Preoperative Oral Health Assessment and Treatment Needs in Candidates for Cardiothoracic and Vascular Surgery: a Brazilian Cross-Sectional Study

Jessica Ferreira Vogel; Diego Belmiro; José Alcides Almeida de Arruda; Sílvia Paula de Oliveira; Luciana Munhoz; Bruno Augusto Benevenuto de Andrade; Jefferson R. Tenório

doi:10.5327/2525-5711.461

Authors

Jessica Ferreira Vogel Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. https://orcid.org/0009-0005-0862-8067
Diego Belmiro Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. https://orcid.org/0000-0002-0109-6863
José Alcides Almeida de Arruda Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. https://orcid.org/0000-0002-6599-3950
Sílvia Paula de Oliveira Clinical Dentistry Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. https://orcid.org/0000-0003-1892-7069
Luciana Munhoz Department of Stomatology, Public Healthy and Forensic Dentistry, Ribeirão Preto School of Dentistry, Universidade de São Paulo, Ribeirão Preto, Brazil. https://orcid.org/0000-0003-2375-5935
Bruno Augusto Benevenuto de Andrade Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. https://orcid.org/0000-0002-3259-606X
Jefferson R. Tenório Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. https://orcid.org/0000-0002-6986-9148

DOI:

https://doi.org/10.5327/2525-5711.461

Keywords:

cardiovascular surgical procedures, thoracic surgery, Gingivitis, oral health, oral hygiene

Abstract

Objective: To assess the oral health status and dental treatment needs of patients with cardiovascular diseases (CVD) preparing for cardiothoracic and/or vascular surgery in a Brazilian population. Methods: This cross-sectional study included adults with CVD. Demographic and cardiological data were obtained from medical records, while dental examinations assessed Decayed, Missing, and Filled Teeth (DMFT) scores, periodontal alterations, and sources of oral infection. Radiographic evaluations identified bone defects and intraosseous lesions. Results: Forty-eight participants (54.2% male, mean age 62.4 years) were included. Coronary artery disease (CAD) and aortic stenosis were the most prevalent CVD. Myocardial revascularization and valve replacement surgeries accounted for 97.9% of the procedures. Participants had a high mean DMFT score (18.8±6.8). Oral findings included dental calculus (35.4%), gingival recession (31.1%), and horizontal bone defects (83.3%). CAD was not significantly associated with gingival inflammation and/or salivary calculus (p = 0.063), although a trend toward significance was observed.. A significant association was found between valvular surgery and myocardial revascularization (p=0.019). Conclusion: Patients awaiting cardiovascular surgery exhibited significant dental treatment needs, underscoring the importance of preventive, restorative, and periodontal care to minimize adverse cardiac outcomes. Our findings align with international guidelines and contribute to promoting safer and more effective perioperative care for individuals with complex cardiac conditions. Clinical significance statement: Comprehensive dental evaluations in candidates for cardiovascular surgery are crucial to address prevalent oral health issues, such as periodontal disease and dental infections. Early interventions can reduce systemic inflammation, minimize the risk of postoperative complications, and optimize surgical outcomes, especially in patients with coronary artery disease and multiple comorbidities.

References

1. Ndubuisi NE. Noncommunicable Diseases Prevention In Low- and Middle-Income Countries: An Overview of Health in All Policies (HiAP). Inquiry. 2021 Jan-Dec;58:46958020927885. doi: 10.1177/0046958020927885.

2. Kostova D, Richter P, Van Vliet G, Mahar M, Moolenaar RL. The Role of Noncommunicable Diseases in the Pursuit of Global Health Security. Health Secur. 2021 May-Jun;19(3):288-301. doi: 10.1089/hs.2020.0121.

3. Kanaoka K, Iwanaga Y, Tsujimoto Y, Shiroshita A, Suzuki T, Nakai M, Miyamoto Y. Quality indicators for acute cardiovascular diseases: a scoping review. BMC Health Serv Res. 2022 Jul 5;22(1):862. doi: 10.1186/s12913-022-08239-0.

4. Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. J Am Coll Cardiol. 2018 May 8;71(18):2015-2040. doi: 10.1016/j.jacc.2017.12.068.

5. Rochmah TN, Rahmawati IT, Dahlui M, Budiarto W, Bilqis N. Economic Burden of Stroke Disease: A Systematic Review. Int J Environ Res Public Health. 2021 Jul 15;18(14):7552. doi: 10.3390/ijerph18147552.

6. Borges MGB, Borges DL, Ribeiro MO, Lima LSS, Macedo KCM, Nina VJDS. Early Mobilization Prescription in Patients Undergoing Cardiac Surgery: Systematic Review. Braz J Cardiovasc Surg. 2022 May 2;37(2):227-238. doi: 10.21470/1678-9741-2021-0140.

7. Chowdhury MZI, Haque MA, Farhana Z, Anik AM, Chowdhury AH, Haque SM, Marjana LL, Bristi PD, Al Mamun BA, Uddin MJ, Fatema J, Rahman MM, Akter T, Tani TA, Turin TC. Prevalence of cardiovascular disease among Bangladeshi adult population: a systematic review and meta-analysis of the studies. Vasc Health Risk Manag. 2018 Aug 21;14:165-181. doi: 10.2147/VHRM.S166111.

