Why do you need dental clearance before surgery or an organ transplant?

You might be wondering why your surgeon wants you to see a dentist before an operation that has nothing to do with your teeth. It's a fair question that deserves a straight answer: Your mouth can hold bacteria that reach the rest of your body, and before a big surgery or an organ transplant, your medical team wants to check for that risk first. The American Dental Association (ADA) says it helps to get your mouth as healthy as it can be before these procedures.¹ That's what dental clearance is for. 

What you will learn in this article: 

• Your mouth can hold bacteria that raise infection risk during surgery or a transplant. 

• Oral bacteria can enter your bloodstream and reach other organs. 

• A dental clearance visit checks your teeth and gums for signs of infection. 

• Dental clearance is not always required before joint replacement surgery. 

If you have a surgery or transplant coming up, schedule an appointment with an Aspen Dental provider. Your care team can check your teeth and gums. They can also send your results to your medical team. 

Why does your mouth matter before a surgery or transplant? 

Your mouth is full of bacteria. Most of the time, your gums keep them where they belong. But the ADA says the mouth can act as a storage spot for germs.¹ Those germs can slip into your blood. 

That can cause problems in other parts of your body. This is called bacteremia. It just means bacteria have entered your bloodstream. 

Before a major surgery or transplant, your body is more open to infection. A cut, an incision or a new organ gives germs a way in. The ADA says it's best to improve your oral health before joint replacements, heart surgery, organ transplants and other procedures.¹ That's why your surgical team may ask for dental clearance first. 

How can gum disease affect your heart or new joint? 

Gum disease is an infection in the tissue around your teeth. The American Academy of Periodontology (AAP) says it can make heart problems worse.² Your dentist may need to prescribe antibiotics before dental work if you're at risk for a heart infection.²

Only a small group of heart patients truly need antibiotics before dental care. That's based on 2021 guidance from the American Heart Association. The ADA says those antibiotics are used when dental work touches the gum tissue, the tooth root area or breaks the lining of the mouth.³

Joint replacements are treated differently. The ADA says most patients with an artificial joint do not need antibiotics before dental visits. Any rare exception should come from a talk between your dentist, your orthopedic surgeon and you.³ It is not an automatic step. 

Is dental clearance required before joint replacement surgery? 

Not always. A study published in the journal Cureus looked at patients before knee and hip replacement. It found no real difference in infection rates between patients who had dental clearance and those who did not.⁴

The same study checked what actually caused the infections that did happen. It found none of them came from mouth bacteria.⁴

There's a cost to routine clearance too. The study found that when clearance was required for everyone, about 18.5% of patients needed dental work done first.⁴ That can delay surgery. 

Some surgeons stopped requiring dental clearance altogether. The study found their infection rates did not change.⁴ So the decision often comes down to your specific surgeon, your health history and your surgery type. Ask your surgical team what they require. 

Why does oral surgery itself carry infection risk? 

Oral surgery opens tissue that is normally protected. The Centers for Disease Control and Prevention (CDC) says this raises the risk of infection, since germs from inside or outside the mouth can enter deeper tissue. Without the right precautions, that infection can turn serious. The CDC says patients face serious or life-threatening infections when infection control steps are skipped.⁵

That's why dental offices follow strict steps during oral surgery. The CDC recommends hand antisepsis before the procedure. It also recommends sterile gloves. And it recommends sterile fluid for rinsing, since regular dental water lines can't reliably stay germ-free.⁵

If you need dental implant surgery or another oral surgery before your medical procedure, these steps matter. They lower the chance that the surgery itself introduces new germs. 

What happens at a dental clearance visit? 

Your dental provider checks your teeth, gums and any signs of infection. They look for cavities, loose teeth or gum disease that could act as a source of bacteria. The ADA says the goal is to get your oral health in good shape before your surgery or transplant.¹ 

Your dental provider will explain what they find and what, if anything, needs treatment first. Your dental provider may suggest a cleaning, periodontal surgery or a tooth removal depending on what they find. They will walk you through your options and send a report to your medical team. 

What if you need dental treatment before your surgery? 

If your dental provider finds an infection or damaged tooth, treating it first can lower your risk. Healing time matters here too. Ask your dental provider and your surgical team how much time to leave between dental work and your surgery date. 

Ask your dental provider for a cost estimate for any treatment you need, so you know what to expect before you schedule anything. After a dental procedure, your dental provider may also suggest soft foods while your mouth heals. 

Don't wait until close to your surgery date to bring this up. Contact your local dental provider to check your oral health and get any needed treatment done with enough time to heal before your procedure. 

Why do you need dental clearance before surgery or an organ transplant? FAQs 

Still have questions about dental clearance? These answers cover a few common concerns. 

What oral health problems concern surgical teams the most? 

Gum disease and hidden infections top the list. The AAP says gum disease can make heart problems worse.² The ADA says your mouth can store germs that spread to the rest of your body.¹ Your dental provider checks for both before clearing you for surgery. 

Does every surgery require dental clearance? 

No. Requirements differ by hospital, surgeon and type of surgery. Organ transplants often call for a dental check because of the immune system risks involved. Ask your surgical team what they require for your specific procedure. 

Who pays for dental clearance and any needed treatment? 

This depends on your dental insurance and your treatment needs. Ask your dental office for a cost estimate before your visit. You can also check with your insurance provider about what your plan covers. 

Why do transplant patients face extra scrutiny for dental clearance? 

After a transplant, medicines that prevent organ rejection also lower your body's defenses. That makes it harder to fight off infection, including infection that starts in your mouth. That's part of why transplant teams often ask for a dental check before the procedure. 

Sources 

¹ American Dental Association: “Oral-Systemic Health.” https://www.ada.org/resources/ada-library/oral-health-topics/oral-systemic-health 
² American Academy of Periodontology: “Gum Disease and Other Diseases.” https://www.perio.org/for-patients/gum-disease-information/gum-disease-and-other-diseases/ 
³ American Dental Association: “Antibiotic Prophylaxis Prior to Dental Procedures.” https://www.ada.org/resources/ada-library/oral-health-topics/antibiotic-prophylaxis 
⁴ National Institutes of Health, Cureus: “Routine Preoperative Dental Clearance for Total Joint Arthroplasty: Is There a Benefit?” https://pmc.ncbi.nlm.nih.gov/articles/PMC10399090/ 

⁵ Centers for Disease Control and Prevention, Division of Oral Health: “Best Practices for Oral Surgical Procedures.” https://www.cdc.gov/dental-infection-control/hcp/dental-ipc-faqs/oral-surgical-procedures.html