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Potter C, Ritson Z, Walton G, Coats L, Irvine T, Ohlsen-Turner K. The heart of it: dental care and cardiothoracic surgery. Br Dent J 2024; 237:33-39. [PMID: 38997368 DOI: 10.1038/s41415-024-7558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 07/14/2024]
Abstract
Both dental and cardiovascular disease are prevalent in the general population, have common risk factors and may be closely associated.Following cardiothoracic surgery, patients may be higher risk for developing infective endocarditis (IE) than the general population. Before cardiothoracic interventions, it is common practice for a dental assessment to be carried out and any necessary dental treatment provided. This aims to reduce the risk of IE arising from dental sources and avoid dental pain or infection during the peri- and post-operative period. There is little guidance on which treatments should be performed and when.Many patients with cardiac disease may have dental treatment provided safely in primary care. However, there is often a need to consider additional factors, including bleeding risk, condition stability or medication interactions. Dental teams must have an awareness of the implications of cardiac disease and provide reasonable adjustments to care provision where necessary, ensuring patient safety.This article proposes a protocol for dental management of patients awaiting cardiothoracic surgery and explores important considerations for dental care in this patient group.
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Affiliation(s)
- Claire Potter
- Community Dental Officer, Newcastle upon Tyne Hospitals NHS Foundation Trust, Community Dental Services, Molineux Street NHS Centre, Byker, Newcastle upon Tyne, NE6 1SG, UK
| | - Zoe Ritson
- Locum Community Dental Officer, Newcastle upon Tyne Hospitals NHS Foundation Trust, Community Dental Services, Molineux Street NHS Centre, Byker, Newcastle upon Tyne, NE6 1SG, UK.
| | - Graham Walton
- Consultant in Special Care Dentistry, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Dental Hospital, Richardson Road, Newcastle upon Tyne, NE2 4AZ, UK
| | - Louise Coats
- Consultant in Adult Congenital Heart Disease, Newcastle upon Tyne Hospitals NHS Foundation Trust, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Tim Irvine
- Consultant Cardiologist, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - Kate Ohlsen-Turner
- Specialty Doctor in Oral and Maxillofacial Surgery, Arrowe Park Hospital, Arrowe Park Road, Arrowe Park, Upton, Wirral, CH49 5PE, UK
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Zhou MX, Viozzi CF, Heneberk O, Lee SK, Klarich KW, Salinas TJ. Oral Health Clearance Outcomes for Cardiovascular Surgery. Mayo Clin Proc Innov Qual Outcomes 2024; 8:121-130. [PMID: 38384717 PMCID: PMC10879629 DOI: 10.1016/j.mayocpiqo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Objective To determine the risk of morbidity and mortality in patients receiving dental extractions before planned cardiovascular surgery (CVS) and examine factors that may affect the chance of oral health clearance. Patients and Methods A retrospective medical record review was performed of patients who underwent dental screening before CVS from January 1, 2015, to December 31, 2021, at a major medical institution. A total of 496 patients met the inclusion criteria and were divided into 2 groups. Group 1 patients were cleared to advance to planned CVS (n=390). Group 2 patients were not cleared for surgery and subsequently underwent dental extractions before planned CVS (n=106). Results Six patients (5.7%) experienced postoperative complications after dental extraction that resulted in an emergency room visit. No deaths occurred after dental extraction before CVS. However, 4 patients died within 30 days of CVS, 3 from Group 1 (0.77%) and 1 from Group 2 (0.94%). Dental extraction before planned CVS showed a borderline significant association with death based on unadjusted (P=.06) and age-adjusted analysis (P=.05). Patients who reported seeing a dentist routinely had a significantly higher chance of oral health clearance (P <.001). No differences were noted between the 2 groups with regard to age, sex, or 30-day hospital readmission rate. Conclusion Patients who had dental extractions completed before planned CVS may be at an increased risk of mortality. Further studies are needed to examine this relationship. Emphasis should be on prioritization of routine dental visits before planned CVS.
