Dentist clearance letter for heart surgery?

[hx77]

I am consulting a specialist for minimally invasive coronary artery bypass (MIDCAB) procedure. The nurse asked me to get a clearance letter from a dentist stating my mouth is free of infection. Is this a common requirement? I have seen other surgeons including one is ready to replace my aortic valve, no other doctor ever asked about this.

I went to see a dentist yesterday and she asked me to take 18 individual x-ray. I thought it's too much x-ray and I did not do that. The office of MIDCAB specialist seemed to be firm on getting a clearance from a dentist and there is no other surgeon as I know is willing to do MIDCAB. Any suggestions?

Thanks,
John

 

[honeybunny]

I’ve never heard of that. If I remember correctly, I had to take an antibiotic before surgery and shower with a special soap. And why are they specifically worried about your mouth? You could have a mild infection anywhere in your body and not necessarily be aware of it. Not to be TMI, but I had a rash along the bra line during the summer that I assumed was a heat rash. Turned out it was a yeast infection.

I don’t have any advice based on what you’ve written. It appears you will need the clearance if you use that surgeon. But I would want to know why the clearance is necessary out of curiosity.

 

[astle9]

my surgeon requires dental clearance and i am currently going through it ready for AVR in the next few weeks, i have had a deep clean by the hygienist and having x rays next week, my dentist actually stated that none of these dental issues should delay my op due to the fact that everyone has a mouth full of bacteria on any given day but as dental work is to be avoided if possible for first 6 months after op best go get it done prior to op. My dentist was confused as to why a dental clearance letter was needed as he has never come across this before. I am UK based so maybe that is the difference.

 

[amarG]

Its becoming pretty standard to require dental clearance. If you have a dental procedure done, the bacteria in your mouth can enter your bloodstream through the wound and sometimes cause endocarditis. So surgeons are now requiring dental clearance to ensure u have no active oral infection or in need of a dental procedure for 6 months after AVR. I just got my dental clearance

 

[LondonAndy]

When I had my AVR in September 2014, the surgery was carried out without a dentist's letter as I was already admitted as an emergency case (severe stenosis and had had a funny turn similar to what I think a heart attack would be like), but in the paperwork they give to planned surgery cases they do ask for this. Endocarditis is the concern, as AmarG says, as mouth infections can be particularly serious for heart valve patients.

 

[hx77]

Thanks everyone for the reply!

I guess the conclusion from the discussion is - Dental procedures could cause damage to the heart. Heart surgery in the presence of infection, though not ideal, presents no greater risk of endocarditis than not doing the surgery.

Not sure I am able to convince my surgeon but I will take a full mouth pano X-ray as requested but I will not ask my dentist to write a clearance letter. If he agree to it, it's fine. Otherwise I will just not do MIDCAB.

 

[carolinemc]

hx77, the reason you need to have a clearance from the dentist is the risk of infection from teeth or gums. What can happen, the infection in the mouth can down to the heart, causing encarditis, a really deadly infection. They do not want to take any risks of infection affect the heart. Good luck and you do exactly as the doctors and nurses tell you. Hugs for today.

 

[heatherak]

For all the reasons already posted, my surgeon also requested a dental clearance; no letter was required, just that I have a once over and have an X-ray to ensure there wasn't any deep infections (I hadn't been to a dentist in years;have never had a cavity or issue). The dentist was great; did only enough xrays to show all teeth (maybe 4 total) and did an exam. Cleaning was not part of an exam and he said when I was ready to schedule a good cleaning. My suggestion might be to look for another dentist; 18 xrays sounds a bit radical. Best on your upcoming procedure; I went through my whirlwind in October and am doing and feeling great!

 

[ZachL]

I went to the dentist last week for the same reason. My surgeon has requested my dentist signs a release form ensuring that i do not have issues or that the issues are taken care of at least 2 weeks prior my heart surgery. My dentist has been a family friend for years and took a ton of xrays. Not sure of the exact number, but 18 sounds pretty close. I dont think i fully understand your concern about the 18 xrays. Being personal friends with my dentist I highly doubt that he is taking advantage of me, but maybe your dentist charges per xray? which mine does not.

 

[hx77]

Caroline, Heather and Zach, thanks for the replies and good wishes! I wish you all the best too. I will have an appointment with a dentist tomorrow, I will not ask her to write a clearance letter but just state the fact of my teeth. Phrases like "no active infection" or "minor infection" will be great. Together with a full-mouth x-ray, that might fulfill the requirements of my surgeon.

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In the waiting room. BAV, modest stenosis, LAD total occlusion. Under medical therapy but desire minimally invasive CABG or CTO.

 

[epstns]

hx - Why do you resist asking for a "clearance" letter? My surgeon made it very clear that he would not continue without the letter. When I asked my dentist she said "We do these all the time. They ask for clearance for heart procedures and even for orthopedic procedures like joint replacements." She didn't need to take any X-Rays, as my exams were current including X-rays. Since I had been monitoring my aortic stenosis for many years prior to surgery, and since the dental care protocol was the same before and after surgery (for stenosis/BAV patients and for valve recipients, they were then recommending cleaning 4 times a year, complete X-rays every 2 years), I just needed to finish some planned restorations and get the letter.

Dental X-rays, especially the new digital ones, are not a significant source of radiation to the body. Why not do what they ask?

 

[hx77]

Hi Steve,

As you hinted, I worry about x-ray exposure. Even it's minimal, I assume it's harmful. I do cleaning twice a year, but I always resist x-ray as much as possible. I allow them to take a few of the trouble spots but not full set. I will not ask for a clearance letter because I will not get a absolute clearance because I know I won't get it. One of my teeth wasn't filled properly many years ago and there is fluid coming out on and off. But that tooth does not hurt. I do not want to pressure the dentist.

I floss every night, brush twice a day using sonic toothbrush, kill germs at night with mouthwash. I believe my gum is healthy. At last cleaning, a dentist did not complain my teeth after she examed (w/o x-ray).

Thanks,
John

 

[LondonAndy]

Just to add that teeth health continues to be important after surgery too, for the same (Endocarditis) reasons. I go to my dentist for teeth cleaning every three months, even though I use an electric tooth brush and inter-dental brushes

 

[tom in MO]

Teeth health is important irrespective of your hear health.

I had a friend who ignored his teeth. He got an infection and aspirated the bacteria into his lungs. His infected teeth were easily taken care of but the lung infection was resistant to medication. He finally had to have about 1/2 of one lung removed to treat the infection he got from his mouth.

An operation due to the infection or endocarditis is a lot worse than the exposure to 18 XRays.

 

[DanielB]

I also was required to have dentist clearance. I, like I would suspect most others here who have had the valve replacement done, taker an antibiotic with every dental visit. I'm good with that as from what I understand, Endocarditas is a bad thing to get.

 

[ejc61]

I have to agree that a clearance letter would not be that big a deal. As one who has experienced endocarditis resulting in a subsequent "freak" arterial thrombectomy and fasciotomy, I can't have any procedure whether a hernia repair or prostate biopsy without a sign off from cardiology; infectious disease and dentist. Interestingly, I remember my x-rays several months prior to my endocarditis being ok. Try to look at the big picture.

 

[Carnelian]

It is common. my dentist signed a letter that my root canal work was finished. Very important that you get all your teeth and gums fixed
and treated before surgery, my surgeon told me. Otherwise, bacteria from the mouth may get into the blood and cause problems, perhaps
serious. Take an antibiotic before dental work such as amoxicillin,

Mitral valve replacement and double bi-pass.