Medical conditions that may complicate having your tooth pulled.

Providing your medical history.

Before your dentist can offer to pull your tooth, they’ll first need to collect and evaluate your relevant medical information.

That’s because the most important thing they can do to avoid complications with your extraction process is to carefully check that you’re fit for the procedure and healing process that follows. And if you’re not fully, then plan ahead for how your case will need to be managed.

a) They’ll want to know your medical conditions both current and past.

A large part of the information that your dentist will need to collect will be about current and past medical conditions you’ve experienced, both treated and untreated. As you’ll learn while reading this page, there are numerous medical conditions that are well known for posing risks and complications for oral surgery.

b) They’ll want your “meds list.”

Your dentist will also want information about all of the medications, supplements, vitamins, and herbal compounds you take. That includes prescription and over-the-counter products, as well as professionally and self-prescribed items.

Since this is an exhaustive subject on its own, we now discuss it on this page. Medicinal compounds of concern with tooth extractions.

Medical conditions of concern with tooth extractions.

As you can see in the list below, there are numerous medical conditions that are well known for creating risks and potential complications during oral surgery. And for this reason, they require special consideration and possibly specific management when an extraction is performed.

• Problems with previous extractions.
• Congestive heart failure.
• Cardiovascular disease.
• Heart anomalies.
• Pacemaker.
• Hypertension.
• Hypotension.
• Hematological diseases.
• Leukemia / Lymphoma.
• Hemorrhagic diathesis.
• Anticoagulants.
• Hyperthyroidism.
• Diabetes Mellitus.
• Renal disease.
• Adrenal insufficiency.
• Cushing’s Syndrome.
• Asthma.
• Epilepsy.
• Skeletal diseases.
• Radiotherapy.
• Allergies.
• Fainting.
• Liver disease.
• Pregnancy / Lactation.

Our list isn’t meant to be all-inclusive nor is the information we give below overly detailed. But this page does provide a quick scan of conditions that are usually of most concern to dentists before pulling their patient’s teeth.

Knowing how you did with previous extractions is important.

X-ray of a severely decayed molar slated for extraction.

1) Complications with previous extractions.

So, even if they don’t specifically ask, make a point of telling them if you’ve had problems with extractions before.

2) Congestive heart failure.

A dentist will be concerned if the circulatory function of a patient suffering from congestive heart failure can adequately meet the demands imposed when having their surgery.

▲ Section references – Koerner, Fragiskos

3) Cardiovascular disease.

The elevated levels of stress that frequently accompany oral surgery can place the patient at risk for experiencing a cardiovascular emergency during their extraction procedure.

The physician of patients who have experienced a cardiovascular episode (angina pectoris, myocardial infarction/heart attack, bypass surgery, stroke) within the previous 6 months is typically consulted before their extraction is performed. Delaying the patient’s treatment, even for some months, may be indicated.

▲ Section references – Koerner, Fragiskos

4) Heart anomalies.

A dentist needs to be aware of any heart anomalies their patient may have. This includes murmurs, heart valve damage, prosthetic (artificial) valves, surgically corrected heart disease, congenital heart conditions, or damage caused by rheumatic fever.

After evaluation, it may be determined that the patient should be considered at-risk for postoperative complications associated with a heart-related bacterial infection. If so, they will need to take prophylactic antibiotics prior to their oral surgery. Antibiotic premedication.

▲ Section references – Koerner, Fragiskos

5) Heart pacemaker.

▲ Section references – Fragiskos

6) Hypertension / High blood pressure.

▲ Section references – Koerner, Fragiskos

7) Orthostatic hypotension.

▲ Section references – Fragiskos

8) Hematological conditions.

Patients who have anemia, clotting disorders, or other hematological conditions must be carefully evaluated prior to having an extraction due to their increased risk of severe hemorrhage.

Anemias of special interest to a dentist are aplastic anemia, Biermer’s megaloblastic anemia (a type of pernicious anemia), hypochromic anemias (iron deficiency anemia, thalassemia), sickle cell anemia, and the condition methemoglobinemia. Other conditions include: Von Willebrand’s disease, thrombocytopenia, hemophilia.

▲ Section references – Hupp, Fragiskos

9) Leukemia / Lymphoma.

Patients who have leukemia, lymphoma, and other hematologic neoplasms (cancers) are more susceptible to infection and may run a greater risk for postoperative hemorrhage (bleeding).

▲ Section references – Fragiskos, Hupp

10) Hemorrhagic diathesis.

Hemorrhagic diathesis (a tendency of spontaneous, often severe, bleeding) can be a symptom associated with several medical conditions.

▲ Section references – Fragiskos

Being able to control bleeding after pulling teeth is vital.

11) The use of anticoagulant compounds.

We now discuss this topic on our page: Drugs of concern with tooth extractions.

12) Hyperthyroidism.

Surgical procedures, like having a tooth pulled, are generally postponed until the patient’s medical doctor has been consulted and the function of their thyroid gland has been normalized (usually via the use of medication).

▲ Section references – Fragiskos

13) Diabetes Mellitus.

A dentist will have a number of issues of concern with diabetic patients, not the least of which is the type of diabetes they have (Type 1 insulin-dependent or Type 2 non-insulin-dependent) and if their condition is considered controlled or not.

Testing (blood glucose level) and consultation with the patient’s medical doctor may be needed before planning their procedure. Treatment is preferably deferred until the patient’s condition is well controlled.

When extractions are performed, the following case management guidelines are usually followed.

