When you’re coming to terms with the prospect of heart valve surgery, your mouth is probably the last thing you’re thinking about. You may be surprised to learn that the state of your gums and teeth is, in fact, very relevant to your surgery and recovery, as well as having an effect on dental treatment and oral hygiene in the future. Here are five things you need to know about oral health and heart valve surgery, including advice from the British Dental Association

  1. Good dental hygiene may help to prevent heart disease

Heart valve deterioration and poor oral health can be linked. It’s rare, but bacteria in the mouth can trigger endocarditis – an infection of the inner lining of the heart chambers and valves. If it’s left untreated, endocarditis can damage or destroy the heart valves. This comes about when bacteria from tooth plaque multiplies and causes inflamed gums (gingivitis), which can worsen and become fully-fledged gum disease, known as periodontosis. This is a severe gum infection that damages the soft tissues and can even destroy the bone beneath the tissue that supports your teeth. Once gums are inflamed and prone to bleeding, bacteria can enter the bloodstream and infect other parts of the body, including the heart.

If you’re at risk of infective endocarditis, looking after your teeth and gums may help as brushing healthy teeth and gums is less likely to introduce bacteria into the bloodstream. You can read more about that here.

Says Peter Dyer, the chair of the British Dental Association (BDA)’s hospital dental committee: “To ensure optimum dental health at any time, see your dentist regularly to pick up and treat any problems early and stick to a good oral hygiene routine.”

  1. Your daily oral hygiene routine matters

Peter advises: Brush all the surfaces of the teeth twice daily with fluoride toothpaste, for at least two minutes, this should include brushing before going to bed to remove plaque from the teeth, which may build up more at night due to the reduced flow of saliva whilst asleep.”

In addition, use dental floss to clean the gaps between your teeth every day, rinse with an antiseptic mouthwash at least once a day and get regular dental check-ups. This will cut down the risk of gum disease and, if you already have it, will make increase the chances of successful treatment of the problem.

  1. Your mouth needs to be healthy before surgery

Your medical team should check for any oral problems before your heart valve surgery takes place to make sure you’re fit for surgery, so they’ll be looking for possible active periodontitis (severe gum disease). If you do have gum disease, it will probably be treated before your op. Getting on top of gum disease, addressing plaque build-up and improving oral hygiene in general will help to put you in the best possible condition for surgery and recovery afterwards.

Says Peter: “Anyone undergoing heart valve surgery must be dentally fit, because gum disease, severe tooth decay, tooth abscesses or any soreness in the mouth increases the risk of spreading infection and compromising surgery.

“Left untreated, bacteria in the mouth can travel through the bloodstream to the surgery site, causing complications such as infective endocarditis — a potentially life-threatening infection of the inner tissues of the heart, including the heart valves.

“You will need to see a dentist in plenty of time before the surgery, who will do a thorough assessment of your teeth and gums to either eliminate or treat any potential sources of infection.

“If treatment is necessary, which could include extractions, this may require one or several visits to the dentist to ensure your teeth and gums are in a healthy state before having heart surgery.”

  1. Oral infections can be a risk post-surgery

Once you’ve had heart valve surgery, it’s important to avoid future infection. That means you may need to take preventative antibiotics before dental procedures in the future as a precaution against infection, if you’re thought to be a high-risk patient. This is likely to be given in the form of a single dose of antibiotics an hour before the dental treatment. The medical term for playing it safe through antibiotic use is antibiotic prophylaxis and, in the UK, it’s at the discretion of your dentist and GP or cardiologist; however, anyone with a replacement heart valves or previous endocarditis is deemed to be ‘high risk.’

  1. You should let dentists know if you’ve had heart valve surgery

You can carry an infective endocarditis card to tell others, including your dentist, that you’re at risk and make sure that they understand your wishes – this is a particularly good idea for times when you are away from home in the event that you need emergency dental treatment. The warning card has been developed by the NHS and includes information on whether or not you have decided that you would like precautionary antibiotics, based on a previous discussion with your cardiologist.

Medical information. This is provided for informational purposes only and is not meant to be a substitute for advice by a doctor or other qualified healthcare professional. Patients should not use the information on the Active Patients website for diagnosing a health or fitness problem or disease. Patients should always consult with a doctor or other health professional for medical advice or information about diagnosis and treatment. Never ignore professional medical advice because of something you have read on Active Patients.