Not everyone does. Medical clearance is typically required for patients on blood thinners, patients with significant heart conditions, patients on bisphosphonate or immunosuppressive therapy, and patients with poorly controlled diabetes or other systemic conditions that affect healing or bleeding. We will evaluate your medical history and tell you if clearance is needed.

We contact your physician directly with a written request that specifies the planned dental procedure and the clinical information needed to proceed safely. The physician responds with clearance, recommendations for medication adjustments, or requests for additional testing. We do not begin treatment until clearance is confirmed.

In most cases, no. Current AHA and ADA guidelines recommend continuing anticoagulant therapy for most dental procedures, including extractions. Stopping blood thinners increases the risk of stroke or embolism, which is far more dangerous than minor surgical bleeding. We use local hemostatic measures to control bleeding. Your cardiologist is consulted for complex cases.

Oral bisphosphonates at standard doses carry a low risk of medication-related osteonecrosis of the jaw (MRONJ). IV bisphosphonates and denosumab carry higher risk. We evaluate your specific medication, duration of use, and other risk factors. Many patients on oral bisphosphonates can safely receive implants with appropriate precautions and informed consent.

Common tests include a complete blood count (CBC), international normalized ratio (INR) for patients on warfarin, hemoglobin A1c for diabetic patients, and a basic metabolic panel for patients with kidney disease. The specific tests depend on your medical conditions and the planned procedure.

Yes. Poorly controlled diabetes (A1c above 8 percent) increases infection risk and slows healing, particularly after surgical procedures and implant placement. We check your A1c before planned surgery and may recommend improved glycemic control before proceeding. Well-controlled diabetic patients tolerate dental treatment normally.

Yes. We send written clearance requests to your physician, provide the specific clinical details they need to make an informed recommendation, and confirm their instructions in writing before treatment begins. This direct communication eliminates the risk of information being lost or misinterpreted.

Timing is critical. Dental treatment during active chemotherapy must account for immune suppression, low platelet counts, and compromised healing. We coordinate with your oncologist to identify safe treatment windows — typically when blood counts are at their highest in the chemotherapy cycle. Emergency treatment is provided at any point with appropriate precautions.

Antibiotic prophylaxis is a single dose of antibiotics taken before a dental procedure to prevent infection of a heart valve or prosthetic joint. Current AHA guidelines recommend it for patients with prosthetic heart valves, previous infective endocarditis, certain congenital heart defects, and cardiac transplant recipients. Joint replacement patients are no longer routinely recommended for prophylaxis by ADA guidelines, though individual orthopedists may still request it.

IV sedation can be safe for many cardiac patients, but it requires careful evaluation. We review your cardiac history, current medications, and the nature of your condition before recommending sedation. For patients with significant cardiac risk, we may recommend treatment under local anesthesia with monitoring, or coordinate with an anesthesiologist for higher-risk cases.

Kidney disease affects drug metabolism, bleeding tendency, and infection risk. Patients on dialysis require treatment timed around their dialysis schedule, and certain medications commonly used in dentistry must be adjusted for reduced kidney function. We coordinate with your nephrologist to ensure safe dosing and timing.

Immunosuppressive medications can reduce the body's ability to fight infection and heal after surgery. The impact depends on the specific medication and dose. We evaluate each case individually, often in consultation with the prescribing physician, to determine whether implant placement is safe or whether modifications to the protocol are needed.

Medical clearance requests are part of the standard of care and are not billed separately to the patient. Lab work ordered through your physician is typically covered by medical insurance. Dental procedures themselves are billed to dental insurance. We help you navigate both systems.

Yes, with appropriate preparation. We coordinate with your hematologist to determine whether clotting factor replacement, desmopressin, or other hemostatic agents are needed before and during the procedure. Local hemostatic measures including PRF, oxidized cellulose, and suturing techniques are used to control surgical bleeding.

We recommend initiating clearance requests two to four weeks before the planned procedure. This allows time for the physician to respond, for any necessary lab work to be completed, and for medication adjustments to take effect. Emergency situations are handled on an expedited basis with same-day physician communication when possible.