WebMD Medical News
Laura J. Martin, MD
Oct. 18, 2010 -- Heart attack and stroke risk may rise in the month following invasive dental treatments such as tooth extractions, a study shows.
The risk returns to normal levels within six months, according to the study published in Annals of Internal Medicine.
This is not the first time oral health and heart health have been linked, and the likely culprit is inflammation. The theory is that bacteria from periodontal infection can enter your bloodstream. Once this occurs, the bacteria accumulate along the blood vessels, causing inflammation, which can make people more vulnerable to heart attacks and stroke.
"These findings provide further evidence to support the link between acute inflammation and the risk for vascular events," conclude the study researchers, who were led by Caroline Minassian, MSc, of the London School of Hygiene and Tropical Medicine. "The short-lived adverse effects are nevertheless likely to be outweighed by long-term benefits of invasive dental work."
Researchers reviewed Medicaid claims data of 32,060 adults who had a heart attack or stroke, and then they backtracked to see if the person had undergone any invasive dental procedures. There were 650 people who had a stroke and 525 who had a heart attack after invasive dental work. The researchers took into account other factors known to increase risk for heart attack and stroke, such as diabetes and high blood pressure.
Those who underwent invasive dental work had an increased risk for heart attack or stroke in the four weeks after their procedure, but this risk was "transient," the researchers report.
More than half of the heart attack and strokes seen in the study occurred in women, and 30% in people who were younger than 50, the study showed.
Howard Weitz, MD, director of the division of cardiology at Jefferson Medical College of Thomas Jefferson University in Philadelphia, says he is concerned that the new study will encourage people to avoid seeing their dentist out of fear of heart attack or stroke.
"Further work has to be done before we can say there is any link," he says. Weitz co-authored an editorial that accompanied the new study.
The study has its share of limitations, he says. For starters, it was based on insurance claims data, so there could have been coding errors which would affect the findings.
"The next evaluation should be one where patient charts are pulled to confirm that the diagnoses were correct," he tells WebMD. What's more, the database only tracked prescription medications, not commonly used over-the-counter drugs.
Many people take low-dose aspirin every day to lower their risk for heart attack and stroke. Stopping aspirin could be a trigger for heart attack or stroke, he says.
"Some dentists tell patients to stop taking aspirin because it increases bleeding risk," he says. "If your dentist suggests this, check with your primary care doctor or cardiologist first."
"Don't make any changes in your dental practice," he says. "We have to go to the next chapter before we can even say this is a real risk."
Don't skip the dentist because you are concerned about your risk for heart attack or stroke, agrees Saul Pressner, a dentist in private practice in New York City. "This study provides more of a reason to see the dentist regularly and take care of your mouth so you are not at as much at risk for coronary events."
Prevention is key. "It is always best not to let infections including gum disease or dental carries get out of hand because there can be systemic effects," he says.
SOURCES:Minassian, C. Annals of Internal Medicine, 2010; vol 153: pp 499-506.Weitz, G. Annals of Internal Medicine 2010; vol 153: pp 542-543.Saul Pressner, dentist, New York City.Howard Weitz, MD, director, cardiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia.
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