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      Prior oral conditions in patients undergoing heart valve surgery

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          Abstract

          Background

          Patients scheduled for heart valve surgery should be free of any oral infectious disorders that might pose a risk in the postoperative period. Few studies have been made on the dental conditions of such patients prior to surgery. The present study describes the most frequent prior oral diseases in this population group.

          Material and Methods

          A prospective, observational case-control study was designed involving 60 patients (30 with heart valve disease and 30 controls, with a mean age of 71 years in both groups). A dental exploration was carried out, with calculation of the DMFT (decayed, missing and filled teeth) index and recording of the periodontal parameters (plaque index, gingival bleeding index, periodontal pocket depth, and attachment loss). The oral mucosa was also examined, and panoramic X-rays were used to identify possible intrabony lesions.

          Results

          Significant differences in bacterial plaque index were observed between the two groups ( p<0.05), with higher scores in the patients with valve disease. Probing depth and the presence of moderate pockets were also greater in the patients with valve disease than among the controls ( p<0.01). Sixty percent of the patients with valve disease presented periodontitis.

          Conclusions

          Patients scheduled for heart valve surgery should be examined for possible active periodontitis before the operation. Those individuals found to have periodontal disease should receive adequate periodontal treatment before heart surgery.

          Key words:Valve disease, aortic, mitral, heart surgery, periodontitis.

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          Most cited references24

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          Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study.

          Valvular heart disease (VHD) is expected to become more common as the population ages. However, current estimates of its natural history and prevalence are based on historical studies with potential sources of bias. We conducted a cross-sectional analysis of the clinical and epidemiological characteristics of VHD identified at recruitment of a large cohort of older people.
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            Meta-analysis of periodontal disease and risk of coronary heart disease and stroke.

            The purpose of this study was to analyze published studies and abstracts in order to provide a quantitative summary of periodontal disease as a risk factor for cardiovascular disease and to explore the possible causes for conflicting results in the literature. We searched all published literature on the Medline literature search engine since 1980. An additional search was performed with bibliographic citations from each article. Nine cohort studies (8 prospective and 1 retrospective), in which relative risks (RRs), CIs, and P values were reported or could be calculated were included. Four researchers independently extracted RRs, CIs, and P values from each study and evaluated the degree of confounding adjustment. The combined result was calculated with weighted average, and sources of disparity were tested with regression analyses. The summary RR was 1.19 (95% CI, 1.08 1.32), indicating a higher risk of future cardiovascular events in individuals with periodontal disease compared with those without. In an analysis stratified to individuals of
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              Periodontal diseases and cardiovascular events: meta-analysis of observational studies.

              Many studies have investigated the relationship between periodontal and cardiovascular diseases but their results are heterogeneous. Meta-analyses were conducted to examine the association between exposure to periodontitis and cardiovascular diseases. Studies published between 1989 and 2007 were retrieved from seven databases. The included articles reported the results from observational studies (cohort, cross-sectional and case-control studies) and assessed the link between periodontal exposure and cardiovascular diseases as confirmed by one of the following criteria: diagnosed coronary artery disease, angina pectoris, acute myocardial infarction, mortality caused by cardiac pathology. The study characteristics were abstracted by independent researchers following a standardised protocol. The MOOSE guidelines for meta-analysis of observational studies were followed. From 215 epidemiological studies, 47 were observational, of which 29 articles could be combined by the meta-analysis methodology. The pooled odds ratio calculated from the 22 case-control and cross-sectional studies was 2.35 (95% CI [1.87; 2.96], p < 0.0001). The risk of developing cardiovascular disease was found to be significantly (34%) higher in subjects with periodontal disease compared to those without periodontal disease (pooled relative risk from the 7 cohort studies was 1.34 (95% CI [1.27; 1.42], p < 0.0001). It seems from observational studies that subjects with periodontal diseases have higher odds and higher risks of developing cardiovascular diseases but the reduction in the risk of cardiovascular events associated with the treatment of periodontitis remains to be investigated.
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                Author and article information

                Journal
                J Clin Exp Dent
                J Clin Exp Dent
                Medicina Oral S.L.
                Journal of Clinical and Experimental Dentistry
                Medicina Oral S.L.
                1989-5488
                1 November 2017
                November 2017
                : 9
                : 11
                : e1287-e1291
                Affiliations
                [1 ]Professor, Department od Stomatology, University of Valencia, Spain
                [2 ]Diplomate of medical-surgery dentistry, University of Valencia. Spain
                [3 ]Research fellow, Department of Stomatology, University of Valencia. Spain
                [4 ]Professor of Medicine and Surgery, Department of Universitty of Milano-Bicocca. Italy
                [5 ]Associate Professor, Department of Stomatology, University of Valencia
                Author notes
                Unidad de Estomatología Hospital Universitario Dr. Peset C/ Juan de Garay s/n (46017-Valencia. España) , E-mail: francisco.silvestre@ 123456uv.es

                Conflict of interest statement:*The authors declare no potential conflict of interest and no sources of funding regarding the authorship and/or publication of this article. All authors have viewed and agreed to the submission. All patients whose records were used in the study received detailed information about the study and gave their informed consent to take part on the understanding that personal data and records would remain confidential and would only be used for scientific purposes.

                Article
                53902
                10.4317/jced.53902
                5741840
                29302279
                503c6a51-0498-4dde-978d-fdc05611e4b0
                Copyright: © 2017 Medicina Oral S.L.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 June 2017
                : 3 April 2017
                Categories
                Research
                Oral Medicine and Pathology

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