### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a 64-yr. old caucasian woman who had a mitral valve tissue replacement 8/28/14.  I have had endocarditis twice, in 2008, and in August 2014.  At the time of the valve replacement,  4 of my molars which had deteriorating fillings which were done during childhood, were removed.  My question is one which each of the doctors I have followed up with, the epidemiologist, heart rhythm, surgeon, have not given me the answer to the question I have:  If I have a replacement valve, do I still have mvp?  If so, why - that is what I dont understand.  How did I go 58 years with no problem with endocarditis, and for the first half of my life did not take antibiotics at the time of any dental work, and didnt acquire the disease until I was 58?  I live with the horror of the possibility of this happening again, and the fact that my new valve will wear out about the time I am in my 70s.  Can I undergo surgery for a third time while in my 70s? I am following everything the doctors have told me to do, including different methods and mouthwashes for my gums, which my dentist told me are very healthy at this time.  I dont think they were ever unhealthy, but my deteriorating fillings were causing me to use toothpicks constantly.

### output:

Hello, Please keep in mind that taking antibiotics prior to dental treatment is a prophylactic measure. Anytime there is bleeding, there is a chance that bacteria in the oral environment may enter the blood stream. Certain tissue and replacement valves are prone to affects of exposure to the bacteria. Consider having your oral bacteria analyzed to see your particular strains. Discuss this further with your dentist or visit a periodontist, gum and bone specialist. This is what I would recommend to my patient with your concerns. Your cardiologist should be able to discuss your condition with your dentist and advise if any additional precautions are necessary with your health history. Many surgeons require good dental health status prior to surgical clearance. I avoid nonemergency dental procedures for the first few months following surgery. Dentists follow a standard antibiotic prophylaxis regime prior to dental treatment. I follow guidelines set by the American Heart Association. Thank you for your inquiry. I am glad to answer any additional questions that you may have and hope you find my information helpful.