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Affiliation(s)
- Miao Xian Zhou
- Department of Dental Specialties, Mayo Clinic, Rochester, MN
| | | | - Ondřej Heneberk
- Department of Dentistry, University Hospital, Hradec Kralove, Czech Republic
| | - Sarah K. Lee
- Department of Dental Specialties, Mayo Clinic, Rochester, MN
| | - Kyle W. Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Ramadan M, Stewart V, Elsherif N, Milligan R, Beresford A, Marley J. Infective endocarditis and oral surgery input before cardiac surgery: time to prick the paradigm of pre-cardiac surgery assessments? Br Dent J 2023; 234:678-681. [PMID: 37173494 PMCID: PMC10177729 DOI: 10.1038/s41415-023-5796-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 05/15/2023]
Abstract
Purpose To review current practice regarding oral surgery input for patients awaiting cardiac valvular surgery and who are at risk of infective endocarditis (IE) in the context of the COVID-19 pandemic, and to stimulate debate around the indications for pre-operative oral surgery assessment. It also opens the way to developing a new research-based approach which is patient-centred, safe, effective and efficient.Methods A desk-top based patient review was undertaken between 27 March 2020 and 1 July 2022 to record the outcome of patients undergoing cardiac valvular surgery in Northern Ireland, following the revision of the referral guidelines for oral surgery intervention. Data were collected for all cardiac referrals to the oral surgery on-call service in the Royal Victoria Hospital, Belfast. Complications were recorded at two weeks, two months, and six months post-surgery, using Northern Ireland Electronic Care Records.Results In total, 67 cardiac patients were identified between 27 March 2020 and 1 July 2022: 65.7% of patients were male and had an average age of 68, while the female patients had an average age of 61. The mean interval of date of cardiology referral to surgery date was 9.7 working days, with 36% of patients referred within five days of the planned surgery date. Moreover, 39% had valvular surgery in combination with another type of cardiac surgery. No complications linked to dental aetiology were noted.Conclusions This paper raises questions about the advisability of oral surgery input before cardiac surgery for anything other than pain relief, management of acute dental sepsis, or IE whose source has been identified as an oral commensal. The COVID-19 pandemic has presented an opportunity to review current practice and open the way to developing a new approach which is patient-centred, safe, effective and efficient.
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Affiliation(s)
- Marwa Ramadan
- General Dental Practitioner and Postgraduate Student, Queen´s University Belfast, Belfast, United Kingdom.
| | - Victoria Stewart
- Speciality Dentist, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
| | - Nusaybah Elsherif
- Department of Oral Medicine, Guy´s and St. Thomas´ NHS Foundation Trust, London, United Kingdom
| | - Rebekah Milligan
- Dental Core Trainee, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
| | - Amanda Beresford
- Consultant and Honorary Senior Lecturer, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
| | - John Marley
- Consultant and Honorary Professor, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
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Cotti E, Arrica M, Di Lenarda A, Serri SB, Bassareo P, Padeletti L, Mercuro G. The perioperative dental screening and management of patients undergoing cardiothoracic, vascular surgery and other cardiovascular invasive procedures: A systematic review. Eur J Prev Cardiol 2017; 24:409-425. [DOI: 10.1177/2047487316682348] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Mariantonietta Arrica
- Department of Surgery, Microsurgery and Medical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Di Lenarda
- Cardiovascular Centre of Trieste, University of Trieste, Trieste, Italy
| | - Sara B Serri
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | | | - Luigi Padeletti
- Department of Cardiology, University of Florence, Florence, Italy
| | - Giuseppe Mercuro
- Department of Cardiology, University of Cagliari, Cagliari, Italy
