I recently had the opportunity to visit a foreign charity that provides free cardiac surgery for people from the third world. My tour group got to meet some of the patients both pre & post op, tour the facilities etc. One interesting question from the group was regarding the poor dental hygiene of the patients we met. Basically they looked like they had a lot of cavities (even the kids) and didn’t really have any concept of brushing one’s teeth.
So the question posed to the doctors running this charity was “isn’t it dangerous/irresonsible to perform heart surgery on patients with major dental issues because they have a very high risk of infection spreading from their mouth into their heart”? Apparently at most western hospitals, cardiac surgeries will be cancelled if the patient hasn’t had dental issues resolved.
Seeing as how this charity wanted a ton of money for each patient (they get flown in for the surgery from Africa, Iraq etc) would it not make sense to spend a little more on each one and ensure that they goto the dentist before their cardiac surgeries? How likely is it that terrible dental health could lead to infection/death in conjunction with heart surgery?
For people with heart defects that raise the risk of endocarditis (e.g., in my case, a bicuspid valve), prophylaxis with antibiotics prior to dental cleanings and other procedures is recommended. It’s also important for antibiotics to be administered after any injury to the mouth that draws blood–the idea being that bacteria from the mouth could get into the blood stream and attack the heart.
Based on this, a WAG: If there is a bleeding injury in a poorly tended mouth, and if the heart is more susceptible to infection after the surgery, it could be a problem.
However, I would think that anyone requiring heart surgery might already be susceptible to such problems–even with prophylaxis, would it be worth the risk of endocarditis to perform the dental work prior to correcting the issue with the heart?
With what little, and incorrect species, medical knowledge I have, addressing the teeth problem at the same time as the heart problem makes good sense. I could see situations where the heart problem is life threatening enough that you would want to correct that before dealing with the teeth, but if they are healthy enough to go traveling for cardiac care, surely they can wait a couple weeks and get some antibiotics circulating. And surely long term dental care would help improve the odds post-operatively.