Effect of dental treatment before cardiac valve surgery: Systematic review and meta-analysis

Peter B. Lockhart, Hillary R. DeLong, Ruth D. Lipman, Elliot Abt, Larry M. Baddour, Monica Colvin, Craig S. Miller, Thomas Sollecito, Kelly O'Brien, Cameron G. Estrich, Marcelo W.B. Araujo, Alonso Carrasco-Labra

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Background: The purpose of this systematic review was to determine the potential effect of dental treatment before cardiac valve surgery (CVS) or left ventricular assist device (LVAD) implantation on morbidity and mortality. Types of Studies Reviewed: The authors included relevant studies from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, including randomized controlled trials and cohort studies, published from 1998 through 2019 and involving adults who received dental treatment before CVS or LVAD implantation. The authors assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and evidence certainty by using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors used a meta-analysis with a random-effects model to estimate dichotomous and continuous outcomes, expressed as relative risk (RR) and weighted mean difference. Results: Six studies met the inclusion criteria for CVS but none for LVAD implantation. Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not. Postsurgical outcomes included all-cause mortality (RR, 1.00; 95% confidence interval [CI], 0.53 to 1.91), infective endocarditis (RR, 1.30; 95% CI, 0.51 to 3.35), postsurgical infection (RR, 1.01; 95% CI, 0.76 to 1.33), and length of stay in the hospital (weighted mean difference, 2.9; 95% CI, −2.3 to 8.1). Conclusions and Practical Implications: From the available evidence, it is unclear whether postoperative outcomes differ in patients receiving dental treatment before CVS compared with outcomes in those who do not. Dentists and medical care professionals should collaborate on an appropriate course of action for each patient, weighing any potentially relevant care considerations.

Original languageEnglish
Pages (from-to)739-747.e9
JournalJournal of the American Dental Association
Issue number9
StatePublished - Sep 2019

Bibliographical note

Publisher Copyright:
© 2019 American Dental Association


  • Cardiac
  • dental clearance
  • medically complex
  • presurgical
  • pretreatment

ASJC Scopus subject areas

  • General Dentistry


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