Pre-Cardiac Dental Treatment Does Not Increase the Risk of Adverse Events.

PURPOSE: Elimination of dental sources of infection prior to cardiovascular surgery (CVS) is performed to reduce perioperative infection and complications. This study aims to evaluate if preoperative dental intervention is associated with increased risk of adverse events. METHODS: A retrospective medical record review of inpatient consultations (n = 1513) completed by the Hospital Dentistry Service at University of California Los Angeles Medical Center from January 2011 to December 2020 was performed. Seven hundred thirty-eight consults met the inclusion criteria and were divided into 4 groups: Group A were patients that were dentally unhealthy and received surgical dental intervention (n = 265), Group B were patients that were dentally unhealthy and underwent non-surgical dental treatment (n = 14), Group C were patients that were dentally unhealthy and did not receive the recommended dental treatment (n = 29), and Group D were patients that were dentally healthy requiring no intervention (n = 430). They were evaluated for major adverse events in 3 categories: dental complications, medical adverse events and death. RESULTS: Dental complications were only experienced in Group A, all of which were bleeding. Only 2 patients were found to have major bleeding, which was more likely due to anticoagulation and CVS rather than dental extractions. There was no significant difference in the number of medical adverse events or number of deaths during the postoperative period between groups. CONCLUSIONS: The results of this study suggest that elimination of oral infection prior to CVS does not increase the risk of morbidity or mortality.

Augmenting patient monitoring during intravenous moderate sedation with artificial intelligence: A pilot study.

PURPOSE/OBJECTIVES: A precordial stethoscope (PS) is essential for ensuring clear breath sounds during open airway sedations. However, a traditional PS limits the ability of new users to simultaneously listen to heart and lung sounds alongside experienced practitioners, hindering their learning and development. Bluetooth speaker systems allow for multiple providers but amplify all noise. An artificial intelligence (AI) PS has the potential to selectively reduce ambient noise, allowing multiple providers to monitor concurrently and provides a visual representation of the sound waves. The study looks at the benefits of AI PS in teaching in the dental setting. METHODS: A questionnaire was created to compare the new AI PS to a conventional PS during intravenous moderate sedation in a dental clinic setting. RESULTS: Sixteen individuals involved in sedations (four dental attendings, seven dental residents, and five dental assistants), were polled with a 100% response rate. 75% of participants agreed that clarity was improved using the AI PS and 81.25% of participants agreed that breath sounds and loudness were improved using the AI PS. 93.75% reported the AI PS was beneficial in allowing attendees to concurrently monitor a sedation case alongside dental residents. 100% of assistants reported that the AI PS benefited from their participation in sedation cases. CONCLUSION: As technology advances, it is important that we as providers continue to evolve and consider implementing AI to improve our ability to monitor patients and enhance educational experiences for dental resident trainees.

A retrospective chart review evaluating pre-operative dental extractions on patients with end-stage heart failure undergoing advanced surgical cardiac therapies.

OBJECTIVES: End-stage heart failure patients are functionally compromised by multiple physiologic mechanisms, placing them at increased risk of peri- and post-operative complications. This study aimed to evaluate if dental treatment performed before advanced cardiac interventions, including orthotopic heart transplant and mechanical circulatory support, increases the risk of adverse events. STUDY DESIGN: A retrospective chart review spanning January 2011 to December 2020 was performed. Inpatients with end-stage heart disease were evaluated by the hospital dentistry service at UCLA Ronald Reagan Medical Center. Three hundred and five consults met the inclusion criteria. The patients were divided into 2 groups: those who underwent dental treatment and those who did not require dental treatment. The wait time from dental consultation to cardiac intervention (days), dental complications, medical adverse events, and deaths were evaluated. RESULTS: Dental complications were only experienced in the form of intraoral bleeding. There was no significant difference in the number of medical adverse events or deaths between groups. CONCLUSIONS: The elimination of oral infection before advanced cardiac interventions does not increase the risk of morbidity or mortality.

Dexmedetomidine reduces the amount of benzodiazepines and opioids administered during moderate conscious sedation for dental treatment.

AIM: To assess the efficacy of dexmedetomidine (DEX) on the intravenous moderate sedation (IVMS) regimen, while treating patients of the special patient care (SPC) population. This study aims to incorporate DEX into the typical IVMS drug regimen in order to reduce the amount of benzodiazepines (BZD) and opioids administered and as a result reduce the amount of unwanted side effects. METHOD AND RESULTS: A retrospective study was performed in the University of California Los Angeles (UCLA) SPC Clinic, where 42 patients were seen with and without DEX for dental treatment under IVMS. Medications administered, vital signs, and complications were recorded at 5 minute intervals over the first hour. All BZDs and opioids were converted to their IV midazolam and IV fentanyl equivalents, respectively. An opioid conversion equation was developed to summate the total amount of anesthetic agents administered. Data were analyzed by t-test. The amount of BZDs administered was reduced, however the decrease was not statistically significant (P = .066). There was a significant reduction in opioids (P < .05) and total anesthetic agents (P < .05) administered. CONCLUSION: The addition of DEX to the anesthetic regimen results in a reduction of overall medications administered.