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Dental Clearance Letter Template
A dental clearance letter answers a dentist’s or oral surgeon’s questions before treatment: the conditions and medicines that matter, whether to change a blood thinner, and whether antibiotics are needed. Copy the template, see a patient on apixaban having 2 extractions and a patient with a mechanical valve having a scaling, and check what dental and thrombosis guidance says in each country.
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- Two filled examples
Blank dental clearance letter template
FreeDENTAL CLEARANCE LETTER [Practice name] [Address] [Phone and fax] Date: [Date you write the letter] To: [Dentist or oral surgeon, practice, and phone or fax] Re: [Patient's full name] Date of birth: [Date] Thank you for your request of [date] about [patient name], who is planning [the dental procedure, e.g. extraction of 2 teeth] on [date, if known]. [Patient name] agreed that I could share the information below with you. RELEVANT CONDITIONS [Only what bears on dental care, with dates: e.g. atrial fibrillation, a coronary stent and when it was placed, a heart valve replacement and its type, a joint replacement and when] MEDICINES AND ALLERGIES Medicines: [Each relevant medicine, its dose, and why the patient takes it] Drug allergies: [Each drug and the reaction, or none known] BLOOD THINNERS Medicine: [Name, dose, and reason, or none] Latest INR, for warfarin: [Result and date, or not applicable] Other bleeding risks: [Kidney or liver disease, low platelets, a second blood thinner, or none known] Recommendation: [Continue without change; or the exact change, by dose and day, e.g. take the morning dose after the procedure] Please do not stop [medicine] without speaking to me first. [For dual antiplatelet therapy after a stent: neither drug should be stopped without the cardiologist] ANTIBIOTIC PROPHYLAXIS Highest-risk heart condition for endocarditis: [None, or which one] Joint replacement or other implant: [None, or which one and when] Recommendation: [Not indicated, and why; or indicated, with the regimen, the timing, and who will prescribe it] OTHER CAUTIONS [Antiresorptive medicines such as a bisphosphonate or denosumab, with the route and how long; diabetes control with the latest A1C; a recent heart attack, stroke, or stent, with the date; or none] The dental treatment plan, and how to carry it out, is your decision. Please call me if the procedure changes or you have questions. [Your name, credentials] [License or registration number] [Signature] Direct line for your office: [Phone or fax]
Use it for
- Extractions on a blood thinner
- Patients with a coronary stent
- Prosthetic heart valves
- Joint replacement questions
- Oral surgery and implants
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
Dental clearance letter: apixaban, 2 extractions
Family practice, reply to a general dentist’s written request
Request
Her dentist wrote on Tuesday, October 13, 2026, asking whether this 74-year-old patient can have 2 lower right molars extracted on Tuesday, October 27, 2026, and whether she should stop her blood thinner first. She agreed that I could share what follows.
Conditions
Atrial fibrillation since 2023, with no stroke. Right total knee replacement in 2021, without complications. Osteoporosis. Normal kidney function: eGFR 74 on Monday, October 5, 2026.
Medicines and allergies
Apixaban 5 mg twice daily for atrial fibrillation. Alendronate 70 mg by mouth once a week since 2022. No aspirin or other antiplatelet drug. No known drug allergies.
Blood thinner
Please continue apixaban; 2 extractions don’t require stopping it, so please use your usual local measures for bleeding. If you prefer, she can take her morning dose after the extractions instead of before, and her evening dose as usual. Please don’t hold it for longer without calling me, as stopping raises her risk of stroke.
Antibiotic prophylaxis
Not indicated. She has no prosthetic heart valve, no past endocarditis, and no other highest-risk heart condition. Her knee replacement doesn’t call for routine prophylaxis, and her orthopedic surgeon hasn’t asked for it.
Other cautions
She has taken alendronate for about 4 years. I mention it because of the risk of osteonecrosis of the jaw after extractions; I haven’t changed it. No diabetes, and no heart attack or stroke.
