Getting Dental Clearance Before Heart Surgery

Getting Dental Clearance Before Heart Surgery

I Need Dental Clearance

What is dental clearance and when is it necessary?

Allow me to tell you about a delightful couple that I met this week.
A husband and wife came to me with a form that required a signature from a dentist. The form came from his cardiologist in preparation for a heart valve replacement and a possible bypass procedure scheduled for the following week.

Why does the cardiologist and, more specifically, the bypass procedure necessitate a dental exam or dental clearance?

Before we answer that question, let’s explore what the mouth has to do with the heart?

A Possible Connection Between The Mouth And The Heart

I can sum up the inquiry in one word – bacteria.
Whenever any patient has any surgical procedure performed, the concern for infection is always present. We take infections lightly today since we are blessed with all types of antibiotics.
Just over a century ago, the understanding of bacteria and their ability to cause infections was unknown. Many patients died after surgery because the operating area was not sterile or even disinfected. Once a brilliant doctor noticed the post-surgical death rate and theorized that keeping a clean surgical environment might be helpful, the rest was history.

Oral Bacteria, Plaque & Periodontal Disease

The history lesson that I just provided you does not answer our question. What does the mouth have to do with a heart procedure?
The answer revolves around our friend and neighbor, bacteria.

Oral Bacteria

Bacteria are living things that are all around us and in us. Some bacteria are good, and others are not so good. Bacteria are the cause of gum disease and cavities in our mouth. When we do not keep them in check by maintaining a clean mouth, they grow and multiply.

Diet also plays a role in mouth bacteria. There are certain types of foods that the mouth, that oral bacteria, like for their diet. Sticky and sugary foods are a treat for us and the mouth bacteria. The bacteria come together in colonies and help form a sticky coating on the film called plaque.

Plaque & Periodontal Disease

Plaque attacks teeth and our gums, resulting in cavities and gum disease, also known as periodontal disease. This disease attacks the gum and bone of our teeth.

Oral Bacteria Travels to the Bloodstream

Armed with that fact, we see that the disease and its accompanying bacteria are in our bodies. The organisms that are part and parcel of this disease will travel into our bloodstream. Our circulatory system carrying our blood travels to all areas of the body, which of course, includes our heart and its valves.

The fact that bacteria from the mouth travel to the heart and potentially lodge on the new heart valve is why my patient needed dental clearance. His cardiologist wanted to be sure that the heart procedure would be successful and not be sabotaged by rogue bacteria emanating from his mouth.

Addressing The Disease Before Getting Dental Clearance

Unbeknownst to my patient, he had four teeth with severe decay. I could not save these teeth, and I plan to remove them.
His gums also showed severe signs of gum disease. After I take care of all of these issues, he will schedule his cardiac procedures.

After he is healthy, I will go back and replace his missing teeth, of which two of them are his front teeth.

This seemingly innocuous dental clearance appointment saved him from intense pain, infections, and maybe even his life.

If you need an exam and cleaning for your peace of mind, give us a call at 440.951.7856. I look forward to meeting you.

Jeffrey Gross, DDS, FAGD is an Ohio-licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

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