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Allareddy V, Prakasam S, Rampa S, Stein K, Nalliah RP, Allareddy V, Rengasamy Venugopalan S. Impact of Periapical Abscess on Infectious Complications in Patients Undergoing Extracorporeal Circulation Auxiliary to Open-Heart Surgical Procedures. J Evid Based Dent Pract 2016; 17:13-22. [PMID: 28259310 DOI: 10.1016/j.jebdp.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Extracorporeal circulation auxiliary to open-heart surgeries (ECAOHS) may exert nonphysiological stresses on periapical abscessed tissues leading to hematogenous spread of microbes. The aim of this report was to estimate risk of postoperative infectious complications in patients with periapical abscesses and undergoing ECAOHS. METHODS A retrospective analysis of Nationwide Inpatient Sample (years 2009 and 2010) was conducted. All patients (aged 19 to 65 years) who underwent ECAOHS were selected. International Classification of Diseases-9-Clinical Modification codes were used to identify the presence of periapical abscess and infectious complications. Multivariable logistic regression models were used to examine the associations between the presence of periapical abscess and occurrence of infectious complications. RESULTS A total of 265,235 patients underwent an ECAOH procedure. Of these, 431 patients had a periapical abscess. Septicemia developed in 16% of those with periapical abscess (compared with 4.2% in those without periapical abscess). Those with periapical abscess had higher rates of any of the infectious complications when compared with those without periapical abscess (30.2% vs 11.6%, respectively). After adjustment for multiple confounders, those with periapical abscess were associated with higher odds for developing septicemia (odds ratio = 2.51, 95% confidence interval = 1.06-5.91, P = .04) and any of the infectious complications (odds ratio = 2.23, 95% confidence interval = 1.08-4.59, P = .03) when compared with those who did not have periapical abscess. CONCLUSIONS Those with periapical abscess are associated with higher odds for infectious complications when compared with those without periapical abscess.
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Affiliation(s)
- Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA, USA.
| | - Sivaraman Prakasam
- Department of Periodontology, Oregon Health & Science University, Portland, OR, USA
| | - Sankeerth Rampa
- Health Services Research & Administration Department, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kyle Stein
- Department of Oral and Maxillofacial Surgery, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA, USA
| | - Romesh P Nalliah
- Department of Cariology, Restorative Sciences, and Endodontics, Office of Patient Services, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Veerajalandhar Allareddy
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA, USA
| | - Shankar Rengasamy Venugopalan
- Department of Orthodontics and Dentofacial Orthopedics, University of Missouri, Kansas City School of Dentistry, Kansas City, MO, USA
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Silvay G, Zafirova Z. Ten Years Experiences With Preoperative Evaluation Clinic for Day Admission Cardiac and Major Vascular Surgical Patients: Model for "Perioperative Anesthesia and Surgical Home". Semin Cardiothorac Vasc Anesth 2015; 20:120-32. [PMID: 26620138 DOI: 10.1177/1089253215619236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Admission on the day of surgery for elective cardiac and noncardiac surgery is the prevalent practice in North America and Canada. This approach realizes medical, psychological and logistical benefits, and its success is predicated on an effective outpatient preoperative evaluation. The establishment of a highly functional preoperative clinic with a comprehensive set up and efficient logistical pathways is invaluable. This notion in recent years has included the entire perioperative period, and the concept of a perioperative anesthesia/surgical home (PASH) is gaining popularity. The anesthesiologists as perioperative physicians can organize and lead the entire process from the preoperative evaluation, through the hosptial discharge. The functions of the PASH include preoperative optimization of medical conditions and psychological preparation of the patients and their support system; the care in the operating room and intensive care unit; pain management; respiratory therapy; cardiac rehabilitation; and specialized nutrition. Along with oversight of the medical issues, the preoperative visit is an opportune time for counseling, clarification of expectations and discussion of research, as well as for utilization of various informatics systems to consolidate the pertinent information and distribute it to relevant health care providers. We review the scientific foundation and practical applications of a preoperative visit and share our experience with the development of the preoperative evaluation clinic, designed specifically for cardiac and major vascular patients scheduled for day admission surgery. The ultimate goal of preoperative evaluation clinic is to ensure a safe, efficient, and cost-effective perioperative care for patients undergoing a complex type of surgery.
