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Meta-Analysis
. 2022 May;49(5):467-479.
doi: 10.1111/jcpe.13600. Epub 2022 Mar 16.

Invasive dental treatment and acute vascular events: A systematic review and meta-analysis

Shailly Luthra  1 , Marco Orlandi  1 , Yago Leira  1   2   3 , Desta Bokre  4 , Debora Marletta  4 , Roberto Rotundo  1 , Simon Harden  5 , Francesco D'Aiuto  1
Affiliations
Meta-Analysis

Invasive dental treatment and acute vascular events: A systematic review and meta-analysis

Shailly Luthra et al. J Clin Periodontol. 2022 May.

Abstract

Background: Acute infection/inflammation increases the risk of acute vascular events (AVEs). Invasive dental treatments (IDTs) trigger short-term acute inflammation.

Purpose: The aim of this work is to critically appraise the evidence linking IDTs and AVEs.

Data sources: Six bibliographical databases were searched up to 31 August 2021. A systematic review following PRISMA guidelines was performed.

Study selection: Intervention and observational studies reporting any AVEs following IDT were included.

Data extraction: Two reviewers independently extracted data and rated the quality of studies. Data were pooled using fixed-effect, inverse variance weights analysis.

Risk of bias: Risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Handbook-Rob 2.0 for randomized controlled trials.

Data synthesis: In 3 out of 16 clinical studies, a total of 533,175 participants, 124,344 myocardial infarctions, and 327,804 ischaemic strokes were reported. Meta-analysis confirmed that IDT did not increase incidence ratios (IR) for combined vascular events either at 1-4 weeks (IR of 1.02, 95% CIs: 0.92 to 1.13) and at 5-8 weeks (IR of 1.04, 95% CIs: 0.97 to1.10) after treatment.

Limitations: A high level of heterogeneity (study designs and time point assessments) was found.

Conclusion: Patients who received IDT exhibited no substantial increase in vascular risk over 8 weeks post treatment.

Keywords: cardiovascular diseases; dental treatment; extraction; inflammation; periodontitis.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Acute vascular event over 1–4 weeks post treatment—incidence ratio (IR). Summary forest plot for incidence ratio of acute vascular events. (a) Ischaemic stroke (IS), (b) myocardial infarction (MI), and (c) all combined vascular events over 1–4 weeks post treatment in self‐controlled case series studies. The fixed‐effect, inverse variance weighed pooled analysis was used, and the data markers indicate the time length and events in each study. CI, confidence interval
FIGURE 2
FIGURE 2
Acute vascular event over 5–8 weeks post treatment—incidence ratio (IR). Summary forest plot for incidence ratio of acute vascular events. (a) Ischaemic stroke (IS), (b) myocardial infarction (MI), and (c) all combined vascular events over 5–8 weeks post treatment in self‐controlled case series studies. The fixed‐effect, inverse variance weighed pooled analysis was used and the data markers indicates the time length and events in each study. CI, confidence interval
FIGURE 3
FIGURE 3
Plausible mechanistic links between invasive dental treatment and acute vascular events. Putative pathways through which oral infection and inflammation can increase the risk of an acute vascular event
See this image and copyright information in PMC

References

    1. Aarabi, G. , Raedel, M. , Kreutzburg, T. , Hischke, S. , Debus, E. S. , Marschall, U. , Seedorf, U. , & Behrendt, C.‐A. (2020). Periodontal treatment and peripheral arterial disease severity – A retrospective analysis of health insurance claims data. VASA. Zeitschrift für Gefässkrankheiten, 49, 128–132. 10.1024/0301-1526/a000846 - DOI - PubMed
    1. Beck, J. D. , Couper, D. J. , Falkner, K. L. , Graham, S. P. , Grossi, S. G. , Gunsolley, J. C. , Madden, T. , Maupome, G. , Offenbacher, S. , Stewart, D. D. , Trevisan, M. , Van Dyke, T. E. , & Genco, R. J. (2008). The Periodontitis and Vascular Events (PAVE) pilot study: Adverse events. Journal of Periodontology, 79, 90–96. 10.1902/jop.2008.070223 - DOI - PubMed
    1. Bergh, C. , Fall, K. , Udumyan, R. , Sjöqvist, H. , Fröbert, O. , & Montgomery, S. (2017). Severe infections and subsequent delayed cardiovascular disease. European Journal of Preventive Cardiology, 24, 1958–1966. 10.1177/2047487317724009 - DOI - PubMed
    1. Bhagat, K. , Moss, R. , Collier, J. , & Vallance, P. (1996). Endothelial “stunning” following a brief exposure to endotoxin: A mechanism to link infection and infarction? Cardiovascular Research, 32, 822–829. - PubMed
    1. Cahill, T. J. , Dayer, M. , Prendergast, B. , & Thornhill, M. (2017). Do patients at risk of infective endocarditis need antibiotics before dental procedures? BMJ (Clinical research ed.), 358, j3942. 10.1136/bmj.j3942 - DOI - PubMed

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