Signed
Family physician, with credentials, license or registration number, signature, and a direct line for the dental office. Issued Thursday, October 15, 2026. The plan for the extractions is the dentist’s decision.
Dental clearance letter: mechanical valve, scaling and root planing
Primary care nurse practitioner, reply to a dental office
Request
His dental office asked on Friday, October 16, 2026, about scaling and root planing planned for Thursday, October 29, 2026, for this 63-year-old patient: his blood thinner, and whether he needs antibiotics. He agreed that I could share what follows.
Conditions
Mechanical aortic valve, placed in 2019 for a bicuspid valve. No past endocarditis. Hypertension, well controlled.
Blood thinner
Warfarin, currently 5 mg daily, for the mechanical valve. INR 2.7 on Monday, October 19, 2026, within his target range. No antiplatelet drug, and no kidney or liver disease. Please continue warfarin at his usual dose and use local measures; don’t stop or reduce it, because with a mechanical valve that risks valve clots and stroke. I will check his INR again on Tuesday, October 27, and fax you the result.
Antibiotic prophylaxis
Indicated. A prosthetic heart valve is one of the highest-risk conditions for endocarditis, and scaling and root planing manipulates the gum tissue.
Regimen
Amoxicillin 2 g by mouth, as a single dose 30 to 60 minutes before the procedure. He has no penicillin allergy and no other drug allergies. Please prescribe it as you usually do, or let me know and I will.
Other cautions
None. No bisphosphonate or other antiresorptive drug, no diabetes, and no heart attack or stroke.
Signed
Nurse practitioner, with credentials, registration number, signature, and a direct line. Issued Tuesday, October 20, 2026. The treatment plan is the dentist’s decision. If the appointment moves or the work needs more visits, please call so we can review his INR and the prophylaxis.
Blood thinners and antibiotics before dental work: the guidance. Checked October 2026.
What dental and thrombosis guidance in each country says about changing a blood thinner and about antibiotic prophylaxis. It is guidance, not law: the dentist and the prescriber each decide their own part, so check the full source.
United States, blood thinners
For most patients, warfarin, DOACs, and antiplatelet drugs don’t need to change before dental procedures; bleeding is controlled with local measures. Any change before dental surgery should be made with, and on the advice of, the patient’s physician; for a DOAC in a patient at higher bleeding risk, options include delaying the day’s dose until after the procedure, scheduling it as late as possible after the last dose, or interrupting for 24 to 48 hours. After a stent, antiplatelet drugs shouldn’t be stopped prematurely, and the dentist should contact the cardiologist first.
Canada, DOACs
For a minor dental procedure, it is likely safe not to interrupt a DOAC, though data to support this are lacking; alternatives are holding it on the day of the procedure or delaying that day’s dose until after it. Extraction of 1 or 2 teeth, root canal treatment, and subgingival scaling are rated low or very low bleeding risk; complex procedures such as multiple extractions, moderate risk.
Canada, warfarin
Warfarin can be safely continued for a simple extraction of 1 or 2 teeth or a root canal. To reduce gum bleeding, patients can use a tranexamic acid mouthwash just before the procedure and 2 to 3 times a day afterward until the bleeding stops.
Canada, antiplatelet drugs
For minor dental procedures such as an extraction or a root canal, ASA can be continued without interruption, and it is reasonable to continue a P2Y12 inhibitor taken on its own. For dual antiplatelet therapy, management should be individualized, weighing the risk of thrombosis against the risk of bleeding.
United States, heart conditions
Under the AHA’s 2007 guideline, confirmed without change by its 2021 scientific statement, endocarditis prophylaxis is only for the highest-risk patients: a prosthetic valve, including a transcatheter valve, or prosthetic valve repair material; previous endocarditis; a heart transplant with regurgitation from a structurally abnormal valve; and specific congenital heart disease. For them, it is recommended for all dental procedures that manipulate gingival tissue or the periapical region of teeth, or perforate the oral mucosa. Clindamycin is no longer recommended.
