What "dental clearance" actually asks for

A clearance request is not a request to make the mouth perfect. It is a request to remove anything that will become an infection or a non-healing wound at the one moment the patient cannot afford it. Active disease is cleared and emergencies treated definitively in every case; what happens to the quiet chronic lesion is where the five indications part company, sometimes on the answer and more often on the threshold and the reason behind it. In a radiation field it comes out, because the bone will not cope with it later. Before chemotherapy it can usually be left, documented, and dealt with once the marrow has recovered, and a 2025 consensus reaches the same answer for asymptomatic caries and asymptomatic apical disease before an osteoporosis drug, while still taking out teeth with advanced periodontal disease. Transplant is where the evidence and the practical answer pull apart: the only systematic review of the question is thin but reads as support for clearing oral foci, while the same literature warns against holding up an organ for asymptomatic pathology — so the workable answer is a lower threshold for anything of doubtful prognosis, and documentation for what is deliberately left. Timing is its own decision: the plan is built backward from the physician's start date, and the surgery is booked as early in the referral as it can be organised rather than as late, because the start date belongs to the physician and healing time is what the dentist can still add to. Joint replacement is the outlier; routine clearance before arthroplasty has weak evidence behind it and is mostly a question of who is at risk, not whether everyone is. The letter back to the physician says what was found, what was done, what was deliberately left, and when the dentist wants the patient back.