Tooth Care for the Prosthetic Valve Patient


That’s the best fake smile I’ve got

My 2nd open heart surgery was 3.5 months after my initial aortic valve replacement, and was due to Bacterial Endocarditis (BE). BE is an infection along the lining of the heart tissue, and usually involves the valves. It is fatal if left untreated and often involves replacement of the infected valves and hefty doses of antibiotics. People with Bicuspid Aortic Valve or a prosthetic valve will sometimes get BE. They will try to identify the organism by testing the patient’s blood. In my case, they were not able to identify what it was. Because of this, after the surgery, I was given a 6 week course of 2 different types of wide range antibiotics.

BE can occur AFTER Bacteremia takes place in the bloodstream. Bacteremia is when bacteria enters the bloodstream. It can be the result of any cut. Intravenous drug users will sometimes get BE from using dirty needles. People like me are often told to take good care of their teeth, and to avoid gum bleeding because bacteremia can occur from any bleeding in the mouth, inflicted by yourself or a dentist. Though the recommendations have changed recently, people with prosthetic valves or a history of BE will usually take a dose of amoxicillin before a visit to the dentist.

My infectious disease doctor explained a method that might help prevent bacteremia from occurring from gum bleeding during normal daily tooth brushing. The idea is to kill the germs potentially opening up the gums with a brush/floss. The method:

1. Swish Listerine/ antimicrobial mouthwash for 30-60 seconds. Sometimes I mix 1 part hydrogen peroxide with 1 part Listerine. 
2. Wait 3-5 Minutes
3. Brush thoroughly with a soft bristle toothbrush
4. Mouthwash again (I added this step myself for redundancy. I know, I use a lot of Listerine)
5. Floss gently and correctly

6. Mouthwash again

Another tip given to me by another patient: Clean your toothbrush every now and then by soaking it in Hydrogen Peroxide overnight.

I understand that this is redundant and excessive. This was recommended to me after my horrific battle with Endocarditis, to avoid getting it again. 2 years later, I have loosened up on this method (I usually skip step 4).

I would definitely recommend this method to anyone recovering from valve surgery, because the first year after valve replacement surgery is when you are most susceptible to BE.

Other Links related to BE:

The 2007 Revision of the AHA Guideline for Preventing Infective Endocarditis (read the Conclusion at the top of page 2 / Table 3 at the top of page 10/ Table 6 at the top of page 13 )




5 thoughts on “Tooth Care for the Prosthetic Valve Patient

  1. Luke

    Hi Anthony, I wanted to ask if you take antibiotics before every dental visit even regular cleanings. I’m 4 weeks post-op from aorta valve replacement and graft for an ascending aorta aneurysm. I asked my cardiologist and he said it wasn’t needed for regular cleanings which I was surprised to hear. I’m going to ask my surgeon in a follow-up appointment I have in 2 weeks. Also, do you use a water pick – years ago my dentist had suggested putting some Listerine in the water pick.

    Thanks for a very informative blog,

  2. Rob

    Luke — no antibiotic prophylaxis prior to a dental procedure?? Insanity for a guy with AVR. I can’t believe a cardiologist would tell you this. I got endocarditis following a routine teeth cleaning. I only had a heart murmur. Now I rinse with peridex before and after a teeth cleaning, as well as take the 2 grams of amoxicillan. It’s interesting to read Anthony’s procedure for even brushing his teeth — I didn’t realize that even that was a risk. It’s also important to disinfect your toothbrush – while I was in the hospital my family met another family whose loved one apparently got serious infection from his toothbrush.


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