Patient referred before open-heart surgery for clearance. Has 2 hopeless teeth and one endodontically treated tooth with a periapical lesion. What do you do?

Correct answer: B. Redo RCT and extract the 2 hopeless teeth before surgery

• A. Extracting the endodontically treated tooth with a periapical lesion is overly aggressive if it can be salvaged with retreatment; only hopeless teeth should be extracted.
• B. Correct. All sources of potential infection/bacteremia (hopeless teeth via extraction, retreatable tooth via RCT redo) should be resolved BEFORE cardiac surgery to minimize the risk of bacteremia/endocarditis during the perioperative/recovery period.
• C. Delaying treatment until after surgery leaves active infection sources in place during the high-risk perioperative period, which is inappropriate.

Note: All questionable teeth should ideally be resolved BEFORE cardiac surgery to prevent bacteremia during recovery.