Risk of Myocardial Infarction and Ischemic Stroke after Dental Treatments

J Dent Res. 2019 Feb;98(2):157-163. doi: 10.1177/0022034518805745. Epub 2018 Oct 25.


The association between invasive dental treatments (IDTs) and a short-term risk of myocardial infarction (MI) and ischemic stroke (IS) remains controversial. Bacterial dissemination from the oral cavity and systemic inflammation linked to IDT can induce a state of acute vascular dysfunction. The aim of study is to investigate the relation of IDTs to MI and IS by using case-only study designs to analyze data from a large Taiwanese cohort. A nationwide population-based study was undertaken by using the case-crossover and self-controlled case series design to analyze the Taiwanese National Health Care Claim database. Conditional logistic regression model and conditional Poisson regression model were used to estimate the risks of MI/IS. In addition, we used burn patients as negative controls to explore the potential effect of residual confounding. In total, 123,819 MI patients and 327,179 IS patients in the case-crossover design and 117,655 MI patients and 298,757 IS patients were included in the self-controlled case series design. Results from both study designs showed that the risk of MI within the first 24 wk after IDT was not significantly different from or close to unity except for a modest risk during the first week for patients without other comorbidities (odds ratios [95% confidence intervals] of 1.31 [1.08-1.58] and 1.15 [1.01-1.31] for 3 d and 7 d, respectively). We also observed no association between IDTs and IS, or the risk ratio was close to unity. IDTs did not appear to be associated with a transient risk of MI and IS in the Taiwanese population, with consistent findings from both case-only study designs. However, we cannot exclude that dental infections and diseases may yield a long-term risk of MI and IS.

Keywords: cardiovascular diseases; case-crossover; case-only study; epidemiologic studies; retrospective studies; self-controlled case series.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnosis
  • Brain Ischemia / epidemiology
  • Brain Ischemia / microbiology*
  • Case-Control Studies
  • Cross-Over Studies
  • Dental Care / adverse effects*
  • Female
  • Humans
  • Insurance, Health / statistics & numerical data*
  • Male
  • Middle Aged
  • Mouth / microbiology
  • Mouth / surgery*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / microbiology*
  • Oral Surgical Procedures / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / microbiology*
  • Taiwan / epidemiology