Ontario, dentists
The RCDSO lists the same highest-risk heart conditions, with amoxicillin 2 g by mouth, 30 to 60 minutes before the procedure, as the drug of choice; prophylaxis isn’t suggested for coronary or other vascular stents. When a surgeon or family physician recommends prophylaxis that differs from the joint replacement consensus, dentists are encouraged to consult them on the reason; each provider is responsible for their own decisions, and a dentist who declines may suggest the physician prescribe it.
United States, joint replacements
In general, prophylactic antibiotics are not recommended before dental procedures to prevent prosthetic joint infection (ADA clinical practice guideline, 2015). For a patient with a history of complications from the joint replacement, they should be considered only after consulting the patient and the orthopedic surgeon; where they are deemed necessary, it is most appropriate for the surgeon to recommend the regimen and, when reasonable, write the prescription.
Canada, joint replacements
Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, or with orthopedic pins, plates, and screws. The consensus statement of the Canadian Orthopedic Association, the Canadian Dental Association, and AMMI Canada found no reliable evidence that it prevents prosthetic joint infections.
What goes in each part.
Request and consent
What the dentist asked, about which procedure, and that the patient agreed to share the answer.
- The dentist’s or oral surgeon’s name and practice
- The procedure they plan, and the date if they gave one
- That the patient agreed to the information going to the dental office
Avoid: A one-line “cleared for dental work.” It doesn’t answer any of the dentist’s questions.
Conditions, medicines, and allergies
Only what changes the dental plan. The dentist doesn’t need the whole chart.
- Heart conditions and devices, with the dates of any stent, valve, or heart attack
- Each blood thinner, with its dose and the reason for it
- Other medicines that affect bleeding, healing, or infection
- Drug allergies, and what the reaction was
Avoid: Pasting the full problem list. Unrelated history hides the facts the dentist needs.
Blood thinners
Most dental procedures go ahead without stopping an anticoagulant or antiplatelet drug, with local measures such as pressure, sutures, and hemostatic agents. Say clearly whether to continue, and give any change exactly.
- The drug, the dose, and why: atrial fibrillation, a past clot, a mechanical valve, or a stent
- For warfarin, the latest INR and its date
- Other bleeding risks: kidney or liver disease, low platelets, or a second blood thinner
- Continue unchanged, or the exact change, such as taking that morning’s dose after the procedure
Avoid: “Stop blood thinners 5 days before.” Stopping raises the risk of stroke and clots, and dual antiplatelet therapy after a stent should never be stopped without the cardiologist.
Antibiotic prophylaxis
Endocarditis prophylaxis is for a small group of heart patients at the highest risk, on the American Heart Association’s list, which the dental guidance below refers to. A joint replacement on its own generally doesn’t need it.
- Whether the patient has a highest-risk condition: a prosthetic valve or valve repair material, previous endocarditis, certain congenital heart disease, or a heart transplant with valve disease
- If prophylaxis is indicated: the regimen exactly as the guidance gives it, the timing, and who will prescribe
- If it isn’t: say so, and why
- For a joint replacement, any specific reason the orthopedic surgeon gave
Avoid: Antibiotics out of habit for a stent, a pacemaker, a bypass, or a joint replacement. Current guidance doesn’t suggest them routinely for any of these.
Other cautions
Anything else that changes the plan, so the dentist doesn’t learn it from the patient on the day.
- Antiresorptive drugs, such as a bisphosphonate or denosumab, with the route and how long, because of the risk of osteonecrosis of the jaw
- Diabetes control, with the latest A1C and its date
- A recent heart attack, stroke, or stent, with the date
- Chemotherapy, immunosuppression, or a central line
Avoid: Leaving a section blank. Write “none” so the dentist knows you checked.
Decision and signature
The dental plan is the dentist’s decision. Your letter gives the medical facts and your recommendation, and a way to reach you.
