Objectives: In this paper we outline how inflammation related to oral disease such as periodontitis, bacteraemia and pulpal lesions have been linked to cardiovascular disease and undertake a systematic review of the literature focused on acute dental infection and cardiac arrhythmia. We also describe an illustrative case where an acute oral infection was associated with occurrence of new onset atrial fibrillation (AF). Methods: An electronic search was undertaken using MEDLINE and SCOPUS from 01 Jan 1970 until 30 June 2020. We also undertook manual searches using forward and backward citation chasing. Inclusion criteria were any primary research studies investigating symptomatic apical infections or dental abscess with outcomes of arrythmia. Results Over the last fifty years, only two low quality studies have been investigated this area. Our illustrative case involved a 58-year-old who was diagnosed with an acute dental infection from an upper canine tooth. The patient later developed tachycardia and new-onset AF. Conclusions: Based on the biological plausibility of a link between acute dental infection and arrythmia, together with the case report presented, it is evident that further study in this area is needed. If there are possible cardiovascular consequences for patients suffering acute dental infections, this has future implications for healthcare staff as they can integrate professional advice related to oral health and cardiovascular disease. Screening programmes situated in dental settings can also facilitate early intervention and prevention producing benefits not just for patients, but in savings to the health system.
Background Identification of published data on prevalent/incidence of atrial fibrillation/flutter (AF) often relies on inpatient/outpatient claims, without consideration to other types of healthcare services and pharmacy claims. Purpose To examine AF prevalence/incidence and associated individual comorbidity and multi-morbidity profiles for a large US adult cohort spanning across a wide age range for both males/females based on both medical/pharmacy claims. Methods We studied a population of 8,343,992 persons across many geographical areas in the U.S. continent from 1 January /2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analyzed for different healthcare parameters. Results Based on integrated medical and pharmacy claims, AF prevalence was 12.7% in the elderly population (> 65 years) and 0.9% in the younger population (< 65 years). These prevalence rates are different from estimates provided by the US CDC for those aged > 65 years (9%) and age < 65 years (2%); thus, the prevalence is under-estimated in the elderly population and over-estimated in the younger population. The incidence ratios for elderly females relative to younger females was 15.07 (95%CI 14.47-15.70), a value that is about 50% higher than for elderly males (10.57 (95%CI 10.24-10.92)). Comorbidity risk profile for AF identified on the basis of medical and pharmacy criteria varied by age and sex. The proportion with multimorbidity (defined as ≥2 long term comorbidities) was 10-12%. Conclusion Continued reliance only on outpatient and inpatient claims greatly underestimates AF prevalence and incidence in the general population by over 100%. Multimorbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with 4 or more co-morbidities captured 20 to 40% of the AF cohorts depending on age groups and prevalent or incident cases. Our proposed methodology can guide future analysis of quality/cost of care for progressive medical conditions at the population level.