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Molecular and cellular effects relevant to myocardial injury following dental surgery in patients with and without coronary artery disease

Chronic dental disease is associated with elevation of systemic markers of chronic inflammation that play a role in the pathogenesis of atherosclerosis and its complications. However, to date there is no evidence that invasive dental treatment may serve as a trigger for acute cardiovascular events. An understanding of the precise molecular and cellular mechanisms that underly the vascular events associated with invasive oral health care is essential to improve the dental management of patients with known CAD. This present research was intended to determine if such mechanisms were possible. Forty Five patients (36 men and 9 women) referred for dental extraction were categorized into two groups (28 with and 17 without coronary artery disease). Venous blood samples were obtained before, immediately after and 24 hours after the dental procedure. A spectrum of biomarkers were used to assess myocardial injury (highly sensitive troponin T), systemic inflammation (CRP, fibrinogen, IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α, ICAM, E-selectin and P-selectin), endothelial injury (t-PA, PAI-1, vWF and thrombomodulin), bacterial burden (LPS endotoxin), psychological stress (cortisol), cellular oxidative stress (DHR), monocyte/macrophage activation (neopterin) and thrombin generation (TGA). Dental surgery was associated with a significant rise in hs-cTnT, acute systemic inflammation, a rise in bacterial LPS endotoxin, increase in hypercoagulable state and a tendency of intracellular OxS to increase. These changes were similar in both patients with or without CAD, with the changes in systemic inflammation, LPS endotoxin and OxS being more evident in those with hs-cTnT rise. The present study is the first to demonstrate that exodontia is associated with minor myocardial injury, representing a possible link between invasive dental treatment and acute cardiovascular events. The observed molecular and cellular changes may represent the possible mechanisms by which minor myocardial injury may occur following dental surgery. If proven to be clinically significant, the present observation of an hs-cTnT rise indicates that exodontia can have a negative impact upon the management of dental patients with CAD.
Date January 2014
CreatorsHabbab, K. M. A.
PublisherUniversity College London (University of London)
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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