- That the treatment plan is the dentist’s decision
- Your name, credentials, and license or registration number
- A direct phone or fax line for the dental office
- What the dentist should do if the procedure changes
Avoid: “Medically cleared for all dental treatment.” Answer for the procedure the dentist asked about.
Common mistakes, and how to avoid them.
Telling the patient to stop a blood thinner
Most dental work goes ahead on an anticoagulant or antiplatelet drug, with local measures. If a change is needed, give the exact dose and day. Never stop dual antiplatelet therapy after a stent without the cardiologist.
“Cleared” with no answers
One word leaves the dentist’s questions open. Answer each one: the blood thinner, antibiotics, and anything else that changes the plan.
Antibiotics out of habit
Prophylaxis is for the highest-risk heart conditions. A stent, a pacemaker, a bypass, or a joint replacement on its own doesn’t call for it.
An INR with no date
Give the latest result and the day it was drawn. If the dentist wants a newer one, say when it will be done and how you will send it.
A regimen from memory
If prophylaxis is indicated, copy the regimen from the current guidance and check allergies first. Clindamycin is no longer suggested.
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Frequently asked questions.
What should a dental clearance letter include?
The procedure the dentist asked about, the conditions and medicines that bear on it, your recommendation on any blood thinner, whether antibiotic prophylaxis is indicated, and other cautions such as antiresorptive drugs or a recent heart attack. Sign it with your credentials and a direct line.
Should a patient stop a blood thinner before a tooth extraction?
Usually not. Dental and thrombosis guidance says most patients on warfarin, a DOAC, or an antiplatelet drug can have simple extractions and most other dental work without stopping, with local measures to control bleeding. Any change should come from the prescriber, for that procedure and that patient.
Can a patient on apixaban or another DOAC have a tooth pulled?
Yes, in most cases. For a minor dental procedure, guidance says it’s likely safe not to interrupt a DOAC; alternatives are skipping that day’s dose or taking it after the procedure. Longer breaks are for more extensive procedures or patients at higher bleeding risk, on the prescriber’s advice.
What INR is safe for a dental extraction on warfarin?
Dental guidance cites a review finding that patients with an INR in the therapeutic range, 3.0 or less, could continue warfarin for extractions, and an oral medicine statement that uncomplicated extraction is safe with an INR of 3.5. Give the dentist the latest result and the day it was drawn.
What if the patient has a stent and takes dual antiplatelet therapy?
Don’t advise stopping either drug without the cardiologist. Stopping early risks stent thrombosis, and dental guidance asks dentists to contact the cardiologist before any change. A review of minor oral surgery on dual therapy found bleeding rates similar to single or no antiplatelet therapy, managed with local measures.
Which heart patients need antibiotics before dental work?
Only those at the highest risk of a bad outcome from endocarditis: a prosthetic valve or valve repair material, previous endocarditis, certain congenital heart disease, and a heart transplant with valve disease. For them, it is for procedures that manipulate the gums or the area around the root tip, or perforate the oral mucosa.
Show all questions
What antibiotic is used for endocarditis prophylaxis before dental work?
For adults who can take it by mouth and aren’t allergic to penicillin, the regimen is amoxicillin 2 g as a single dose 30 to 60 minutes before the procedure; children’s doses go by weight. The guidance lists alternatives for allergy or when oral medicines aren’t possible, and no longer suggests clindamycin.
Do patients with a joint replacement need antibiotics before dental work?
Generally, no. Current dental guidance in both countries says routine prophylaxis isn’t indicated for joint replacements. If an orthopedic surgeon recommends it for a specific reason, it’s most appropriate for the surgeon to choose the regimen and, where reasonable, prescribe it.
Is this dental clearance letter template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write a dental clearance letter?
Yes. Paste this template into Vero, and it drafts the letter from the chart and your notes: the medicines, the latest INR, and your recommendations. Review and edit it, then export it to PDF or Word, print it, or email it.
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