Earlier this summer, Catherine O’Neill Grace of Sherborn, Mass., was scheduled for plastic surgery to repair skin that was damaged when she had radiation treatment for breast cancer.
But a visit to her dentist just four days before her surgery date changed her plans. Her dentist was repairing a chipped filling, and the x-ray uncovered a worrisome problem. “She found additional decay above the old filling in a back upper molar, very close to the root and jaw,” Grace says.
If Grace, 68, went ahead with surgery, the mouthpiece for the anesthesia could disturb the tooth and spread the infection. Her dentist wasn’t comfortable clearing her for general anesthesia until after she had a root canal.
Grace rescheduled her surgery and was in the endodontist’s chair within a week.
“I was surprised that my dentist was so vehement about the danger the decayed tooth posed during general surgery,” Grace says.
Should you see your dentist before surgery?
Grace’s surgery didn’t require dental clearance—she just happened to see her dentist shortly before her scheduled surgery date.
Anthony Kouri, an orthopedic surgeon at the University of Toledo Medical Center in Ohio, says that dental exams should be considered before any surgeries, but are especially important for certain heart surgeries, and surgeries like joint replacements that use implanted devices.
“With both joint replacement and cardiovascular valve replacement surgery, the risk of the bacteria from the mouth traveling systemically to the surgical site is incredibly high,” says Rhonda Kalasho, a dentist who practices in Los Angeles.
She says that in examinations of 36 people with joint replacement failure, DNA evidence pointed to bacteria that traveled from the mouth to the joint 14% of the time.
“For valve surgeries, patients who neglect to get dental clearance risk contracting dangerous, life-threatening infections. In joint replacement surgeries, the risk is an infection and consequent joint failure,” says Bobbi Stanley of Stanley Dentistry in Cary, NC.
Kouri explains that during a dental procedure the gum tissue can be broken, and that allows bacteria from the mouth to enter the bloodstream.
“Those bacteria can go to any foreign material in the body and attach themselves to it. They often develop a biofilm, making them very difficult to treat with antibiotics alone, and requiring surgical removal for complete eradication,” he says.
People starting chemotherapy might also need dental clearance. Kristie Lake Harriman, a general dentist with Drews Dental Services in Lewiston, Maine, says, “In the case of chemotherapy, when the body’s immune system is compromised by the drugs used to fight the cancer cells, it can’t fight off infection as well as it used to, and consequently a previously asymptomatic infection in the mouth can now become significantly more severe, and sometimes life threatening.”
Ryan Clancy, a Boston-area dentist, points out that people who take immunosuppressant medications should also ask whether they need clearance for surgery. People with a lot of conditions, such as rheumatoid arthritis, lupus, Crohn’s disease, and multiple sclerosis, take these medications, he notes.
What if your dentist finds a problem?
Stanley says, “If there’s severe tooth decay, the dentist will extract the tooth and make sure all the bacteria in the mouth are gone. If there’s late-stage periodontal disease, your dentist will recommend a deep cleaning to remove the bacteria from your gums. Both of these procedures are minor and take only one trip to the dentist.”
But, like in Grace’s case, these procedures can push back your surgery date. Your dentist and surgeon can determine how soon you can have surgery after your dental treatment.
Stanley says, “The body isn’t a closed circuit—an infection in the mouth means infection all over the body. Bacteria can easily go from your gums to a surgery site without even the most experienced surgeon realizing it. Going to the dentist a few months before surgery for dental clearance is the best way to guarantee a healthy recovery.”