A patient is scheduled for open-heart surgery in three weeks. What dental management is appropriate?

Correct answer: B. Complete the necessary extractions AND the prophylaxis before the cardiac surgery

• A. Deferring the prophylaxis leaves untreated periodontal inflammation as an ongoing source of bacteraemia at the very moment the patient is most vulnerable.
• B. CORRECT. The purpose of preoperative dental clearance is to eliminate every potential source of bacteraemia BEFORE prosthetic material is implanted, because seeding of a new valve or graft causes prosthetic valve endocarditis — a complication with very high mortality. Both the extractions and the periodontal debridement must therefore be completed beforehand, and three weeks allows adequate healing (a minimum of about 2 weeks is generally sought).
• C. Deferring everything defeats the purpose of clearance entirely and is the option most likely to lead to prosthetic valve endocarditis.
• D. Leaving hopeless or infected teeth in place until after cardiac surgery leaves the principal source of infection untouched, and post-operatively the patient will be anticoagulated, making extraction more hazardous.

Note: Coordinate directly with the cardiac team on timing. After valve surgery the patient will usually be on lifelong warfarin or a DOAC and will fall permanently into the AHA prophylaxis category — so getting the mouth into a maintainable state beforehand pays dividends for years.