Cardiovascular
Dental Management of Patients with Open-heart / cardiac surgery (CABG, valve)
Confirm time since open-heart surgery
Timing since cardiac surgery determines whether elective care should wait. Also confirm whether a prosthetic valve or prosthetic material was placed (endocarditis prophylaxis may apply).
Emergency vs routine management
If EMERGENCY — what to do
- • Within 6 months of cardiac surgery: treat only urgent conditions after cardiac surgeon/cardiologist consultation.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • If a prosthetic valve or prosthetic material was used: give endocarditis prophylaxis.Ref: Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
- • Check anticoagulant/antiplatelet therapy and INR.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
If ROUTINE — what to do
- • Defer elective care for ~6 months after surgery and until cardiology clearance.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • CABG alone does not require antibiotic prophylaxis.Ref: Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
Clinical precautions
- • Establish date of surgery
- • Confirm if a prosthetic valve/material was placed
Information & tests to request
- • Days since open-heart surgery — Elective invasive dental care is usually deferred for ~6 months after cardiac surgery while the patient stabilises and is often on antithrombotics.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Confirm time since open-heart surgery |
| Supragingival scaling / polish | MODIFY / CAUTION Confirm time since open-heart surgery |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Confirm time since open-heart surgery |
| Root canal treatment | MODIFY / CAUTION Confirm time since open-heart surgery |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Confirm time since open-heart surgery |
| Surgical / bony extraction | MODIFY / CAUTION Confirm time since open-heart surgery |
| Implant placement | MODIFY / CAUTION Confirm time since open-heart surgery |
References
- Dental management after cardiac surgery
- AHA 2021 (prophylaxis if prosthetic valve/material placed)
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
- SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.