“Should I Get A Teeth Cleaning Before Heart Surgery?” Asks Karen

I just received an interesting question from Karen about teeth cleaning before heart surgery.

Karen writes to me, “Adam – Next month, I’m going in for valve replacement due to a stenotic aortic valve. I’ve been watching my valve slowly deteriorate over the past 10 years, so I’ve had time to mentally and physically prepare for the procedure. Quick question… I’ve read that I should get a teeth cleaning before heart surgery. Is that true? Thanks for your all you do! Karen”

Teeth Cleaning Before Heart Valve Surgery

After reading Karen’s question, I did not recall visiting my dentist for a cleaning prior to heart valve surgery. As my memory isn’t that great, I checked with Robyn, my wife. Robyn quickly confirmed that I did not have my teeth cleaned before my operation.

Still, I wanted a professional opinion prior to publishing this blog about teeth cleaning before heart surgery.

So, I contact Dr. Allan Stewart, M.D., the Director of NewYork-Presbyterian’s Aortic Valve Program. Here is what Dr. Stewart told me:

Dr. Allan Stewart, M.D.

No, it is unnecessary to get a teeth cleaning before heart surgery. However, it is a good idea to get a dental exam prior to surgery in order to rule out significant decay. Any significant loose teeth may harbor bacteria, which could infect a new heart valve.  An elective teeth cleaning should also be delayed for about 12 weeks, in order for the valve to heal in place.  There is also some confusion about antibiotics before dental work after valve surgery. The current information suggests that it is unnecessary, but I would advise taking antibiotics if the work is within 3 months of heart valve surgery.

I hope that helps answer Karen’s question about teeth cleaning before heart surgery. Thanks to Dr. Stewart!

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

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  • M.Montgomery

    Am I understanding that it is no longer necessary to have antibiotics before teeth cleaning or dental work ? No one has told me and I am still taking them. I had mechanical aortic heart valve replacement about 6 years ago. Is there somewhere I can find this information online ? Thanks.

  • Dale P.

    I’ve been told by my cardiologist, surgeon and dentist, within the last few months, that I DO need to take antibiotics before having my teeth cleaned or work on.

  • Jim Campbell

    Received my St. Jude Medical Biocor™ Stented Tissue Valve on Jan 21, 2010, model number ESP100-25-00 and the information given to me by them clearly states antibiotics are to be taken prior to teeth cleaning.
    In fact my Urologist requried an infusion of antibiotics before a prostate biopsy.

    I’m not saying the surgeon is incorrect but I would choose to protect the valve with all precautions after having gone through the surgery.

    Jim Campbell

  • Mark kappel

    I had aortic valve replacement one year
    Ago tomorrow. My surgery required me
    to have dental exam and general cleaning before
    Surgery.
    Also, my dentist does require me to take pre- meds
    Antibotics Before every dental visit now.

  • Robin Hirsch

    Regarding teeth cleaning…my surgeon, Dr. Alfredo Trento, required a letter from my dentist that I had recently had my teeth examined and had no infections. I was told that any infection in your mouth can easily get into your bloodstream. During and after surgery you are particularly vulnerable for infection, so a clean mouth is very important.

  • Carole Wiley

    I had an aortic value replacement June 11th at MGH. Dr. Agnihotri advised that I have my mouth and teeth checked for any signs of infection before surgery. In fact, my dentist was requested to send a letter stating the fact.

  • Cindy

    I AM A DENTAL HYGIENIST & MY HUSBAND IS A DENTIST. I had a mitral valve & tricuspid valve repair in ’09. I needed a letter that I was in good dental health prior to surgery. My cardiologist wants me to ALWAYS take pre-med antibiotics before ANY dental work to be safe. Personally I would take them even if not “required”!!! The heart association has changed some of their criteria … but many of us in the dental field are NOT comfortable with the change. Understandably we don’t want to over take antibiotics, but for cleaning the teeth … there is so much chance of getting bacteria into the bloodstream & ANY other dental treatment that will likely cause any bleeding. My husband … the dentist just said “NO WAY, pre-med forever after any repair OR replacement valve.” He said ALWAYS with a replacement!!!

    The reason is that IF any bacteria (and even a healthy mouth has loads of it!!) gets into the bloodstream it tends to find any sort of surface that may trap bacteria. I have the annular rings for example … but any nook or cranny will do for the bacteria to attach to & grow. The result can be bacterial endocarditis … a very serious condition for anyone to have, but especially a valve surgery patient!!!

