Dental work can give you a heart attack

Invasive dental procedures, such as some treatments for gum disease, may increase the risk of heart attack and stroke, according to a new study.

Medicare patients who had had a heart attack or stroke over a five-year period were 1.5 times more likely to suffer one of these cardiovascular events in the four weeks after an invasive dental treatment than they were at any other time.

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However, the researchers point out this effect, although real, is quite small and brief.

"It very quickly settled back down to their ordinary risk again, so that looking over years, the effect would be very small indeed," said study researcher Liam Smeeth of the London School of Hygiene and Tropical Medicine in the United Kingdom.

Previous studies have linked periodontal disease, which is a chronic bacterial infection of the gums, with an increase in inflammation in the body. Inflammation is an immune response and can be beneficial when your body is fighting off infection, but chronically high levels are known to play a role in health conditions, including cardiovascular disease.

And earlier study has linked gum disease with an increased risk of heart attack and stroke. Some studies have suggested that treating gum disease by getting rid of the oral bacteria that cause it allow the cells that line blood vessel walls to work better, reducing the risk of heart attack.

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But surgery can increase inflammation. The researchers said invasive dental procedures, particularly treatment for periodontal disease, may increase the risk of heart attack and stroke because they boost inflammation in the body as it responds to bacteria entering the bloodstream following surgery.

So which is worse for cardiovascular heath — periodontal disease or the treatment for it? The researchers said it's the former.

"I'm pretty certain that the long-term treatment is far more beneficial for people than this very small increase [in risk] that we see just after the treatment," Smeeth said.

But people who are already taking medications to prevent cardiovascular disease, such as aspirin or cholesterol-lowering statins, should, if possible, stay on those drugs throughout the dental treatment, Smeeth said.

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The study was based on records of 1,152 Medicare patients diagnosed with a heart attack or stroke between 2002 and 2006, and also had an invasive dental procedure during that time period. The most common procedure was the surgical removal of teeth.

The study's results held even after the researchers took out patients with conditions that might also contribute to an increased risk of cardiovascular events, such as diabetes, hypertension and coronary artery disease.

Patients taking certain prescription drugs were also removed from the study to account for the possibility that these patients could have stopped or changed drugs before or after treatment. However, the researchers were not able to account for those taking over-the-counter drugs, such as aspirin, which may have influenced the results.

And because the participants were all on Medicare, the findings might not apply to the population in general, the researchers say.

Overall, the study provides more evidence that inflammation and infection may be triggers for cardiovascular events, Smeeth said.

The findings will be published tomorrow (Oct. 19) in the Annals of Internal Medicine.

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