Humans are complicated creatures with body types that vary in susceptibility, and when one organ does not operate at a high level, it impacts several other components. While dental professionals take extensive anatomy and physiology and biology courses, we still rely on our connections in the medical field to assist when treating certain patients. 

If an individual has underlying health issues, outpatient dental treatment isn’t a black-and-white issue; they may require medical clearance beforehand. However, determining when this is appropriate can be tricky, as clinicians must make informed decisions based on more than just the patient’s condition. 

A new study by the Journal of the American Dental Association (JADA) investigated when medical clearance for patients with complex health histories should be mandatory. Researchers examined those with cardiovascular, pulmonary, cerebrovascular, hepatic, kidney, endocrine, orthopedic, and oncologic complications and how these may affect outpatient oral procedures.¹ 

The authors identified specific thresholds that indicate when oral treatment requires modifications, when elective care should be deferred, and when coordination with a physician is warranted. 

Medical clearance should be selective rather than routine 

Ultimately, each patient has a unique medical background, which means deciding whether they need medical clearance cannot be based on their condition alone; one patient suffering from a particular disease may be at a greater risk for developing complications than someone else with the same disease. 

Researchers determined that stable chronic diseases rarely require physician consultation before dental treatment, whereas unstable conditions, recent major cardiovascular or cerebrovascular events, severe metabolic disease, significant bleeding disorders, advanced organ failure, and active cancer therapy often warrant a conversation with a medical professional. 

The review also reinforces several updated recommendations, including continuing most anticoagulant and antiplatelet therapies during routine dental care, limiting antibiotic prophylaxis for infective endocarditis to high-risk patients, and avoiding unnecessary medical consultations for stable conditions like osteoporosis or prosthetic joints.¹ 

How unnecessary clearance may inhibit patient care 

As the JADA article notes, selective and intentional care can help ensure patients get treatment soon, and when needed. But having more medical consultations isn’t always a good thing as it can counterintuitively delay dental care. Delayed care for those with preexisting oral conditions can exacerbate systemic issues. Blood clots can form in patients with cardiovascular issues, gum infections can complicate blood sugar management, bacteria from oral abscesses can migrate to other parts of the body, and so on. 

Additionally, the back-and-forth between medical appointments and dental appointments may make patients shy away from care as a whole. Spending money on copays and taking time out of their day (or off work) for these appointments can snowball into a larger burden; some patients may give up on care because the system is too complicated.  

Miscommunication and liability 

Fragmented communication between dental and medical professionals may also inhibit care. If dental professionals are not speaking the same language as the medical teams initiating medical clearance, problems often arise. Research has shown that cohesive communication between health-care professionals improves patient safety and prevents undesirable care outcomes.² 

A great example of this is how dental clinicians classify the patient’s health status. The decision was made to base it on the American Society of Anesthesiologists (ASA) physical status classification, the patient’s disease stability, their symptom burden, and procedural risk. With these parameters, dentists can make more consistent, evidence-based decisions while avoiding unnecessary delays in care. 

Obtaining medical clearance does not permit clinicians to perform dental procedures; rather, it is meant to provide the treating dentist with the necessary information to move forward with confidence. Clearance also does not transfer responsibility for treatment outcomes to the physician.

According to oral health researcher Dr. Randolph R. Resnik, the dental professional is still responsible for treatment planning, surgical execution, anesthetic management, intraoperative decision-making, complication management, and postoperative care. The physician’s role is secondary; they can assess a patient’s medical stability and identify potential risks.³ 

Poor communication between dental and medical professionals may also result in lawsuits and liability issues. For example, a physician advising a patient to stop taking anticoagulants prior to surgery would contradict dental and anticoagulation guidance. If they are unfamiliar with the effects of dental hemostasis and the patient suffers negative side effects following surgery, they can argue the following: 

• The physician’s recommendation deviated from evidence-based standards for dental procedures. 

• The dentist reasonably relied on the physician’s written directive to alter anticoagulation.

• The injury, such as embolic stroke, was a foreseeable consequence of unnecessary interruption.⁴ 

Conclusion 

Here are some things to remember for clinicians when it comes to medical clearance: 

• Base clearance decisions on disease stability, not diagnosis alone. 

• Follow current evidence on anticoagulants, antiplatelets, and antibiotic prophylaxis. 

• Avoid unnecessary medical clearances that delay treatment. 

• Conduct a risk assessment before requesting clearance. 

Ultimately, the nuance of medical clearance cannot be overlooked, especially when it comes to patients with a complex medical record. Findings from JADA’s recent report underscore how clear interdisciplinary communication between doctors and dental providers and an individualized approach are key for reducing patients’ health risks following surgery—as well as liability issues if something goes wrong. 

References

1. Sandhu S, Newsome L, Shazib MA. Medical clearance considerations for medically complex adult patients. J Am Dent Assoc. 2026;157(7):716-726. doi:10.1016/j.adaj.2025.11.017 

2. Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: an integrative review. Nurse Educ Pract. 2016;19:36-40. doi:10.1016/j.nepr.2016.04.005 

3. Resnik R. Medical clearance for implant procedures. Glidewell. https://glidewelldental.com/company/blog/medical-clearance-for-implant-procedures-a-complete-guide-for-general-dentists  

4. Resnik R. Dental surgery, primary care and malpractice risk: what to know about medical clearances for oral care. Medical Economics. Updated April 2026.  https://www.medicaleconomics.com/view/dental-surgery-primary-care-and-malpractice-risk-what-to-know-about-medical-clearances-for-oral-care