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Affiliation(s)
- George Silvay
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Silvay G, Zafirova Z. Improving the Quality and Safety as Well as Reducing the Cost for Patients Undergoing Cardiac Surgery: Missing Some Issues? J Cardiothorac Vasc Anesth 2015; 29:e46-7. [PMID: 25847414 DOI: 10.1053/j.jvca.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- George Silvay
- Department of Anesthesiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Zdravka Zafirova
- Department of Anesthesiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
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How Important Is Dental Clearance for Elective Open Heart Operations? Ann Thorac Surg 2015; 99:377. [DOI: 10.1016/j.athoracsur.2014.04.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/02/2014] [Accepted: 04/22/2014] [Indexed: 11/18/2022]
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Abstract
Many patients requiring surgery possess poor oral health. The presence of decayed teeth and periodontitis represent potentially potent causes of odontogenic infection that could significantly compromise the surgical outcome. Geriatric patients presenting for surgery who have not had a dental examination for years may be harboring an undetected oral infection. In the perioperative period, the harmful effects of such an infection are amplified in terms of treatment and expenses. This article will elaborate on the association between oral health and systemic disease, present unique intraoral characteristics of elderly patients, and emphasize the importance of obtaining a dental evaluation and treating any acute oral infection before surgery. Augmenting the awareness of the perioperative dental considerations in the geriatric population can lead to the implementation of effective and preventive measures that can contain costs and achieve optimal patient care.
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Affiliation(s)
- Jeffrey S Yasny
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY, USA.
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Yasny J. The Importance of Oral Health for Cardiothoracic and Vascular Patients. Semin Cardiothorac Vasc Anesth 2010; 14:38-40. [DOI: 10.1177/1089253210362272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prior to cardiothoracic or vascular surgery, a patient's oral health is not usually a high priority for the surgical team. Yet, oral neglect often mirrors systemic disease and the need for proper dental care is often unmet. In the perioperative period, the presence of untreated decayed teeth and periodontal disease can result in a potent odontogenic infection with significant consequences. Patients can unknowingly present for such operations with undetected oral infections that can magnify the likelihood of an adverse outcome, increase costs, morbidity, and possibly mortality. Considering scheduling constraints and the urgency of the procedure, a pre-operative dental screening is suggested for patients who undergo elective cardiothoracic or vascular surgery, to ensure that any oral infection is diagnosed and definitively treated. Implementing such an effective and preventive approach can improve surgical outcome and overall patient health.
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Silvay G, Castillo JG, Chikwe J, Flynn B, Filsoufi F. Cardiac anesthesia and surgery in geriatric patients. Semin Cardiothorac Vasc Anesth 2008; 12:18-28. [PMID: 18397906 DOI: 10.1177/1089253208316446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The average age of US population is steadily increasing, with more than 15 million people aged 80 and older. Coronary artery disease and degenerative cardiovascular diseases are particularly prevalent in this population. Consequently, an increasing number of elderly patients are referred for surgical intervention. Advanced age is associated with decreased physiologic reserve and significant comorbidity. Thorough preoperative assessment, identification of the risk factors for perioperative morbidity and mortality, and optimal preparation are critical in these patients. Age-related changes in comorbidities and altered pharmacokinetics and pharmacodynamics impacts anesthetic management, perioperative monitoring, postoperative care, and outcome. This article updates the age-related changes in organ subsystems relevant to cardiac anesthesia, perioperative issues, and intraoperative management. Early and late operative outcome in octogenarians undergoing cardiac surgery are reviewed. The data clearly indicate that no patient group is "too old" for cardiac surgery and that excellent outcomes can be achieved in selected group of elderly patients.
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Affiliation(s)
- George Silvay
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
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