Health History Special Concerns

• Blood Thinners
• Heart Conditions
• Chronic Illness
• Bisphosphonates

Blood Thinners

If you are currently taking Coumadin or other medication associated with the thinning of the blood, please make us aware when you schedule your appointment. The decision of whether or not you should stop this medication before a surgical procedure is up to your primary care physician or cardiologist. We may require that your INR be checked within 24 hours of your scheduled procedure. Your INR count would need to be less than 3.0 in order for us to proceed with treatment.

Heart Conditions

If you have been treated in the past or are currently being treated for a heart-related condition, please be advised that we may need to obtain medical clearance from your primary care physician or cardiologist before a procedure is done in our office.

Chronic Illness

If you are currently under the care of a medical specialist for a chronic illness, please be advised that we may need to obtain medical clearance from your specialist before a procedure is done in our office.

Bisphosphonates

If you are currently taking any medications relating to bone density such as Fosmax, Actonel, Evista, or Zometa please let our office know when you schedule your appointment. It is important for the surgeon to be made aware of this and he will want to discuss this with you during your consult.

Patients who are taking these medications, whether orally or intravenously, are at risk of developing bisphosphonate-associated osteonecrosis of the jaw (BRONJ). This is a condition in which the area of the extraction site does not heal normally and complications can develop. Clinical “symptoms include pain, soft tissue swelling, loosening of teeth, drainage, and exposed bone at the site of extraction”. According to the American Association of Oral & Maxillofacial Surgery (AAOMS), those taking oral bisphosphonates are at a much lower risk of developing BRONJ than those patients who are being administered the medication intravenously. The risks however are still present and patients taking these medications need to be made aware of them.

The standard protocol supported by the AAOMS is that patients who are taking bisphosphonates should discontinue use three months prior to an elective surgical procedure and three months following. This may reduce the risks of developing BRONJ. Before stopping any medication you should consult with your primary care physician.