8. Lu SY, Lin LH, Hsue SS. Management of dental extractions in patients on warfarin and antiplatelet therapy. J Formos Med Assoc. 2018 Nov;117(11):979-986. doi: 10.1016/j.jfma.2018.08.019.

9. Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, Couper DJ, Beaton A, Kilmartin C, Miro JM, Sable C, Jackson MA, Baddour LM; American Heart Association Young Hearts Rheumatic Fever, Endocarditis and Kawasaki Disease Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular and Stroke Nursing; and the Council on Quality of Care and Outcomes Research. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation. 2021 May 18;143(20):e963-e978. doi: 10.1161/CIR.0000000000000969.

10. Cotti E, Arrica M, Di Lenarda A, Serri SB, Bassareo P, Padeletti L, Mercuro G. The perioperative dental screening and management of patients undergoing cardiothoracic, vascular surgery and other cardiovascular invasive procedures: A systematic review. Eur J Prev Cardiol. 2017 Mar;24(4):409-425. doi: 10.1177/2047487316682348.

11. Pimentel MCDS, Fernandes MM, Vogel JO, Freire CH, Pereira CM, Andrade BAB, Rech BO, Tenório JR. What are the main oral manifestations in heart transplant patients? A scoping review. Spec Care Dentist. 2024 Sep;44(5):1317-1325. doi: 10.1111/scd.12999.

12. Kumar A, Rai A. Oral Health Status, Health Behaviour and Treatment Needs of Patients Undergoing Cardiovascular Surgery. Braz J Cardiovasc Surg. 2018 Mar-Apr;33(2):151-154. doi: 10.21470/1678-9741-2017-0137.

13. Souza AF, Rocha AL, Castro WH, Gelape CL, Nunes MCP, Oliveira SR, Travassos DV, Silva TA. Dental management for patients undergoing heart valve surgery. J Card Surg. 2017 Oct;32(10):627-632. doi: 10.1111/jocs.13211.

14. de Souza AF, Rocha AL, Castro WH, Ferreira FM, Gelape CL, Travassos DV, da Silva TA. Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis? Int J Cardiol Heart Vasc. 2016 Jul 7;12:57-62. doi: 10.1016/j.ijcha.2016.07.001.

15. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344-9. doi: 10.1016/j.jclinepi.2007.11.008.

16. Kurt-Bayrakdar S, Bayrakdar İŞ, Yavuz MB, Sali N, Çelik Ö, Köse O, Uzun Saylan BC, Kuleli B, Jagtap R, Orhan K. Detection of periodontal bone loss patterns and furcation defects from panoramic radiographs using deep learning algorithm: a retrospective study. BMC Oral Health. 2024 Jan 31;24(1):155. doi: 10.1186/s12903-024-03896-5.

17. Cotti E, Cairo F, Bassareo PP, Fonzar F, Venturi M, Landi L, Parolari A, Franco V, Fabiani C, Barili F, Di Lenarda A, Gulizia M, Borzi M, Campus G, Musumeci F, Mercuro G. Perioperative dental screening and treatment in patients undergoing cardio-thoracic surgery and interventional cardiovascular procedures. A consensus report based on RAND/UCLA methodology. Int J Cardiol. 2019 Oct 1;292:78-86. doi: 10.1016/j.ijcard.2019.06.041.

18. McDonald EG, Aggrey G, Aslan AT, Casias M, Cortes-Penfield N, Dong MQD, Egbert S, Footer B, Isler B, King M, Maximos M, Wuerz TC, Azim AA, Alza-Arcila J, Bai AD, Blyth M, Boyles T, Caceres J, Clark D, Davar K, Denholm JT, Forrest G, Ghanem B, Hagel S, Hanretty A, Hamilton F, Jent P, Kang M, Kludjian G, Lahey T, Lapin J, Lee R, Li T, Mehta D, Moore J, Mowrer C, Ouellet G, Reece R, Ryder JH, Sanctuaire A, Sanders JM, Stoner BJ, So JM, Tessier JF, Tirupathi R, Tong SYC, Wald-Dickler N, Yassin A, Yen C, Spellberg B, Lee TC. Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open. 2023 Jul 3;6(7):e2326366. doi: 10.1001/jamanetworkopen.2023.26366. Erratum in: JAMA Netw Open. 2023 Aug 1;6(8):e2332858. doi: 10.1001/jamanetworkopen.2023.32858.

19. Krasniqi L, Schødt Riber LP, Nissen H, Terkelsen CJ, Andersen NH, Freeman P, Povlsen JA, Gerke O, Clavel MA, Dahl JS. Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study. Lancet Reg Health Eur. 2023 Nov 22;36:100789. doi: 10.1016/j.lanepe.2023.100789.

