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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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Terano K, Motoi T, Nagata E, Oho T. Association of remaining tooth number with postoperative respiratory complications in heart valve surgery patients. Int J Dent Hyg 2024; 22:394-400. [PMID: 36760162 DOI: 10.1111/idh.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES This study examined the association between the number of remaining teeth and the incidence of postoperative respiratory complications in patients undergoing heart valve surgery. METHODS We retrospectively enrolled 157 patients who underwent heart valve surgery between April 2010 and March 2019. Data on patient characteristics including systemic and oral conditions were extracted and postoperative respiratory complications were set as outcomes. Patients were divided into two groups according to the number of remaining teeth (≥20, <20). After adjusting for confounding factors with propensity scoring, logistic regression analysis was performed to examine the association of remaining teeth number with the incidence of postoperative respiratory complications. In addition, subgroup analysis was performed by stratifying the data into quintiles based on the propensity score. RESULTS Univariate analysis showed significant differences between the two groups in factors, including age, past cardiac surgery experience, New York Heart Association functional classification class IV, denture use, tooth extraction before surgery, occlusal support, and periodontitis. Logistic regression analysis showed that patients with <20 remaining teeth had a significantly higher incidence of postoperative respiratory complications than those with ≥20 remaining teeth, with an odds ratio of 29.800 (p = 0.004). Subgroup analysis showed that the odds ratio for the patients with <20 remaining teeth was 9.000 (p = 0.038). CONCLUSIONS The results suggest that heart valve surgery patients shall get attention on oral disease prevention by dental care practitioners to maintain a sufficient number of teeth for the prevention of postoperative respiratory complications.
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Affiliation(s)
- Kurara Terano
- Division of Clinical Technology, Kagoshima University Hospital, Kagoshima, Japan
| | - Toshihiro Motoi
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Emi Nagata
- Division of Preventive Dentistry, Kagoshima University Hospital, Kagoshima, Japan
| | - Takahiko Oho
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Young JR, Bannon AL, Anoushiravani AA, Posner AD, Adams CT, DiCaprio MR. Oral health implications in total hip and knee arthroplasty patients: A review. J Orthop 2021; 24:126-130. [PMID: 33679037 PMCID: PMC7930502 DOI: 10.1016/j.jor.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/14/2021] [Indexed: 12/19/2022] Open
Abstract
Over the past two decades, oral health has emerged as a health care priority. Historically, patients greater than 65 years of age, the economically disadvantaged, members of racial or ethnic minority groups, or the disabled or home bound have experienced significant barriers to routine dental care. The connection between oral health care and periprosthetic joint infections (PJI) continues to be of importance to the orthopedic surgeon, as such infections are significantly morbid and costly. This review aims to introduce the importance of oral health as a small but crucial portion of an arthroplasty patient's overall perioperative management.
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Affiliation(s)
- Joseph R. Young
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Annika L. Bannon
- Department of Family Medicine, Albany Medical Center, Albany, NY, USA
| | | | - Andrew D. Posner
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Curtis T. Adams
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Implementation of a standardized oral screening tool by paediatric cardiologists. Cardiol Young 2020; 30:1815-1820. [PMID: 32959733 DOI: 10.1017/s1047951120002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND An examination of invasive procedure cancellations found that the lack of pre-procedural oral screening was a preventable cause, for children with congenital heart disease. The purpose of this study was to implement an oral screening tool within the paediatric cardiology clinic, with referral to paediatric dental providers for positive screens. The target population were children aged ≥6 months to <18 years old, being referred for cardiac procedures. METHODS The quality implementation framework method was used for this study design. The multi-modal intervention included education, audit and feedback, screening guidelines, environmental support, and interdisciplinary collaboration. Baseline rates for oral screenings were determined by retrospective chart audit from January 2018 to January 2019 (n = 211). Provider adherence to the oral screening tool was the outcome measure. Positive oral screens, resulting in referral to the paediatric dental clinic, were measured as a secondary outcome. Provider adherence rates were used as a process measure. RESULTS Data collected over 14 weeks showed a 29% increase in documentation of oral screenings prior to referral, as compared to the retrospective chart audit. During the study period, 13% of completed screenings were positive (n = 5). Provider compliance for the period was averaged at 70% adherence. CONCLUSION A substantial increase in pre-procedural oral screenings by paediatric cardiologists was achieved using the quality implementation framework and targeted interventions.
