1 Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
2 Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
J Dent Res. 2018 Sep;97(10):1100-1105. doi: 10.1177/0022034518767834. Epub 2018 Apr 10.
Invasive dental treatment is suggested to be associated with an increased risk for the development of cardiovascular events. We tested the hypothesis that the incidence of a first myocardial infarction (MI) within 4 wk after invasive dental treatments is increased. A registry-based case-control study within nationwide health care and population registries in Sweden was performed. The case patients included 51,880 individuals with a first fatal or nonfatal MI between January 2011 and December 2013. For each case, 5 control subjects, free from prior MI and matched for age, sex, and geographic area of residence, were randomly selected from the national population registry through risk set sampling with replacement, resulting in 246,978 control subjects. Information on dental treatments was obtained from the Dental Health Register, and the procedures were categorized into invasive dental treatments or other dental treatments. Conditional logistic regression was used to estimate odds ratios (ORs) for MI with corresponding 95% confidence intervals (CIs). In addition to the matching variables, adjustments were made for the following confounders: diabetes, previous cardiovascular disease (CVD), CVD drug treatment, education, and income. The mean age for case patients and controls subjects was 72.6 ± 13.0 y and 72.3 ± 13.0 y, respectively. Case patients more often had previous CVD (49% vs. 23%; P < 0.001) and diabetes (19% vs. 11%; P < 0.001) and received more treatment with CVD drugs (68% vs. 56%; P < 0.001) than control subjects. There was no association between invasive dental treatments during the 4 wk preceding the MI index date (crude OR = 0.99; 95% CI, 0.92 to 1.06; adjusted for confounders OR = 0.98; 95% CI, 0.91 to 1.06). This study did not support the hypothesis of an increased incidence of MI after recent invasive dental treatment.
侵袭性牙科治疗与心血管事件发生风险增加相关。我们检验了这样一个假设，即在侵袭性牙科治疗后 4 周内首次发生心肌梗死（MI）的发生率是否增加。这是一项在瑞典全国医疗保健和人口登记处进行的基于登记的病例对照研究。病例患者包括 2011 年 1 月至 2013 年 12 月期间首次发生致命或非致命性 MI 的 51880 人。对于每个病例，通过风险集抽样替换从全国人口登记处随机选择 5 名对照，无既往 MI 且年龄、性别和居住地地理区域匹配，共选择了 246978 名对照。牙科治疗信息从牙科健康登记处获得，将程序分为侵袭性牙科治疗或其他牙科治疗。采用条件逻辑回归估计 MI 的优势比（OR）及其相应的 95%置信区间（CI）。除了匹配变量外，还对以下混杂因素进行了调整：糖尿病、既往心血管疾病（CVD）、CVD 药物治疗、教育和收入。病例患者和对照组患者的平均年龄分别为 72.6±13.0 岁和 72.3±13.0 岁。病例患者既往 CVD（49%比 23%；P<0.001）和糖尿病（19%比 11%；P<0.001）更为常见，并且接受 CVD 药物治疗的比例更高（68%比 56%；P<0.001）。在 MI 索引日期前 4 周内进行侵袭性牙科治疗与 MI 之间没有关联（未经调整的 OR=0.99；95%CI，0.92 至 1.06；调整混杂因素后的 OR=0.98；95%CI，0.91 至 1.06）。本研究不支持侵袭性牙科治疗后 MI 发生率增加的假设。
