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Could dental surgery trigger a heart attack?

BMJ Group News

dentist and patient

People’s risk of heart problems or a stroke is higher in the month after major dental work, according to an analysis of US health insurance claims. Invasive dental procedures, such as having a tooth taken out, could cause inflammation and allow bacteria to get into the bloodstream, which may explain the extra risk. However, the overall chance of problems was fairly small, and dropped back to normal within six months.

What do we know already?

There seems to be a link between gum disease and a higher risk of heart problems. One possibility is that people who don’t take care for their teeth also take less care of their health in general, but there’s also a theory that inflammation in the body - in the gums in this case - produces chemical changes that make heart problems or a stroke more likely.

Inflammation happens when you’re injured too, and some dental procedures, such as having a tooth extracted, can be quite invasive. Dental surgery could also allow bacteria from your mouth to get into your bloodstream.

Researchers have now looked at whether there could be a link between major dental work and heart problems or a stroke.

What does the new study say?

People’s risk of a heart attack or stroke was higher in the month after an invasive dental procedure, such as having a tooth extracted.

The researchers looked at data from US health insurance claims, which included 1,152 people who’d had a heart attack or stroke, and who’d also had invasive dental work. Among these people, 40 had heart attacks or strokes in the first month after dental surgery, which dropped to 29 in the second month, 30 in the third month, and 25 in the fourth month. There were 53 heart attacks and strokes in the fifth and sixth months combined.

After adjusting the figures to take into account people’s ages, the researchers worked out that the risk of a heart attack or stroke in the month after dental surgery was one-and-a-half times the person’s normal risk.

How reliable is the research?

The study was done using medical records, so relies on those records being accurate. The medical records didn't include people’s use of over-the-counter drugs such as aspirin. Aspirin can prevent heart problems or strokes by making blood clots less likely, but it can also increase the risk of bleeding. Some dentists ask people to stop taking aspirin before dental surgery, to prevent problems with bleeding. So, changes in aspirin use could have been the reason for some of the extra heart attacks and strokes.

Where does the study come from?

The study looked at people who were enrolled in the US Medicaid health programme. It appeared in the Annals of Internal Medicine, which is published by the American College of Physicians. Funding came from the Wellcome Trust.

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