Medical Management

Cardiovascular disease
Hypertension
Coagulopathy
Asthma
Seizures
Diabetes
Patients on steroids
Patients on bisphosphonates
Pregnancy
Breastfeeding

Cardiovascular disease
Patients with a history of angina, heart attack, congestive heart disease, or valve disorders are evaluated by Dr. Kazemi in order for him to make appropriate and specific medical management and evaluation guidelines.

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 their physician for therapeutic levels.

Diabetes
Patients with uncontrolled diabetes have significant chances of infection and poor healing. Proper control is essential for 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 cannot 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 advised 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
Patients taking bisphosphonate drugs may have an increased risk of osteonecrosis of the jaw bone. Patients using the oral form (Fosamax, Actonel, and Boniva) for more than three years should discontinue medication for 3 months before surgery. Those on the IV form (Zometa, Aredia, and Boniva-IV) are advised to avoid surgery and seek non-surgical options. Risks and benefits should be discussed thoroughly with your surgeon.

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.

Breastfeeding
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.