• Patients are ideally scheduled for comparatively shorter procedures, preferably in the morning shortly after breakfast.
• The patient is encouraged to maintain their normal diet both before and following their surgery. If this isn’t possible (like after having a tooth pulled), the dosing of their diabetes medication should be adjusted.
• The dentist will need to have supplies on hand that can be used to treat emergency hyperglycemia or hypoglycemia situations.
• Infection concerns should be treated aggressively (antibiotic use, surgical drainage of pus).
• To reduce stress levels associated with the patient’s procedure, the use of antianxiety measures may be indicated.

▲ Section references – Fragiskos, Hupp, Koerner

14) Renal disease (Kidney disease).

Renal diseases of great concern to a dentist when planning their patient’s extraction are acute glomerulonephritis, chronic glomerulonephritis, and renal failure. Consultation with the person’s nephrologist is indicated.

Chronic renal failure.

Persons who experience this condition frequently have associated anemia which with advanced cases can place them at risk for hemorrhagic diathesis (spontaneous bleeding). These patients frequently also have associated hypertension. Both conditions must be monitored and managed when teeth are removed.

Renal dialysis.

▲ Section references – Fragiskos, Hupp

15) Adrenal insufficiency.

When a person is placed in a stressful situation (like having a tooth pulled), their adrenal gland supports their body’s needed response by increasing its production of hormones (notably cortisol, the “stress” hormone).

If the patient’s adrenal gland is unable to produce a satisfactory level of hormones, they are at risk for experiencing acute adrenal insufficiency. Possible symptoms include: hypotension (low blood pressure), syncope (fainting), nausea, confusion, headache, and vomiting.

Reasons for this inability to respond adequately can include Addison’s disease, corticosteroid therapy, or other medical condition. Use this link for more information about issues associated with tooth extractions and taking  Corticosteroid medications.

▲ Section references – Fragiskos, Hupp

16) Cushing’s Syndrome.

This condition involves an overproduction of hormones from the adrenal gland’s cortex, notably the hormone cortisol.

▲ Section references – Fragiskos

17) Asthma.

The symptoms of asthma may be exacerbated by the stress associated with having a tooth pulled, possibly resulting in an acute asthmatic attack.

▲ Section references – Fragiskos

18) Epilepsy.

Epileptic seizures can be precipitated by stress, severe pain, and administering large doses of local anesthetic (the type of drug used to numb up teeth). Of course, all of these may be factors associated with having a tooth pulled.

The dentist must manage their patient’s case in a manner where the potential for these events is kept to a minimum. The patient’s medical doctor may allow for the administration of additional anticonvulsant medication before their surgery is performed. The dentist must be prepared to manage their patient’s seizure if one occurs.

▲ Section references – Fragiskos

19) Diseases of the skeletal system.

These conditions include: osteoporosis, osteopetrosis, osteogenesis imperfecta, cleidocranial dysplasia, Marfan’s syndrome, Down’s syndrome, idiopathic histiocytosis (histiocytosis X), Gaucher’s disease, Paget’s disease, fibrous dysplasia of the jaws, and encephalotrigeminal angiomatosis (Sturge–Weber syndrome).

Patients who suffer from these conditions are at greater risk for jaw fracture during extraction procedures, possibly excessive hemorrhage, and possibly delayed surgical site healing due to postoperative infection. Some conditions may have associated heart disease considerations.

Precautions a dentist will take when performing extractions for patients suffering from skeletal system diseases are the use of minimal extraction force, the use of additional agents to aid in the control of bleeding, and when indicated, the use of antibiotics to minimize the risk of postoperative infection.

▲ Section references – Fragiskos

FYI: A history of having taken medications that are used to treat some bone-related conditions (like Bisphosphonate Drugs ) can be an important factor for the dentist to know before pulling a patient’s tooth.

20) Radiotherapy patients.

Patients whose treatment includes irradiation of their head and neck have an increased risk of experiencing complications with bone healing (osteoradionecrosis) and infection following extractions.

Case management frequently includes the use of pre and post-treatment antibiotic therapy, if available, hyperbaric oxygen therapy, and close monitoring of the patient’s postoperative healing progress. These cases are usually best handled by an oral surgeon.

▲ Section references – Hupp

Report all of your known allergies. Cross-reactivity between drugs is possible.

21) Allergies.

Patients may be allergic to substances routinely used during extraction procedures. This includes local anesthetics (the type of medication used to numb up teeth), antibiotics, analgesics (pain relievers), anxiolytic (anti-anxiety) drugs, or dental materials or products.

▲ Section references – Fragiskos

22) Fainting.

Some of the most common causes of fainting are emotional stress, severe pain, and orthostatic hypotension (a sudden drop in blood pressure due to a change in position like when a patient is quickly returned to an upright position in a dental chair).

▲ Section references – Fragiskos

23) Liver dysfunction.

Having liver disease (hepatitis, cirrhosis, alcoholic hepatitis) places the dental patient at increased risk for complications with bleeding. Additionally, the use of medications that are metabolized (broken down) by the liver must be carefully monitored.

▲ Section references – Fragiskos, Koerner

24) Pregnancy / Lactation.

Both pregnant and breastfeeding women can have extractions performed. There are, however, a number of guidelines that should be followed. We now discuss this topic here: Tooth extraction considerations with  Pregnancy and Breastfeeding.

Our list of conditions is not meant to be all-inclusive.

It would be impossible for us to include every medical condition that has the potential to be a concern for a dentist when planning their patient’s extraction. Our primary goal here is to simply give you an idea of the wide range of conditions that must be considered and evaluated.

So, don’t be swayed by just the issues we have chosen to discuss. Instead, all of the conditions you have (treated or untreated, no matter how minor you think they are) must be reported to your dentist so nothing is overlooked and your extraction can be performed safely.