Summary Background There are 800,000 heart attacks in the United States each year. There is an increased risk of hospitalization for acute myocardial infarction (AMI) for people with periodontal disease. However, there is a paucity of knowledge regarding AMI aftercare and how it varies with the status of periodontal care. The authors’ objective was to examine the association between periodontal care and hospitalization for AMI and 30 days after acute care. Methods Using the MarketScan database, the authors conducted a retrospective cohort study among patients with dental insurance and medical insurance between 2016 and 2018 who were hospitalized for AMI in 2017. Results There were 2,370 patients who had dental and medical coverage from 2016 to 2018 and received oral health care between 2016 and 2017 and had a hospitalization for AMI in 2017. Forty-seven percent received regular or other oral health care, 7% received active periodontal care, and 10% received controlled periodontal care. More than one-third of patients (36%) had no oral health care before hospitalization for AMI. After adjusting for patient characteristics, we found that patients in the controlled periodontal care group were significantly more likely to have visits within 30 days after hospitalization for AMI (adjusted odds ratio, 1.63; 95% CI). % 1.07 to 2.47; P = 0.02). Conclusions We found that periodontal care was associated with more post-MI visits. This suggests that there is a benefit to incorporating oral health care and medical care to improve AMI outcomes. Practical implications The need for periodontal care is associated with more favorable outcomes related to hospitalization for AMI. Early intervention to ensure stable periodontal health in patients with AMI risk factors could reduce downstream hospital resource use. |
University of Michigan
Synthesis
Researchers studied patients who received periodontal care, dental cleanings, or no dental care during 2016-2018 and who suffered an acute myocardial infarction (heart attack) in 2017. They found that patients who had heart attacks and received maintenance care periodontal disease had the shortest hospital stay and most follow-up visits. The longest stay was experienced by the group without dental care.
Comments
Conventional wisdom is that medical and dental care are related, but less is known about how dental care relates to health outcomes after acute incidents such as heart attacks.
To that end, researchers at the University of Michigan studied patients who received periodontal care, dental cleanings, or no dental care during 2016-2018 and who suffered an acute myocardial infarction (heart attack) in 2017.
They found that patients who had heart attacks and received periodontal maintenance care had the shortest hospital stay and more follow-up visits. The longest stay was experienced by the group without dental care.
"After controlling for several factors, the periodontal care group was more likely to have subsequent hospital visits," said study co-author Romesh Nalliah, associate dean of patient services at the U-M School of Dentistry.
There was no statistically significant difference between the other groups (active periodontal care and regular care) compared to the no care group.
The study, published in the Journal of the American Dental Association , did not establish a causal relationship between periodontal disease and heart disease, but research like this adds weight to the understanding that there is an association between oral health and general health, Nalliah said.
There are 800,000 heart attacks in the United States each year, and people with periodontal disease have a higher risk of hospitalization after a heart attack, he said.
Nalliah and colleagues wanted to examine the association between periodontal care and heart attack hospitalization and follow-up visits within 30 days of acute care. Using the MarketScan database, they found 2,370 patients who met the study criteria. Of them, 47% percent received regular or other oral health care, 7% received active periodontal care (root planing and periodontal scaling), and 10% received controlled periodontal care (maintenance). More than 36% had no oral health care before being hospitalized after a heart attack.
"Dentistry is often practiced in isolation from general medical care," Nalliah said. "Our results add weight to the evidence that medical and dental health are closely interrelated. More and more studies like ours show that it is a mistake to practice medicine without carefully considering the patient’s oral health."
Nalliah said better communication between the medical and dental teams could help with early intervention to ensure stable periodontal health in patients who have risk factors for heart disease.
"It is important to include dental care in routine medical care and this means that insurance companies must facilitate this connection rather than offering dental insurance as a separate additional coverage," he said.
Reference : Romesh P. Nalliah, Tanima Basu, Chiang-Hua Chang. Association between periodontal care and hospitalization with acute myocardial infarction . The Journal of the American Dental Association, 2022; 153 (8): 776 DOI: 10.1016/j.adaj.2022.02.003
Co-authors include Tanima Basu, senior statistician at the Michigan Hospital Medicine Safety Consortium, and Chiang-Hua Chang, research assistant professor at Michigan Medicine.
