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

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).

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.

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.

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.