiration pneumonia or wound infection in cases of head, neck or esophageal surgery; however, the influence of oral management on postoperative infectious complications (POICs) following surgery of the more distal gastrointestinal tract, such as stomach or colorectal surgery, remains unclear.…”