20. Sanz M, Marco Del Castillo A, Jepsen S, Gonzalez-Juanatey JR, D'Aiuto F, Bouchard P, Chapple I, Dietrich T, Gotsman I, Graziani F, Herrera D, Loos B, Madianos P, Michel JB, Perel P, Pieske B, Shapira L, Shechter M, Tonetti M, Vlachopoulos C, Wimmer G. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol. 2020 Mar;47(3):268-288. doi: 10.1111/jcpe.13189.

21. Task Force Members; Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJ; ESC Committee for Practice Guidelines; Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers; Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34(38):2949-3003. doi: 10.1093/eurheartj/eht296.

22. Gualandro DM, Fornari LS, Caramelli B, Abizaid AAC, Gomes BR, Tavares CAM, Fernandes CJCDS, Polanczyk CA, Jardim C, Vieira CLZ, Pinho C, Calderaro D, Schreen D, Marcondes-Braga FG, Souza F, Cardozo FAM, Tarasoutchi F, Carmo GAL, Kanhouche G, Lima JJG, Bichuette LD, Sacilotto L, Drager LF, Vacanti LJ, Gowdak LHW, Vieira MLC, Martins MLFM, Lima MSM, Lottenberg MP, Aliberti MJR, Marchi MFS, Paixão MR, Oliveira Junior MT, Yu PC, Cury PR, Farsky PS, Pessoa RS, Siciliano RF, Accorsi TAD, Correia VM, Mathias Junior W. Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology - 2024. Arq Bras Cardiol. 2024 Oct 21;121(9):e20240590. Portuguese, English. doi: 10.36660/abc.20240590.

23. Al-Mohaissen MA, Al-Mehisen R, Lee T, Al-Madi EM. Managing Cardiac Patients: Dentists' Knowledge, Perceptions, and Practices. Int Dent J. 2022 Jun;72(3):296-307. doi: 10.1016/j.identj.2021.04.006.

24. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol. 2019 Aug;234(10):16812-16823. doi: 10.1002/jcp.28350.

25. Oliveira GMM, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MFM, Lorenzo AR, Fagundes Júnior AAP, Schaan BD, Silva CGSE, Castilho FM, Cesena FHY, Soares GP, Xavier Junior GF, Barreto Filho JAS, Passaglia LG, Pinto Filho MM, Machline-Carrion MJ, Bittencourt MS, Pontes Neto OM, Villela PB, Teixeira RA, Stein R, Sampaio RO, Gaziano TA, Perel P, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2023. Arq Bras Cardiol. 2024 Feb;121(2):e20240079. Portuguese, English. doi: 10.36660/abc.20240079.

26. Niwa H, Sato Y, Matsuura H. Safety of dental treatment in patients with previously diagnosed acute myocardial infarction or unstable angina pectoris. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jan;89(1):35-41. doi: 10.1016/s1079-2104(00)80011-6.

27. Ferreira RC, Vargas AMD, Moura RNV, Fonseca MLV, Gomes VE, Pinheiro EL, Cartaxo SCA, Pinto RDS. Caries and edentulism trends among Brazilian older adults: a comparative analysis of 2003, 2010, and 2023 surveys. Braz Oral Res. 2025 Apr;39(suppl 1):e050. doi: 10.1590/1807-3107bor-2025.vol39.0050.

28. Costa SM, Vasconcelos M, Abreu MH. High dental caries among adults aged 35 to 44 years: case-control study of distal and proximal factors. Int J Environ Res Public Health. 2013 Jun 7;10(6):2401-11. doi: 10.3390/ijerph10062401.

29. Nakamura Y, Tagusari O, Seike Y, Ito Y, Saito K, Miyamoto R, Nakano K, Shikata F. Prevalence of periodontitis and optimal timing of dental treatment in patients undergoing heart valve surgery. Interact Cardiovasc Thorac Surg. 2011 May;12(5):696-700. doi: 10.1510/icvts.2010.255943.

30. Liu W, Cao Y, Dong L, Zhu Y, Wu Y, Lv Z, Iheozor-Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database Syst Rev. 2019 Dec 31;12(12):CD009197. doi: 10.1002/14651858.CD009197.pub4. Update in: Cochrane Database Syst Rev. 2022 Oct 4;10:CD009197. doi: 10.1002/14651858.CD009197.pub5.

31. Wang Z, Liu T, Su Q, Luo H, Lou L, Zhao L, Kang X, Pan Y, Nie Y. Prevalence of Polypharmacy in Elderly Population Worldwide: A Systematic Review and Meta-Analysis. Pharmacoepidemiol Drug Saf. 2024 Aug;33(8):e5880. doi: 10.1002/pds.5880.

32. Mincer RC, Zahr RH, Chung EM, Kubak B, Sung EC. Pre-Cardiac Dental Treatment Does Not Increase the Risk of Adverse Events. J Oral Maxillofac Surg. 2022 Jan;80(1):22-28. doi: 10.1016/j.joms.2021.07.005. Epub 2021 Jul 13. Erratum in: J Oral Maxillofac Surg. 2022 Apr;80(4):785. doi: 10.1016/j.joms.2022.01.016.