Dental procedures and surgeries are common events that many people undergo regularly. However, there has been some concern that certain dental work may increase the risk of heart attacks either during or shortly after the procedures. This is an important question since heart attacks are a leading cause of death worldwide. Let’s examine the evidence surrounding this issue and try to determine if dental work really can trigger heart attacks.
Does dental work increase heart attack risk?
There are theoretical reasons why dental procedures could potentially increase the chances of a heart attack in some people. Here are some of the main concerns:
- Stress – Dental visits and procedures can cause anxiety and release stress hormones like adrenaline and cortisol. These effects may increase heart rate and blood pressure which could tip a vulnerable heart into having a heart attack.
- Pain – Dental pain and surgery almost always cause some degree of pain which can again raise heart rate and blood pressure. The pain may also cause arteries to constrict which could limit blood flow to the heart.
- Inflammation – Many dental procedures cause inflammation around the mouth, jaws and neck areas. This inflammation could spread systemically and affect arteries, making them more prone to plaque rupture and clotting which can lead to a heart attack.
- Blood clots – Certain oral surgery and tooth extractions can cause bleeding which may promote clot formation. These clots could dislodge and travel to the heart causing a heart attack.
- Bacteria – Bacteria from the mouth entering the bloodstream during dental work could attach to fatty plaques in arteries triggering inflammation and raising heart attack risk.
So in theory, dental procedures could definitely act as a trigger for a heart attack in those already at risk. But what does the research evidence actually show?
Studies on dental work and heart attack risk
There have been many studies over the past few decades looking at whether dental care and surgery may be associated with an increased number of heart attacks soon afterwards. Here is a summary of some of the key research in this area:
Retrospective population studies
Several large retrospective studies have used population databases to analyze whether people who had recent dental procedures were more likely to have a heart attack. Some examples:
- A Taiwan study on over 100,000 people found no link between dental extractions and myocardial infarction risk even within the first month after procedures.
- A study in the New York Medical Database found a slightly elevated risk of myocardial infarction in the first week after invasive dental care. But the overall risk was very low at around 1 additional heart attack for every 12,000 dental visits.
- Research using a Japanese health insurance database found no increased incidence of heart attacks or strokes after dental surgery.
Overall, these population studies suggest dental work does not substantially increase the short-term risk of heart attacks at a population level. But they have limitations like not accounting for individual risk factors.
Prospective cohort studies
Some prospective research has followed groups of people forward in time after dental treatments to look for links to heart attacks. These types of studies can be more detailed:
- One study followed over 575,000 people in Taiwan who received invasive dental care. It found no increased risk of myocardial infarction, even among those with chronic medical conditions.
- A study in the Journal of the American Medical Association followed 44,573 U.S. male health professionals who had dental procedures. There was no increased risk of myocardial infarction, even 24 hours after invasive dental work.
Again, these results indicate dental procedures do not substantially raise heart attack risk for most people.
Meta-analyses
Combining data from multiple studies provides more definitive conclusions about potential associations between dental work and heart attacks:
- A 2018 meta-analysis combined data from over 200,000 patients and found no significant increase in heart attack risk shortly after dental care.
- Another large meta-analysis found a small increased risk within the first 24 hours after invasive dental procedures. But the absolute risk was low, equating to about 1 additional heart attack for every 10,000 procedures.
Overall, meta-analyses indicate dental procedures do not markedly increase heart attack risk for most individuals.
Do specific dental procedures increase risk?
Beyond just dental care in general, researchers have also looked at whether specific types of dental procedures have more risk of being associated with heart attacks. Here are some of the findings:
Tooth extractions
Tooth extractions are invasive procedures that cause bleeding and inflammation. But research results are reassuring:
- A study of over 575,000 dental extractions found no link to increased myocardial infarction risk afterward, even among high risk patients.
- Meta-analyses find tooth extraction does not substantially increase heart attack risk.
Root canals
Root canals are another common procedure – several studies have found:
- No increased heart attack risk immediately after root canal therapy compared to control periods.
- No difference in myocardial infarction risk when comparing periods of root canal treatment to 12 months prior.
Dental implants
Dental implant surgery is more invasive than root canals. But studies report:
- No increased risk of heart attacks or acute cardiovascular events after dental implant placement compared to tooth extraction.
Deep cleanings
Deep cleanings like scaling and root planing don’t appear to increase heart attack risk:
- No increased incidence of myocardial infarction after dental scaling based on insurance records of over 100,000 patients.
Do high risk patients have more danger?
The research discussed above indicates dental work does not substantially increase heart attack risk overall. But what about people already at high risk of heart disease?
Studies find the risk of heart attacks related to dental procedures is low even for high risk cardiovascular patients:
- Among over 14,000 high risk patients undergoing invasive dental care, only 4 cardiovascular events occurred within 30 days.
- For patients with cardiovascular disease, the incidence of heart attacks after dental procedures was not higher compared to control periods.
Therefore, there does not seem to be large added danger for those with existing heart conditions. However, more precautions may still be warranted.
Precautions for high risk patients
Although dental care does not seem to considerably increase heart attack risk, it may be prudent for high risk patients to take some precautions:
- Have dental work done soon after seeing a cardiologist – this allows optimization of heart medications and condition prior to procedures.
- Take antibiotics prior to invasive dental work to prevent infection.
- Take medication for pain/anxiety before dental appointments as needed.
- Arrange transportation to and from dental visits so as not to have to drive oneself.
- Schedule morning dental appointments to avoid fatigue.
- Use anesthetic injections to numb areas and minimize procedure pain.
- Ask the dentist to keep procedures as minimally invasive as possible.
Discussing additional precautions with dentists and doctors is wise for those at increased cardiovascular risk.
The bottom line
Based on multiple studies and meta-analyses over the years, there is little evidence that dental procedures significantly increase the risk of heart attacks for most people. Even for those with high cardiovascular risk, dental work does not seem to markedly raise the chances of having a myocardial infarction. So the bottom line is:
- Good oral health and necessary dental work should not be avoided due to fears of triggering a heart attack, even among high risk patients.
- However, some added precautions like antibiotics and pain medication are reasonable for those with high cardiovascular risk before invasive dental procedures.
- Talk to both dentists and doctors about any concerns and optimal precautions to take.
- But overall, while dental procedures can cause anxiety for some, they rarely lead to heart attacks based on the weight of research.
Conclusion
Dental care is essential for preventing cavities, infections, and tooth loss that can all seriously impact quality of life. For most people, dental procedures do not significantly increase the risk of heart attacks, even shortly after invasive treatments. There is a theoretical possibility that the pain, stress, inflammation, and bleeding of dental work could trigger heart problems. However, many large studies find only a very small heart attack risk around invasive dental procedures. Even for those with existing heart conditions, proper precautions can minimize any added dangers from dental treatments. Avoiding necessary dental work due to heart attack fears is likely unnecessary for most. Instead, focus on having good oral health and making sure dentists and doctors work together to optimize cardiac health before any invasive treatments. With reasonable precautions, dental work should be safe for the vast majority of people.