Abstract
We treated 10 cases requiring tooth extraction prior to undergoing cardiac surgery at a cardiovascular hospital during a 17-month period from January 2018 to May 2019.
We visited the patients in the hospital to extract teeth with advanced marginal periodontitis (defined as the presence of pocket depth ≥6 mm and bleeding), teeth with acute periodontitis based on the patient's history, residual teeth with significant damage, and teeth with impending infection. The cardiovascular functions of the patients with cardiovascular diseases were assessed using RCRI. Teeth are typically extracted under intravenous sedation at dental hospitals for patients without active cardiac conditions. For patients with active cardiac conditions, however, we visited the cardiovascular hospital and performed the extractions on site.
We retrospectively assessed 10 cases according to the National Surgical Quality Improvement Program (NSQIP) and Gupta Perioperative Cardiac Risk (GUPTA). We assumed that a risk of ≥3.0% as per the NSQIP and GUPTA was a criterion for alternate strategies for noninvasive treatment or the extraction of teeth at a cardiovascular hospital. Although intravenous sedation was valuable in stabilizing the hemodynamics of the patients with heart disease, monitoring them for at least 1 hour after tooth extraction was necessary. Visiting patients at a cardiovascular hospital for tooth extraction is the safest way of managing cardiovascular conditions during perioperative management. However, it is critical to consider the difficulty in performing dental treatments at bedside in cardiovascular hospitals. Discussions regarding the site of tooth extraction, the number of tooth extractions, the prescription of medicine, and necessary changes because of dental phobia should be conducted with the cooperation of both the cardiovascular hospital and the dental clinic. It is important to perform tooth extractions cautiously, considering the physical conditions of the patients. Moreover, dental anesthesiologists should manage the perioperative tooth extraction.
