A patient needs dental clearance 3 weeks before open-heart surgery. Examination reveals 2 non-restorable teeth and 1 tooth with a previous failed root canal treatment with a periapical lesion. What is the most appropriate dental management prior to surgery?

Pre-cardiac surgery dental clearance aims to eliminate ALL active oral infection foci that could cause bacteremia and endocarditis after surgery. The 2 non-restorable teeth must be extracted — this is non-controversial. The tooth with a FAILED RCT and a PERIAPICAL LESION represents a persistent infection source. With only 3 weeks until surgery: Re-treating the RCT introduces uncertainty — periapical healing takes months; the infection may NOT be resolved before surgery. A failed RCT with a periapical lesion IS an infection focus that must be eliminated. Extraction is the most reliable method to eliminate the infection within the available timeframe. Dental clearance guidelines for cardiac surgery prioritize removing ALL active infection foci before the procedure. Extraction of all 3 teeth is the safest and most definitive option in this time-constrained situation.