A patient is referred before open-heart surgery for dental clearance. There are two hopeless teeth; one has prior root canal treatment with a periapical lesion. What is the most appropriate management before surgery?

Before cardiac surgery (especially valve procedures), active dental infection and hopeless teeth must be eliminated preoperatively to reduce the risk of bacteremia and infective endocarditis. Hopeless teeth and a tooth with persistent periapical pathology should be extracted before surgery.Other options: Retreating a hopeless tooth is not indicated; delaying removal of infectious foci or relying on antibiotics alone leaves a surgical infection risk.Key exam takeaway: Pre-cardiac-surgery clearance: eliminate active infection and hopeless teeth before the operation.