From the Research
Dental work, including tooth extractions, should ideally be completed at least two weeks before scheduled cardiac valve repair surgery, as supported by the most recent and highest quality study 1. This timing allows for adequate healing of the oral tissues and reduces the risk of bacteria entering the bloodstream during the cardiac procedure. For patients awaiting mitral valve repair, it's recommended to inform your dentist about your upcoming cardiac surgery so they can prioritize necessary dental treatments. Some key points to consider include:
- Antibiotic prophylaxis may be required before dental procedures; typically amoxicillin 2g orally one hour before the dental procedure, or for those allergic to penicillin, clindamycin 600mg orally one hour before, as shown in a study 1.
- After valve repair, you'll need antibiotic prophylaxis for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth.
- This precaution is necessary because dental procedures can cause transient bacteremia, where oral bacteria enter the bloodstream and potentially colonize the heart valve, leading to infective endocarditis, as discussed in a study 2.
- Poor dental health is a significant risk factor for valve infections, which is why addressing dental issues before cardiac surgery is essential for reducing post-operative complications, as highlighted in a study 3.
- A study comparing different preoperative dental screening approaches found no significant difference in 90-day mortality between patients who underwent a focused approach versus a comprehensive approach, but reoperation due to infection was less in the focused approach group 4.
- Another study found that invasive dental procedures, particularly extractions and oral surgery, were significantly associated with endocarditis in high-risk individuals, but antibiotic prophylaxis significantly reduced endocarditis incidence following these procedures 1.