1 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.
2 Periodontology Unit, UCL Eastman Dental Institute, London, UK.
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.
侵袭性牙科治疗（IDT）与心肌梗死（MI）和缺血性卒中（IS）的短期风险之间的关联仍存在争议。口腔细菌传播和与 IDT 相关的全身炎症可导致急性血管功能障碍状态。本研究旨在通过使用病例对照研究设计分析来自大型台湾队列的数据，来研究 IDT 与 MI 和 IS 的关系。通过使用病例交叉和自身对照病例系列设计对台湾全民健康保险索赔数据库进行了一项全国性的基于人群的研究。使用条件逻辑回归模型和条件泊松回归模型来估计 MI/IS 的风险。此外，我们使用烧伤患者作为阴性对照来探索潜在的残余混杂效应。在病例交叉设计中，共纳入了 123819 例 MI 患者和 327179 例 IS 患者，在自身对照病例系列设计中，纳入了 117655 例 MI 患者和 298757 例 IS 患者。来自这两种研究设计的结果均表明，除了无其他合并症的患者在第一周风险略高（无其他合并症的患者在 3 天和 7 天的比值比 [95%置信区间]分别为 1.31 [1.08-1.58]和 1.15 [1.01-1.31]）外，IDT 后 24 周内 MI 的风险与无风险相比差异无统计学意义或接近 unity。我们还观察到 IDT 与 IS 之间无关联，或风险比接近 unity。在台湾人群中，IDT 似乎与 MI 和 IS 的短暂风险无关，两种病例对照研究设计均得出一致的结果。然而，我们不能排除牙科感染和疾病可能产生 MI 和 IS 的长期风险。
