Sir, we were interested to read the letter by Lin, describing the development of a pre-cardiac surgery screening pro forma by our colleagues in Oral and Maxillofacial Surgery, Plymouth, for dental assessment.1 This had been devised following on from a similar pilot pro forma outlined in the paper by G. Allen and A. Brooke,2 arguably bringing a more consistent screening for dental pathology prior to invasive cardiac procedures, specifically those at risk of infective endocarditis (IE).

We have also developed a patient referral pathway as we noted in our recent paper.3 The literature remains poorly defined as to the exact benefit of dental intervention prior to cardiac valve surgery,4 with some suggesting that a higher incidence of IE was noted in those patients receiving dental treatment pre-surgery compared with those who did not.5

In our recent paper, we debated the value of one-off, time-limited ‘treatment bursts' for these patients, in the absence of addressing chronic, long-term dental disease.

What we think can be agreed is that these patients deserve tailored, preventative advice as part of their cardiac surgery preparation and a period of follow-up after dental treatment,2,4 as chronic lesions cannot be considered fully resolved.4

Who provides this treatment, when and in what environment is open for debate, but we should strive for it to be timely, safe, effective and efficient in its delivery.