Where can I find dental pre-operative (pre-op) clearance recommendations?

From the Guidelines

Dental pre-operative clearance recommendations can be found through your dentist, oral surgeon, or primary care physician, with a focus on patients with high-risk conditions such as prosthetic heart valves, previous infective endocarditis, or certain congenital heart conditions, as outlined in the 2017 AHA/ACC guideline update 1. To determine the need for pre-operative clearance, patients should start by consulting with the dental professional performing their procedure, as they can provide specific guidelines tailored to their situation.

• For routine dental procedures, healthy patients typically don't need formal clearance, but those with certain medical conditions (heart disease, diabetes, immunosuppression) should seek evaluation.
• Your primary care physician can provide clearance letters addressing your specific health concerns.
• Common pre-op recommendations include antibiotic prophylaxis (typically amoxicillin 2g orally 1 hour before procedure, or clindamycin 600mg for penicillin-allergic patients) for those with prosthetic heart valves, certain congenital heart conditions, or previous infective endocarditis, as recommended by the 2008 ACC/AHA guideline update 1.
• Patients on blood thinners may need medication adjustments, and those with uncontrolled diabetes might require stabilization before elective procedures, as suggested by the 2020 review of guidelines for dental antibiotic prophylaxis 1. These precautions help prevent complications like infection or excessive bleeding during dental work.
• Many dental offices and hospital systems also have their own pre-op clearance protocols available on their websites or through their patient portals. It is essential to note that the current recommendations prioritize the risk of adverse outcomes after infective endocarditis rather than the lifetime risk of acquisition of infective endocarditis, as stated in the 2017 AHA/ACC guideline update 1.
• The use of antibiotic prophylaxis should be determined on a case-by-case basis, considering the individual patient's risk factors and medical history, as emphasized by the 2008 ACC/AHA guideline update 1.
• The 2020 review of guidelines for dental antibiotic prophylaxis also highlights the importance of dental stewardship and the need to balance the benefits and risks of antibiotic prophylaxis 1.

From the Research

Dental Pre-Operative Clearance Recommendations

To find a list of dental pre-operative (pre-op) clearance recommendations, consider the following sources:

• The American Heart Association (AHA) guidelines for the prevention of infective endocarditis (IE) 2, 3
• The American Dental Association (ADA) and American Academy of Orthopaedic Surgeons (AAOS) guidelines for antibiotic prophylaxis in patients with prosthetic joints 4, 5
• The American Family Physician journal, which provides recommendations for medical clearance for common dental procedures 6

Key Recommendations

Some key recommendations to consider:

• Prophylactic antibiotics are not recommended for preventing prosthetic joint infections or infectious endocarditis except in certain circumstances 6
• Anticoagulation and antiplatelet therapies typically should not be suspended for common dental treatments 6
• 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 6
• A detailed history of head and neck radiation therapy should be provided to the dentist 6

Additional Resources

For more information, consult the following studies:

• 2 for findings on antibiotic prescribing practices of dentists
• 4 for recommendations on antibiotic prophylaxis for patients with prosthetic joints
• 3 for acceptance among and impact on dental practitioners and patients of AHA recommendations for antibiotic prophylaxis
• 5 for current recommendations on antibiotic prophylaxis for patients with a history of total joint replacement