Getting Your Health Ready
Starting 2-4 weeks before surgery, your surgical team will ask about your medical history. They want to know about: any previous problems with bleeding or healing, allergies or reactions to anesthesia, heart problems, high blood pressure, asthma or lung issues, diabetes, thyroid problems, and any medications or supplements you take. Be honest and detailed—don't skip anything you think is unrelated because it might matter.
Tell them about ALL your medications, even ones you think are minor. This includes blood thinners (like warfarin or aspirin), blood pressure medications, diabetic medications, corticosteroids, and supplements. Certain medications interact with surgery and anesthesia, so your surgical team needs to know everything.
Your Heart and Lungs
If you've had a heart attack or have heart disease, your surgeon might order an EKG. If you had a recent heart attack, they'll probably want clearance from your cardiologist before doing elective surgery—definitely wait at least 6 weeks, ideally 12 weeks.
If your blood pressure is super high (systolic above 180 or diastolic above 110), elective surgery gets postponed until it's better controlled. Keep taking your blood pressure medications the morning of surgery unless your surgeon says otherwise.
If you have asthma, bring your rescue inhaler (just in case, though you usually won't need it for dental surgery). If you have COPD and use home oxygen, keep using it.
Diabetes Management
If you have diabetes, get your blood sugar under control before surgery. High blood sugar impairs healing and increases infection risk 3-4 times. Ideally, aim for fasting glucose between 140-180 mg/dL on surgery day.
If you're Type 1, check your fasting glucose the morning of surgery and usually cut your insulin dose in half. If you're Type 2 on oral medications, typically hold metformin the morning of surgery but continue other medications. Ask your surgeon specifically about your medications.
Blood Thinners and Bleeding Risk
This is important: most people on blood thinners should KEEP taking them for minor oral surgery. Stopping them increases blood clot risk, which is worse than having a little extra bleeding. Your surgeon will handle the bleeding with local methods (pressure, stitches, hemostatic agents).
If you're on aspirin for heart health, keep taking it. NSAIDs can interfere with aspirin, so if you need pain medication after surgery, timing matters—take NSAIDs at different times than aspirin.
If you're on warfarin, your surgeon will want your INR checked within 24 hours of surgery. An INR of 2-4 is acceptable for dental surgery.
If you're on newer blood thinners (like apixaban or rivaroxaban), usually just continue them. Confirm with your surgeon and your cardiologist.
Special Medications
If you take steroids (like prednisone) regularly, your surgeon might add extra steroid coverage during surgery. If you take blood pressure medications, keep taking them the morning of surgery with just a sip of water.
NSAIDs increase bleeding risk, so ideally stop them 24-48 hours before surgery if possible. But if you have bad pain or arthritis, talk to your surgeon—the bleeding risk isn't huge for minor procedures.
Who Gets Antibiotics?
Healthy people getting simple extractions don't need antibiotics before surgery. But if you have diabetes, a weak immune system, prosthetic joints, heart valve problems, or a history of heart infections, antibiotics are usually recommended. If you need them, typically one dose of amoxicillin (2 grams) or clindamycin (600 mg for penicillin allergy) one hour before surgery is enough.
Bleeding Tests
If you or your family has a history of excessive bleeding or bruising, your surgeon will order blood tests to check your clotting ability. If your blood cells are very low, surgery gets rescheduled.
Don't Eat Before Surgery
If you're getting general anesthesia or sedation, you typically can't eat or drink for 6 hours before surgery, and nothing to drink for 2-3 hours before. For local anesthesia only, you can eat and drink normally—some surgeons even recommend a light snack an hour before to prevent low blood sugar during long procedures.
Essential medications (blood pressure meds, seizure meds, heart meds) should be taken the morning of surgery with just a sip of water, even if you're fasting.
Quit Smoking NOW
Smoking delays healing by 20-30% and increases infection risk 2-3 times. Quit NOW, at least 2 weeks before surgery (4 weeks is even better). If you're going to smoke, at least taper down. Nicotine patches or gum help, though they maintain some blood vessel constriction.
Clean Your Teeth Really Well
Brush for 3 minutes twice daily, floss daily, and ideally get a professional cleaning 2-7 days before surgery (but not the day before—this can increase bleeding). Great oral hygiene reduces bacteria and decreases infection risk 20-30%.
Managing Anxiety
It's normal to be nervous. Tell your surgeon if you're anxious. They can give you a sedative medication (like midazolam) 30-45 minutes before surgery, or use nitrous oxide during the procedure—both reduce anxiety by 30-40%. Knowing what to expect helps too. Ask your surgeon to explain the sounds and sensations you'll experience.
Day Before Surgery
Shower or bathe with regular soap and water. For mouth surgery, special antimicrobial scrubs don't add much benefit, so skip them. Don't shave the surgical area (microabrasions can harbor bacteria); if you need hair removed, clip it instead.
Wear comfortable, loose clothing. Remove jewelry, piercings, and anything metal because it can interfere with monitoring equipment or cause burns during surgery. Hospital policies require removal anyway.
Arrange your ride home NOW. If you're getting sedation or general anesthesia, you cannot drive afterward due to residual grogginess. You need someone to drive you or you need to arrange a taxi/rideshare.
Arrival and Final Checks
Arrive 15-30 minutes early for check-in. They'll review your consent form, confirm you fasted (if required), take your vital signs, and make sure you brought required documents. Your blood pressure and temperature will be checked. If BP is super high or you have a fever, they might postpone surgery.
Special Situations
If you're immunocompromised (HIV, on immunosuppressants, or undergoing chemotherapy), you'll probably need antibiotics for 7-10 days after surgery instead of just one dose before.
If you're pregnant, elective surgery should wait until after delivery. Emergent surgery (infection, trauma) can happen, ideally in the second trimester when organogenesis is done and you're still comfortable.
The Bottom Line
Prep work before surgery sets you up for success. Fill out all forms completely and honestly, manage your medical conditions, take medications as directed, stop smoking, and arrange your ride home. The time and effort spent preparing dramatically improves your recovery and reduces complications. You've got this!
Related reading: General Oral Surgery Recovery Timeline and Functional and Orthognathic Surgery - Understanding Jaw Correction.
Conclusion
Comprehensive preoperative assessment and optimization 2-4 weeks before scheduled surgery substantially reduces perioperative complications and optimizes outcomes. If you have questions, your dentist can help you understand your options.
> Key Takeaway: Starting 2-4 weeks before surgery, your surgical team will ask about your medical history.