Expert advice on valve disease and oral health
Your heart health and the health of your teeth, gums and mouth are closely connected — especially for people living with valve disease. Heart Valve Voice Canada asked Dr. Aviv Ouanounou, a dentist and associate professor at the University of Toronto Faculty of Dentistry, to explain what you need to know.
If I have valve disease, why is my oral health important?
Dr. Ouanounou: We all have bacteria in our mouths, which can enter the bloodstream and travel around the body. Oral health issues such as cavities or gum disease (gingivitis or periodontitis) increase the level of bacteria and makes it easier for it to enter the bloodstream.
A heart valve that has been repaired or replaced has irregularities where bacteria from the mouth can get stuck and cause problems.
The most serious is infective endocarditis, an infection of the inner lining of your heart (endocardium). It is mostly seen in people who have had heart valve procedures, and it can be life threatening.
So, it’s very important to inform your dentist if you have any heart valve diagnosis. This is something I discuss with every new patient, in reviewing their health history.
If a patient tells me they have heart valve disease, or had valve surgery, I know I need to ask more questions. Some of these patients will need antibiotic prophylaxis — that means antibiotics before the dental treatment, to prevent infection.
Do I need to take antibiotics before a dental appointment?
Dr. Ouanounou: The need for preventive antibiotics depends on what dental procedure you are having, and on your heart valve diagnosis.
If your dentist is just taking X-rays or doing an exam, you don't need antibiotics. But for cleaning, extractions, surgery or implants — basically, any procedure that could cause bleeding — antibiotics may be prescribed.
This also depends on your heart valve diagnosis. The Canadian Dental Association recommends antibiotics for anyone who has had a valve repair or replacement. But they are not routinely recommended for conditions including mitral valve prolapse, bicuspid valve and calcified aortic stenosis.
See the Canadian Dental Association statement on preventing endocarditis
Bottom line: Your dentist will use their clinical judgment to determine if you need preventive antibiotics. Currently the typical antibiotic prescription is two grams of Amoxicillin, one hour before your procedure.
Why is it important to see a dentist before having heart valve surgery?
Dr. Ouanounou: If you are scheduled to have a surgical valve repair or replacement, your heart team will likely send you to your dentist for an assessment. This is called dental clearance and it’s an important step to prevent complications after surgery.
The dentist’s job is to make sure that your mouth is healthy as possible. They’ll do a dental exam and cleaning. They will check for decay and gum disease, fix cavities and address any other issues such as extractions. And now you're clear to do the surgery.
Dr. Aviv Ouanounou
If I take a blood thinner, are there concerns when I go to the dentist?
Dr. Ouanounou: It’s important to tell your dentist if you are taking a blood thinner (anticoagulant), because this medication can increase bleeding.
You can still undergo dental procedures — especially low-risk ones like routine cleaning. Your dentist will take steps to minimize bleeding during and after.
For more complex procedures, in past years, any patient on a blood thinner was usually asked to stop taking it two or three days before. Now we don't do that routinely, because stopping the medication can increase the risk of heart attack and stroke.
Instead, your dentist should communicate with your cardiologist or doctor — tell them what procedure you need, and how much bleeding it might cause. Your doctor will determine whether you should pause or continue your medication.
It’s very important that you not stop the medication unless your doctor tells you to.
After the procedure, your dentist should give you clear instructions on what to do to minimize bleeding. For example, avoid spitting, avoid chewing on the affected area, and use a gauze pad or tea bag on the area if there is bleeding.
How can I minimize risk to my heart health?
Dr. Ouanounou: It’s important for anyone with valve disease or other cardiac problems to have good oral hygiene and to see a dentist regularly for checkups. That means brushing, flossing, and keeping a regular schedule of dental appointments.
Keep your mouth healthy and clean. That will prevent other problems.