Medical Conditions

Cardiovascular disease
Hypertension
Coagulopathy
Asthma
Seizures
Diabetes
Patients on steroids
Patients on bisphosphonates (Fosamax, Actonel, and Boniva)
Pregnancy
Breast feeding
Can I take my normal medications on day of surgery?

Cardiovascular disease
Patients with history of angina, heart attack, congestive heart disease, or valve disorders are first evaluated by Dr. Kazemi and then appropriate medical management and evaluations are made.

Hypertension
Hypertension must be controlled with proper blood pressure medications prior to your surgery. Do not alter your regimen; all medications should be taken normally throughout your treatment.

Coagulopathy
If you are on Coumadin, it is best to stop it 72 hours before surgery, if approved by your physician. If it is not advisable to stop the Coumadin, your physician may change the dosage and perform a blood test to check the levels. Patients on aspirin or Plavix may continue the medication as routine, although bleeding might be slightly more prolonged. Patients with bleeding disorders should see their hematologist prior to any oral surgery.

Asthma
If having IV sedation, bring your inhaler with you on the day of surgery. Two puffs are usually recommended right before surgery. Patients with severe asthma that has required hospitalization may require other therapy by their physician before surgery.

Seizures
Patients with epilepsy or seizures must be on appropriate medications and monitored by physician for therapeutic levels.

Diabetes
Patients with uncontrolled diabetes have significant chances of infection and poor healing. Proper control is essential for the overall health. Well controlled diabetic patients can have oral surgery safely with no more risk for infections than non-diabetic patients. If you are insulin dependent and having IV sedation, take half of your normal dose on the morning of surgery as you can not eat or drink anything. You will be given IV fluids with dextrose to help keep you sugar level up during surgery. Non-insulin dependent patients may continue other medications as normally as possible. Antibiotics are often prescribed after the surgery as prophylaxis.

Patients on steroids
Patients with adrenal insufficiency or long term steroid therapy for various medical conditions have decreased production of natural steroids, critical in many regulatory functions of the body. Such patients are recommended to take steroid supplements by doubling their normal dose on the morning of surgery. It may also be administered intravenously during surgery.

Patients on Bisphosphonates (Fosamax, Actonel, and Boniva)
Patients taking bisphosphonate drugs may have increased risk of osteonecrosis of the jaw bone.

  • For individuals who have taken an oral bisphosphonate for fewer than 3 years and have no clinical risk factors, no alteration or delay in the planned surgery is necessary. This includes any and all procedures common to oral and maxillofacial surgeons, periodontitis, and other dental providers. It is suggested that if dental implants are placed, informed consent should be provided related to possible future implant failure and possible osteonecrosis of the jaws if the patient continues to take an oral bisphosphonate. Such patients should be placed on a regular recall schedule. It is also advisable to contact the provider who originally prescribed the oral bisphosphonate and suggest monitoring such patients and considering either alternate dosing of the bisphosphonate, drug holidays, or an alternative to the bisphosphonate therapy.



  • For those patients who have taken an oral bisphosphonate for fewer than 3 years and have also taken corticosteroids concomitantly, the prescribing provider should be contacted to consider discontinuation of the oral bisphosphonate (drug holiday) for at least 3 months before oral surgery, if systemic conditions permit. The bisphosphonate should not be restarted until osseous healing has occurred. These strategies have been determined from the opinion of experts with significant clinical experience and the hypothesis that concomitant treatment with corticosteroids might increase the risk of developing BRONJ and that a drug holiday may mitigate this risk. Long-term, prospective studies are required to establish the efficacy of drug holidays in reducing the risk of BRONJ for these patients.



  • For those patients who have taken an oral bisphosphonate for more than 3 years with or without any concomitant prednisone or other steroid medication, the prescribing provider should be contacted to consider discontinuation of the oral bisphosphonate for 3 months before oral surgery, if systemic conditions permit. The bisphosphonate should not be restarted until osseous healing has occurred. These strategies have been determined from the opinion of experts and observational studies.



Pregnancy
It is always best to defer any elective oral surgery until after delivery. Treatment in the first or last trimester is avoided, unless absolutely necessary. However, if oral surgery must be performed due to pain or infection, local anesthesia is the only method of choice. Medications considered safest are Acetaminophen, Penicillin, Codeine, Erythromycin, and Cephalosporin. Aspirin and Ibuprofen are not used because of possible bleeding.

Breast feeding
Medications known to enter milk and potentially affect infants should be avoided. Acceptable drugs can be delivered according to age and size of the baby. The older the child, the less chance of a problem with the drug. Drugs that can be used sparingly include Acetaminophen, antihistamines, Codeine, Erythromycin, Fluoride, Lidocaine, and Clindamycin. Drugs that are potentially harmful to the infant include Ampicillin, Aspirin, Barbiturates, Diazepam, Penicillin, and Tetracyclines.

Can I take my normal medications on day of surgery?
Yes. You may take all of your normal medications as scheduled with a small sip of water. The exceptions are:

  • Coumadin– Generally discontinued 72 hours before surgery. Please check with your physician to get approval.

  • Insulin– If you take insulin in the morning, take only half of your normal dosage.

  • Aspirin– Aspirin can prolong bleeding, so if possible, discontinue 72 hours before surgery. Please check with your physician for approval.