Invasive Dental Treatment and Risk for Vascular Events A Self-Controlled Case Series

Background: Treatment of periodontal disease may reduce cardiovascular risk in the longer term, but studies have suggested a link among dental procedures, acute inflammation, and endothelial dysfunction. However, whether such acute inflammatory effects translate into a short-lived increased risk for vascular events is not known. Objective: To investigate whether invasive dental treatment transiently increases the risk for vascular events. Design: Self-controlled case series. Setting: Data came from the U.S. Medicaid claims database. Patients: All persons exposed to invasive dental treatment with a primary hospital discharge diagnosis of ischemic stroke (n = 650) or myocardial infarction (n = 525) from 2002 to 2006. Measurements: The incidence of ischemic stroke and myocardial infarction in periods immediately after invasive dental treatment was compared with the incidence in all other observed time periods. Incidence ratios and 95% CIs were calculated. Results: The rate of vascular events significantly increased in the first 4 weeks after invasive dental treatment (incidence ratio, 1.50 [95% CI, 1.09 to 2.06]) and gradually returned to the baseline rate within 6 months. The positive association remained after exclusion of persons with diabetes, hypertension, or coronary artery disease or persons with prescriptions for antiplatelet or salicylate drugs before treatment. Limitations: Power to examine the effects of invasive dental treatment on stroke and myocardial infarction separately was limited because of the low frequency of invasive dental procedures. Lack of information about use of over-the-counter drugs limited the ability to assess confounding by possible withholding of antiplatelet or salicylate drugs before invasive dental treatment or by the use of nonsteroidal anti-inflammatory drugs after treatment. Conclusion: Invasive dental treatment may be associated with a transient increase in the risk for vascular events. However, the absolute risks are minimal, and the long-term benefits on vascular health will probably outweigh the short-lived adverse effects.