Sir, I work in the oral and maxillofacial surgery unit of a district general hospital. In the past years we have seen an increasing number of patients due to undergo planned cardiac surgery referred to us by their general dental practitioners (GDPs) for removal of any poor prognosis teeth. Dental fitness is essential to reduce the risks associated with cardiac surgery and prevent post-operative infections related to dental causes.1

It has recently come to my attention that a number of these patients have brought with them a form requesting the oral surgeons to sign it. This form is a declaration of dental fitness and is issued by their cardiac surgeons. It has been highlighted that it needs to be signed prior to proceeding with their cardiac surgery. It is concerning that a couple of patients reported that they have not been given a date for the operation until this form is returned signed.

In this day and age most patients aim to retain their natural dentition for as long as possible. Our department as well as most oral and maxillofacial surgery departments non-affiliated with a dental hospital offer secondary surgical services but they are unable to provide routine dentistry. Upon completion of their oral surgery treatment, it is likely that further dental issues need to be addressed, including periodontal treatment, restorations and oral hygiene improvement. It is imperative that the GDPs ensure that the oral cavity is in good health prior to planned cardiac surgery. It may therefore be more appropriate that similar forms are signed at the completion of dental treatment by their GDP. The above may not apply to emergency cardiac surgery when patients are unable to attend their dentist.

It is understandable that in certain cases the decision to declare dental fitness beyond any doubt can be difficult and overwhelming for the dentist. The lack of clear guidance, the patient's compliance with everyday oral care and the shift to maintaining the natural dentition is contributing further to the uncertainty.