Integrating patients' medical and dental health care is important because there are correlations between periodontal disease and some medical conditions, such as diabetes mellitus, coronary artery disease, hypertension, kidney disease, and rheumatoid arthritis.^1–7 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. Although dentists are ultimately responsible for the treatments they provide, they need the patient's complete medical information and often consult physicians when planning common dental procedures, such as cleanings, extractions, restorations (e.g., fillings, crowns, bridges, implants), endodontic procedures, abscess drainage, or mucosal biopsies.⁸

A medical consultation in preparation for a dental procedure should detail the patient's medical conditions, treatment plans, and current levels of management.⁷ A medical history, including allergies and use of herbal remedies and prescribed and over-the-counter medications, should be provided. It is essential to include any history of bisphosphonate use or cancer treatments.⁹ A relevant psychiatric history, including special needs, and the patient's resuscitation wishes or advance directive may be helpful.¹⁰

eFigure A is a sample consultation report form to assist physicians when evaluating patients before dental procedures (see template). Table 1 summarizes key concepts discussed in this article.^{1,5,9,11–39}

Antibiotic Prophylaxis

INFECTIOUS ENDOCARDITIS

For decades, the American Heart Association recommended prophylactic antibiotics for patients with cardiac conditions that might increase the risk of contracting infectious endocarditis during dental procedures. However, because studies have found that bacteremia occurs routinely with common activities such as chewing, brushing, and flossing and there is a lack of evidence that procedural prophylaxis is effective,⁴⁰ the American Heart Association now recommends considering it only when dentogingival manipulations are planned for selected patients at highest risk of complications (Table 2).¹¹

PROSTHETIC JOINTS

A high-quality prospective, case-control study found that antibiotic prophylaxis does not affect the incidence of prosthetic knee or hip infections.¹² A 2013 joint guideline from the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons suggests that physicians consider discontinuing routine procedural antibiotic prophylaxis after discussing risks and benefits of antibiotic prophylaxis with patients.⁴¹ Since 2015, the ADA has recommended against routine prophylaxis for patients with prosthetic joints.¹³ Because dentists usually follow ADA guidelines, they often do not provide an antibiotic prescription; patients electing to use prophylaxis may need to obtain the prescription from their physician.¹³

Cardiovascular Conditions

ANTICOAGULATION AND ANTIPLATELET THERAPIES

For simple cleanings or single tooth extractions, evidence supports continuing antiplatelet and anticoagulation medications at a therapeutic international normalized ratio (INR) because the indications for these medications usually outweigh the risks of dental complications.¹⁴ Studies have demonstrated that patients taking a vitamin K antagonist at a therapeutic INR, direct oral anticoagulants, or daily aspirin are not at increased risk of uncontrollable bleeding after outpatient oral surgeries.^15–19 Another study of patients on nonaspirin antiplatelet therapy, alone or in combination with aspirin, demonstrated a negligible increased risk of bleeding after invasive dental treatments.²⁰ Dentists routinely manage such perioperative bleeding using simple topical treatments, pressure packs, or sutures.^19,20