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Oral Surgery · single question

A patient needs extractions of teeth #14 and #19 (non-restorable, with periapical radiolucency on #19), and is going for heart surgery. What is the best plan?

  1. Extract #14 and #19 and prophylaxis
  2. No surgical root canal on #19, extract #14 and prophylaxis
  3. Do nothing and reschedule after heart surgery
  4. No surgical root canal on #14, prophylaxis only
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Correct answer: A. Extract #14 and #19 and prophylaxis

  • A. For pre-cardiac surgery dental clearance, all sources of infection must be addressed. Both non-restorable teeth (#14 and #19, especially #19 with periapical pathology) should be EXTRACTED. Antibiotic PROPHYLAXIS is given if the patient has an appropriate cardiac condition (valve disease, prosthetic valves, prior endocarditis). This is the complete pre-surgical dental clearance protocol.
  • B. Not treating #19 (periapical pathology present) leaves a source of infection that could seed the bloodstream post-cardiac surgery. All foci of infection must be eliminated.
  • C. Leaving infected teeth before cardiac surgery significantly increases the risk of post-operative infective endocarditis.
  • D. Both teeth need extraction — prophylaxis alone does not eliminate the source of infection.

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