Putative role of prosthetic dental implants in the development of cardiac sarcoidosis: A case-control study

Muthiah Subramanian; Debabrata Bera; Jospeh Theodore; Jugal Kishore; Akula Srinivas; Daljeet Saggu; Sachin Yalagudri; Calambur Narasimhan

doi:10.36141/svdld.v38i3.110922

Putative role of prosthetic dental implants in the development of cardiac sarcoidosis: A case-control study

Sarcoidosis Vasc Diffuse Lung Dis. 2021;38(3):e2021023. doi: 10.36141/svdld.v38i3.110922. Epub 2021 Sep 30.

Authors

Muthiah Subramanian¹, Debabrata Bera¹, Jospeh Theodore¹, Jugal Kishore², Akula Srinivas³, Daljeet Saggu¹, Sachin Yalagudri¹, Calambur Narasimhan¹

Affiliations

¹ Department of Cardiac Sciences and Research, AIG Hospitals, Gachibowli, Hyderabad, India.
² Department of Rheumatology, CARE Hospital, Banjara Hills, Hyderabad, India.
³ Department of Dentistry/Dental surgery, CARE Hospital, Banjara Hills, Hyderabad, India.

Abstract

Background: Etiopathogenesis of cardiac sarcoidosis is poorly understood. The objective of this study is to examine a possible role of previous dental procedures on the development of cardiac sarcoidosis (CS).

Methods: Clinical details of 73 patients with CS from the Granulomatous Myocarditis Registry were extracted. Data regarding clinical presentation, comorbidities, baseline electrocardiogram, echocardiogram, and ¹⁸fluorodeoxyglucose(FDG) PET-CT was extracted from the registry database. A comprehensive history of dental procedures for all patients was recorded. The two control groups comprised of 79 patients with idiopathic ventricular tachycardia and/or complete heart block (with similar clinical presentation) and 145 healthy age and sex matched patients, respectively.

Results: Dental evaluation revealed that patients with CS had undergone a previous prosthetic dental implant(PI) (OR 12.4, 95% CI 4.0-38.1, p<0.001) or root canal treatment (RCT) (OR 2.43, 95% CI 1.12-5.26, p=0.025) more often than the healthy controls. The patients with CS and previous dental procedures had higher¹⁸FDG uptake in the LV myocardium (SUV max 8.6±3.3vs.5.5 ±1.8 (mean±SD), p<0.001) and mediastinal lymph nodes (9.3±4.6vs.5.4±1.7 (mean±SD), p<0.001) as compared to patients who did not undergo a dental procedure. The subset of CS patients with a previous PI or RCT had higher uptake levels in the myocardium (max SUV 9.4±3.1vs.6.7±2.0, p=0.011, number of abnormal LV Segments 10.3±3.1vs.6.5±2.8(mean±SD), p=0.008) and mediastinal lymph nodes(max SUV 10.5±4.8vs. 7.2±1.8,p=0.002) compared to those who underwent crowning or extraction. In addition, CS was diagnosed after a shorter latency period (47.3±21.0vs.81.6±25.3 months (mean±SD), p<0.001) following PI and RCT compared to other dental procedures.

Conclusions: We observed a significant association between PI and RCT and the occurrence of CS. This group of patients also appear to have a more severe form of the disease.