Medical Clearance for Common Dental Procedures

Herrick, Kevin R. MD, PhD
Terrio, Jennifer M. DDS
Herrick, Crispin DDS

¹ Bay Area Community Health, San Jose, California; Loma Linda University School of Medicine, Loma Linda, California; Stanford University School of Medicine, Palo Alto, California; University of San Francisco School of Nursing and Health Professions, San Francisco, California
² University of Colorado School of Dental Medicine, Aurora, Colorado
³ Denver Health, Denver, Colorado

KEVIN R. HERRICK, MD, PhD, is director of education and research at Bay Area Community Health, San Jose, Calif.; an assistant clinical professor of family medicine at Loma Linda (Calif.) University School of Medicine; an adjunct clinical instructor at Stanford University School of Medicine, Palo Alto, Calif.; and an affiliate faculty member at the University of San Francisco (Calif.) School of Nursing and Health Professions.

JENNIFER M. TERRIO, DDS, is an orthodontic resident dentist at the University of Colorado School of Dental Medicine, Aurora.

CRISPIN HERRICK, DDS, is a general practice resident dentist at Denver (Colo.) Health.

Author disclosure: No relevant financial affiliations.

Address correspondence to Kevin R. Herrick, MD, PhD, 5504 Monterey Rd., San Jose, CA 95138. Reprints are not available from the authors.

American Family Physician 104(5):p 476-483, November 2021.

Integrating patients' medical and dental health care is important because there are correlations between periodontal disease and some medical conditions. Medical consultations before dental procedures present opportunities to integrate cross-disciplinary preventive care and provide recommendations for treatment considerations before, during, and after a dental visit.

Medical consultations before dental procedures present opportunities to integrate cross-disciplinary preventive care and improve patient health. This article presents recommendations related to patients with certain medical conditions who are planning to undergo common dental procedures, such as cleanings, extractions, restorations, endodontic procedures, abscess drainage, and mucosal biopsies. Specifically, prophylactic antibiotics are not recommended for preventing prosthetic joint infections or infectious endocarditis except in certain circumstances. Anticoagulation and antiplatelet therapies typically should not be suspended for common dental treatments. Elective dental care should be avoided for six weeks after myocardial infarction or bare-metal stent placement or for six months after drug-eluting stent placement. It is important that any history of antiresorptive or antiangiogenic therapies be communicated to the dentist. Ascites is not an indication for initiating prophylactic antibiotics before dental treatment, and acetaminophen is the analgesic of choice for patients with liver dysfunction or cirrhosis who abstain from alcohol. Nephrotoxic medications should be avoided in patients with chronic kidney disease, and the consultation should include the patient's glomerular filtration rate. Although patients undergoing chemotherapy may receive routine dental care, it should be postponed when possible in those currently undergoing head and neck radiation therapy. A detailed history of head and neck radiation therapy should be provided to the dentist. Multimodal, nonnarcotic analgesia is recommended for managing acute dental pain. (Am Fam Physician. 2021;104(5):476-483. Copyright © 2021 American Academy of Family Physicians.)