    Anyone with severe valve damage should be pre-medicated prior to dental cleanings. I have been for the past 36 years! It is an easy treatment & can protect you from so much possible harm!

  • MJ Samer

    I also had a dental exam in the week prior to my heart surgery when I had a valve replaced last fall. I was also told to continue to take antibiotics prior to dental exams. On both the advice of my cardiologist and dentist, I waited several months after heart surgery to have dental work done (a crown) and was pre-medicated for that, too.

  • Adam Pick

    Thanks everybody for all of your comments and discussion about this topic.

    It’s very interesting.

    Even though the guidelines from the American Heart Association (AHA) have been revised, it appears that many of us still pre-medicate before dental visit after heart valve surgery. I fall into that category as well. Doctor Starnes, my surgeon, suggested I continue to pre-medicate before any dental procedure — after my double valve replacement.

    Again, thanks for sharing!!!

    Keep on tickin!
    Adam

  • Andrew

    Hi Adam

    Please delete my message sent at 7.18am here is what I meant to say

    I had my aortic valve replaced in July 08. At the time my surgical team were keen to point out how dangerous infective endocarditis is and on several occasions during my stay insisting I should always have prophylactic antibiotic treatment if potentially invasive dental treatment was being considered.

    However my dentist does not consider it necessary and quotes the NICE (National Insititute of Clinical Excellence) guidelines published in the UK in March 08 (you can obtain a copy from their Website). My reading of their findings is that there might be a small benefit in pre treatment with antibiotics but that is no statistically conclusive evidence to support a view. I might add that my sugical team did not think the guidelines were very helpful.

    My dentist quotes the followng to support not taking antibiotics prior to any potentially invasive treatment:

    1 in taking antibiotics there is a very small chance of anaphylaxis which is also a life threatening condition.

    2build up of resistance to the antibiotics used.

    3brushing teeth every day has a similar risk of infection)

    However I always tell him that I will always follow the advice of my cardiology team and since they recommend taking antibiotics prior to any potential invasive dental treatment that is what I always do.

  • Kerrigan

    Both the cardologist and the dentist said I should continue with the antibiotics prior to any cleaning or procedure. The dentist would not do a cap replacement until at least 6 months after the heart valve replacement surgery.

  • stephanie crummey

    I redcently underwent a valve replacement operation (aortic) and was advised prior to it to ensure my teeth were in good condition and that I didnt have any gum disease. This was easy to do, and it was very useful and gave me peace of mind. My operation was successful and it is now 6 weeks since and I am due to see my surgeon for a post op checkup today.

  • trish

    My son is 16 yrs old Was born with corrected transpoition of great ateries Had a double switch at age 3 with a baffle placed in his upper atrium also had a pacemaker put in He now needs his aortic valve replaced He does not want a mechanical valve due to taking coumadin and the restrictions What advice do you have for a valve His surgeon is at U of Michigan/Mott I asked about the free-style valve from medtronic surgeon said not an option due to his previous procedure said he needed a stented valve

  • sundari sathish

    I had a mechanical valve replaced for my tricuspid valve last week, and my surgen had insisted to have a dental opinion befor the surgery as it helps prevent any infection that may araise due to the teeth, also in the hospital they gave me oral rinsing liquids and asked me to rinse every 2 hrs before the operation.

  • Trent Viavattene

    I had my teeth cleaned before my Mitral Valve repair simply because I knew it would be some time before I was able to do it after the surgery. My surgeon did not require the dental exam.

    Trent V

  • jean

    Just cancelled my dental cleaning because of the antibiotic issue. This is not a good choice but I will follow the dental hygiene protocol of Ellie Phillips until I get better answers. My own primary care MD insisted on antibiotics for a sliver in my foot a year after aortic valve replacement. The DDS is insisting on antibiotics, so does my primary and the Cardiologist defers to the DDS. I have had way to many antibiotics. A few months after taking them my immune system crashes and this has happened the last three times. It takes me months to recover and I can barely function. I have to chose function over fear. Years in the health care field has taught me that lots of protocols are fueled by liability issues. To be safe the provider will protect himself even at the cost of the patient’s overall health and well being. In the end, we are responsible for ourselves.

  • Pam Dorman

    I have a family member that is going to have to have open heart surgery. She is a Hogkins cancer survivor.Has been told to have her last 13 teeth removed before they can do her surgery. She also has no spleen.Was reading this page so I could learn the best way for her to do all of this.

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