Bacterial Endocarditis and the Dental Appointment: What Should Patients Know?
Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Dr. David Sarment, Periodontist, Ann Arbor, Michigan
Published: January 4, 2026
Our post, “How To Avoid Bacterial Endocarditis Infections At The Dentist?”, got a significant response from our patient community. In particular, we received an interesting email from Dr. David Sarment, a board-certified periodontist and mitral valve surgery patient from Ann Arbor, Michigan. As you can read below, David provided several important points about bacterial endocarditis, dental health, and gum disease that I wanted to share with you.
Here is what David wrote to me…
I am a periodontist, and I read your June 12, 2024 post with great interest. After undergoing mitral valve repair surgery several years ago—and through many conversations with cardiologists—I have changed my perspective on this topic for two main reasons.
Antibiotics & Dental Care Risks
First, as Dr. Doug Johnston clearly stated in the post, endocarditis is a life-changing condition that should be avoided whenever possible. Cardiologists generally prefer that antibiotics be used preventively. However, dentists must follow the American Heart Association (AHA) guidelines, which urge caution when prescribing antibiotic prophylaxis. The main concerns are antibiotic resistance across the population and the risk of allergic reactions, given how commonly antibiotics are used.
While these are valid concerns, taking antibiotics before a dental visit often seems reasonable. For most patients, this simply means taking four pills one hour before the appointment. Dentists also have the option of consulting the patient’s cardiologist. I now do this more routinely than I used to, and I find that cardiologists often support the use of antibiotics as well.
The second consideration, in my view, is critical. The guidelines emphasize that everyday oral care—such as brushing and flossing—can also allow bacteria to enter the bloodstream. In other words, home dental care may pose just as much risk as a routine dental visit. For patients with healthy gums, this risk is low: there are fewer bacteria in the mouth, and the gum tissues form a strong barrier. Routine dental visits in these cases usually do not injure the gums.
Gum Disease: A Key Consideration
The situation is very different for patients with periodontal (gum) disease. About 4 in 10 adults over the age of 30 have some form of gum disease, and more than 70% of adults over 65 are affected. Gum disease is a chronic, low-grade infection of the tissues that support the teeth. In these patients, the bacterial load is higher, the gums are inflamed, and the natural barrier against bacteria is weaker. Even normal brushing and flossing can repeatedly injure these tissues, creating frequent opportunities for bacteria to enter the bloodstream.
Dental visits for gum disease aim to stabilize the condition, but they can also loosen plaque and hardened deposits (calculus), which may carry bacteria into the bloodstream as well. Antibiotics are typically used only around the time of the dental visit, so paradoxically, the ongoing risk at home may actually be greater. This makes it even more important for heart patients to remain free of gum disease whenever possible.
Timing Surgery
Prevention is always best. Ideally, periodontal health should be addressed well before a patient faces heart surgery. Cardiac surgeons routinely ask patients to see their dentist prior to surgery, and I have been asked many times to “clear” patients dentally. However, these decisions are largely left to the dentist’s judgment, as there are no clear guidelines defining what counts as a sufficiently stable dental condition.
For example, treating moderate gum disease often takes months, while heart surgery may be scheduled within weeks. Is an initial phase of treatment to control plaque and calculus enough? Another common scenario is a localized dental infection that we might normally be monitored or treated conservatively. In a heart surgery patient, should treatment be accelerated? Should a tooth with a poor long-term prognosis be removed sooner rather than later?
I now tend to be more definitive in these decisions than I used to be. Having experienced heart surgery myself, I believe recovery is best approached without unresolved dental concerns. In general, I strongly encourage preventing dental problems as early as possible. While this is good advice for everyone, it is especially important for patients with heart conditions, who should be even more diligent about their oral health.
Related Links:
- Doctor Q&A: How To Avoid Bacterial Endocarditis Infections At The Dentist?
- Bacterial Endocarditis: What Should Patients Know?
Dr. David Sarment
Mitral Valve Repair Patient
Ann Arbor, Michigan
Written by Adam Pick
- Patient & Website Founder
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