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Cleared for Surgery

When planning a major surgery, it should be normal protocol for the surgeon to ask for dental pre-op clearance because of the strong association between dental disease and overall systemic health.

For example, untreated periodontal disease ramps up the body’s bacterial load which may lead to postoperative systemic infection when the body is challenged by a surgical event.

In fact, dental schools teach dentists to consult with physicians when there are medical issues that may be compromised by dental treatment, such as removing a tooth when the patient is on certain medications.

Early in my career, I actually had a patient who was rejecting a liver transplant and literally on his death bed. He asked me to see him because he had developed “a little toothache.” A routine x-ray revealed that he had actually seven dental abscesses!

Fortunately, his life was saved because after the teeth were removed he began to accept the liver. 20 years later, he is still my patient. Had he had a proper dental evaluation prior to the liver transplant, his life would likely not have been placed in peril unnecessarily.

Clearance exams should identify any dental issues that might cause post-operative infections or compromised results of the medical procedures. These exams might—and probably should— involve an evaluation of current dental x-rays that clearly show each tooth from top to bottom, a gum disease assessment, and an oral soft tissue examination.

Urgent needs should be treated to achieve stability for as long as necessary for the anticipated recovery period following the medical procedure. Elective dental treatments may be postponed, but active disease must be managed as definitively as possible. When the urgency of the needed medical procedure does not permit time to observe resolve of dental treatment, aggressive treatments like elective extraction of teeth may be needed.

It is also important to seek dental clearance prior to being placed on certain medications. For example, some medications used to treat cancer pain and osteoporosis may pose risks for future dental treatments like extractions or periodontal surgery. Ideally, these procedures should be done prior to beginning these medications.

When in doubt, it is always prudent to ask your doctor, “Do I need to check with my dentist first?”

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