Information about your first visit to our San Francisco dental office.
A patient’s first visit to our office will typically consist of a consultation to explain the diagnosis and discuss treatment options. In many cases, treatment will be provided immediately following the consultation, however those patients with complex medical histories or treatment plans may require a second appointment at which treatment will be provided.
Before any procedure requiring anesthetic, it is important to alert staff members if you have a medical condition that may be of concern. These may include hearts disease, high blood pressure, artificial heart valves and joints, diabetes, rheumatic fever, etc. Also please let us know if you are on any medication that may affect the procedure (i.e. heart medications, aspirin, blood thinners, etc.) or if you require medication before dental cleanings (i.e. antibiotics premedication.)
At your first appointment, you will be asked to provide as much of your medical history as possible. This may include things such as a referral slip from another doctor and any dental X-rays in your possession, a current list of medications you are taking, and completed medical or dental insurance forms (if applicable). This helps us avoid unnecessary delay when processing dental insurance claims.
Please note: A parent or guardian must accompany patients under 18 during their first visit to our office.
Premedication
Infective endocarditis overview
For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. The AHA’s latest guidelines were published in its scientific journal, Circulation, in October 2007 and there is good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.
The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria. Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing.
The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:
- mitral valve prolapse
- rheumatic heart disease
- bicuspid valve disease
- calcified aortic stenosis
- congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.
The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.
Preventive antibiotics prior to a dental procedure are advised for patients with:
- artificial heart valves
- a history of infective endocarditis
- certain specific, serious congenital (present from birth) heart conditions, including
- unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
- a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
- any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
- a cardiac transplant that develops a problem in a heart valve.
The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.