Published Article

Effect of Dental Treatment Before Cardiac Valve Surgery: Systematic review and meta-analysis

Original Publisher or Platform

Journal of the American Dental Association

Original Article Link

https://doi.org/10.1016/j.adaj.2019.04.024

Publication Date

9-2019

Abstract

This search strategy was constructed to support the research for the peer reviewed article listed above. Full article abstract:

Background

The purpose of this systematic review was to determine the potential effect of dental treatment before cardiac valve surgery (CVS) or left ventricular assist device (LVAD) implantation on morbidity and mortality.

Types of Studies Reviewed

The authors included relevant studies from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, including randomized controlled trials and cohort studies, published from 1998 through 2019 and involving adults who received dental treatment before CVS or LVAD implantation. The authors assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and evidence certainty by using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors used a meta-analysis with a random-effects model to estimate dichotomous and continuous outcomes, expressed as relative risk (RR) and weighted mean difference.

Results

Six studies met the inclusion criteria for CVS but none for LVAD implantation. Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not. Postsurgical outcomes included all-cause mortality (RR, 1.00; 95% confidence interval [CI], 0.53 to 1.91), infective endocarditis (RR, 1.30; 95% CI, 0.51 to 3.35), postsurgical infection (RR, 1.01; 95% CI, 0.76 to 1.33), and length of stay in the hospital (weighted mean difference, 2.9; 95% CI, −2.3 to 8.1).

Conclusions and Practical Implications

From the available evidence, it is unclear whether postoperative outcomes differ in patients receiving dental treatment before CVS compared with outcomes in those who do not. Dentists and medical care professionals should collaborate on an appropriate course of action for each patient, weighing any potentially relevant care considerations.

PICO(T) or Research Question

  1. Do pre-operative dental procedures affect morbidity/mortality among adults (18 years) undergoing cardiac valve replacement surgery?
  2. Do pre-operative dental procedures affect morbidity/mortality among adults (18 years) undergoing cardiac valve repair surgery?
  3. Do pre-operative dental procedures affect morbidity/mortality among adults (18 years) undergoing LVAD implantation surgery?

Search Type

Meta-Analyses, Systematic Review

Databases included

PubMed or PubMed subsidiary, Embase, Cochrane

Acknowledgments

The full article was authored by:

Peter B. Lockhart, DDS, FDS RCPS; Hillary R. DeLong, JD; Ruth D. Lipman, PhD; Elliot Abt, DDS, MS, MSc; Larry M. Baddour, MD; Monica Colvin, MD, MA; Craig S. Miller, DMD, MS; Thomas Sollecito, DMD, FDS RCSEd; Kelly O’Brien, MLIS; Cameron G. Estrich, MPH; Marcelo W.B. Araujo, DDS, MS, PhD; Alonso Carrasco-Labra, DDS, MSc

in response to the American Dental Association (ADA) House of Delegates resolution 86H-2016:

"Resolved, that the Council on Scientific Affairs work with other appropriate ADA agencies and external stakeholders to develop proposed policy and evidence-based resources to optimize oral health prior to the performance of complex medical and surgical procedures."

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