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Oliver KJ, Casas MJ, Judd PL, Russell JL. Oral health assessment practices and perceptions of North American paediatric cardiologists. Paediatr Child Health 2017; 22:312-316. [PMID: 29479243 PMCID: PMC5804591 DOI: 10.1093/pch/pxx093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Children with cardiac defects should have good oral health, particularly prior to cardiac surgery to minimize risks of infective endocarditis. The aim of the study was to examine the oral health assessment practices of North American cardiologists. METHODS Online surveys were e-mailed to 1409 cardiologists. Cardiologists without paediatric patients or practicing in centres without cardiac surgical care were excluded. Surveys addressed oral health assessment practices for paediatric cardiac patients, and perceptions of the impact of oral health on cardiac care. RESULTS The centre response rate was 69%, individual response rate 20%. Most cardiologists (96%) reported oral health was assessed as part of cardiac care. The most common time for assessment was prior to cardiac surgery (44%), with a quarter assessing by age 1 (28%). While most oral assessments involved a dentist (59%), 17% of cardiologists performed the oral assessment without the aid of a dentist. Four-fifths of cardiologists (83%) reported cancellation of cardiac surgery due to oral disease. Cardiologists who deferred assessment until prior to surgery had the highest experience of cancellation (96%). Assessments were delayed despite the common belief (89%) that children on pre-surgical high-calorie diets are at increased risk of oral disease. CONCLUSION Assessments of oral health status were often deferred until immediately prior to cardiac surgery despite the cardiologist's perception that children with cardiac defects were at increased risk of oral disease and prior experience of surgical cancellation due to oral disease. Paediatricians may need to facilitate early oral assessment for these children.
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Affiliation(s)
- Kelly J Oliver
- The Hospital for Sick Children, Toronto, Ontario
- The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Peter L Judd
- The Hospital for Sick Children, Toronto, Ontario
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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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Maret D, Peters OA, Vigarios E, Epstein JB, van der Sluis L. Dental screening of medical patients for oral infections and inflammation: consideration of risk and benefit. Microbes Infect 2016; 19:84-90. [PMID: 27773850 DOI: 10.1016/j.micinf.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/06/2016] [Accepted: 10/09/2016] [Indexed: 12/30/2022]
Abstract
The primary purpose of preoperative dental screening of medical patients is to detect acute or chronic oral conditions that may require management prior to planned medical interventions. The aim of this communication is to discuss the background of preoperative dental screening and the link between dental pathologies and systemic diseases.
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Affiliation(s)
- Delphine Maret
- Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse (AMIS), UMR 5288, CNRS, Toulouse, France; Faculté de Chirurgie Dentaire, Université Paul Sabatier, Centre Hospitalier Universitaire, Toulouse, France.
| | - Ove A Peters
- Department of Endodontics, University of the Pacific, Arthur A Dugoni, School of Dentistry, San Francisco, CA, USA
| | - Emmanuelle Vigarios
- Oral Oncology Department, Comprehensive Cancer Center Institut Claudius-Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - Joel B Epstein
- Department of Surgery, Cedars-Sinai Medical Center, Los Angelès, CA, USA
| | - Lucas van der Sluis
- Center of Dentistry and Oral Hygiene, University Medical Center Groningen, The Netherlands
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Jenkins G, Holmes A, Colman-Nally J, Mustafa S. What is the role of the oral and maxillofacial department in the preoperative management of patients awaiting cardiac operations? Br J Oral Maxillofac Surg 2015; 53:442-5. [DOI: 10.1016/j.bjoms.2015.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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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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