The perioperative dental screening and management of patients undergoing cardiothoracic, vascular surgery and other cardiovascular invasive procedures: A systematic review

Background: One controversial issue in the relationship between oral care and cardiovascular diseases is how and whether to manage oral infections prior to cardiovascular surgery or other cardiovascular invasive procedures. Design: We designed a systematic review to assess the information available on three main questions. Is there an agreement on the need for dental evaluation and treatment before cardiovascular interventions? Are consistent clinical recommendations or protocols available? Is dental treatment prior to cardiovascular interventions effective? Methods: A systematic electronic search of MEDLINE, Scopus and Web of Science was performed from the database inceptions up to 31 April 2016. Searches were performed using Boolean operators to combine medical subject headings and free text words. Because this review included a large, heterogeneous group of study designs and sources, the results were synthesised in a narrative approach. Results: In total, 2447 studies were identified: 2099 ( +241 duplicates) were excluded after screening; 107 were included for full-text assessment; 55 were excluded for not meeting the inclusion criteria; and 11 were not available. Thus, 44 studies meeting the inclusion criteria were analysed. We found that, for patients undergoing cardiovascular surgery, there is a general agreement on the need for screening and treatment of dental infections, but not on the protocols. We also found that there are conflicting indications on when and to what extent to perform the treatment and that the risk-tobenefit ratios for these treatments are controversial. Conclusion: No satisfactory answers regarding dental care before cardiovascular invasive procedures are available.