Most medical conditions do not rule out dental treatment. Not implants, not crowns, not a full set of teeth. What changes is where the treatment should happen and who should be in the room while it does.

That is the whole of it, and it is worth saying before anything else, because a great many people have quietly decided the opposite about themselves. They have a heart condition, or diabetes, or they are on blood thinners, and over a few years the dental work they need has gone from "I'll sort that out" to "I don't think I can risk that." Nobody told them no. They stopped asking.

Our dental clinic is not a dental practice with a hospital somewhere nearby. It is a unit inside Özel Florya Hastanesi, a full general hospital in Istanbul — cardiology, internal medicine, neurology, respiratory medicine and anaesthesiology in the same building as the dental chair, more than twenty tertiary-level intensive care beds, and the legal authority to give a general anaesthetic, which almost no dental clinic in Turkey has.

This page explains what that actually buys you, what it does not, and how to work out whether you need it.

 

AT A GLANCE

• Most chronic conditions — cardiac disease, high blood pressure, asthma, COPD, diabetes, and many others — are not a barrier to dental treatment, including implants. What they change is the setting and the planning.

• Serious events during dental treatment are uncommon. A study of 1,722,252 dental visits recorded medical emergencies at a rate of 17.4 per 100,000 visits, or 0.017 per cent (Al-Sebaei, BMC Emergency Medicine, 2024).

• When one does happen, most are managed on the spot: in that study 87 per cent of patients recovered in the dental clinic and 13 per cent required transfer to an emergency room. There were no deaths.

• The commonest events were fainting (62.3 per cent), low blood sugar (12 per cent), reactions to adrenaline in the local anaesthetic (3.3 per cent) and panic attacks (2.7 per cent).

• One finding is worth knowing because it cuts against the obvious assumption: 70 per cent of those emergencies happened in patients classified as healthy (ASA 1). Being well is not the same as being safe, which is part of why some of our patients have no medical condition at all.

• In full-mouth treatment of patients with chronic conditions, roughly one patient in ten needs some form of urgent intervention during treatment in our own experience — a blood pressure spike that has to be brought down, glucose that has to be given, a rhythm change that has to be assessed, a physician who has to be called into the room. This is our own operational observation, not a published figure, and we explain below exactly what we count.

• A UK dental practice works to a real and well-designed emergency standard: Resuscitation Council UK requires an automated external defibrillator with immediate access in all clinical areas, defibrillation attempted within three minutes of collapse, oxygen, airway adjuncts, emergency drugs, and resuscitation training updated at least annually (Quality Standards: Primary Dental Care, 2013, updated May 2020).

• What that standard also says, in its own words, is that ambulance crews provide treatments "supplementary to those available in the dental surgery." The practice stabilises you and calls 999. That is the design, and it is the right design for a dental practice.

• A hospital-based dental clinic does not call an ambulance. The anaesthetist is already in the room, the monitoring is already running, the resuscitation team is in the building, and the intensive care unit is upstairs.

• Severe dental fear is common and not a character flaw: 11.6 per cent of UK adults score in the high-anxiety range on the Modified Dental Anxiety Scale (Humphris and colleagues, BMC Oral Health, 2013, from the Adult Dental Health Survey of 11,382 adults).

• Avoidance has a price. Adults with dental phobia had pus, ulceration, fistula or abscess at 12.2 per cent against 5.6 per cent in non-phobic adults — roughly double the rate of frank dental infection (Heidari, Banerjee and Newton, British Dental Journal, 2015).

• We offer local anaesthetic, oral sedation, intravenous conscious sedation, and general anaesthesia in a hospital operating theatre administered by an anaesthesiology and reanimation specialist.

• We will also tell you when you do not need us. A well-controlled condition and routine treatment belong in a good local practice, and you should not be frightened out of one.

• And we will tell you when you should not travel at all. Our exclusion criteria are published further down this page.

 

HAVE YOU BEEN PUTTING THIS OFF BECAUSE OF YOUR HEALTH?

"My dentist never said no — I just stopped asking"

This is the most common version of the story and it almost never involves a refusal.

What happens is smaller than that. A dentist mentions that your blood pressure is a bit high today and suggests coming back. A receptionist asks you to bring a letter from your cardiologist and you never get round to it. You read something about blood thinners and bleeding. You get the sense, without anyone ever saying it, that you are a complicated patient and that complicated patients are a nuisance. So the extraction waits. Then the implant waits. Then you start avoiding the appointment that would have told you where you stand.

Five years later the work needed is much bigger than it was, which makes the whole thing feel riskier still, which makes you put it off again.

If any of that sounds like your last few years, the useful thing to know is that the problem was usually never your heart or your diabetes. It was that nobody sat down and planned around them.

​

Who this page is for

• You have a chronic condition — a heart problem, high blood pressure, asthma or COPD, diabetes, kidney disease, something else — and you have been treating your own health as a reason not to have the dental work done.

• You are frightened of the dentist, perhaps for a very long time, and the amount of treatment you now need has made that worse rather than better.

• You are in good health, but you are having a lot of surgical work in one go, and you would simply rather it happened somewhere with an anaesthetist in the room and an intensive care unit in the building. That is not anxiety. It is a reasonable preference about where you spend four hours under instruments.

• Another clinic has already turned you down on medical grounds. This is the smallest of the four groups and the easiest to help, and it is dealt with near the end of this page rather than the beginning, because most people reading this were never refused anything.

 

WHAT ACTUALLY HAPPENS IF SOMETHING GOES WRONG DURING DENTAL TREATMENT?

Nobody writes this down for patients, which is strange, because it is the question underneath all the others. So here it is, as straight as we can put it.

​

The events clinicians actually plan for

• Fainting (vasovagal syncope) is by far the commonest, at 62.3 per cent of recorded dental emergencies in that 1.7 million-visit study. It is usually brief and usually frightening and almost always managed by laying the patient flat.

• Low blood sugar came second at 12 per cent. It is mostly a problem of long appointments and missed meals in people on insulin or sulfonylureas, which is to say it is a planning problem.

• A sharp rise in blood pressure, from anxiety, pain, or the adrenaline in local anaesthetic. In a patient with no cardiac history this is uncomfortable. In a patient with one, it is the event that matters most.

• Angina or a change in heart rhythm. In the 1999 British survey of 1,500 general dental practitioners, angina accounted for around one in ten emergencies seen in practice (Atherton, McCaul and Williams, British Dental Journal, 1999).

• An asthma attack or bronchospasm — the third commonest category in that same British survey, at 11 to 14 per cent.

• A seizure, which was the single largest category in the British data at 31 to 36 per cent, often in people with known epilepsy.

• Prolonged bleeding, which is the one patients on anticoagulants worry about most and which is, for most dental procedures, manageable locally.

• A reaction to local anaesthetic, including the rare but serious systemic toxicity, and anaphylaxis, which is rare and fast.

 

Two honest points about those numbers. First, they are small: on a per-visit basis these events are rare. Second, and this is the one that matters for anyone planning a full mouth of work, the published rates are per visit, across whole populations having mostly short, simple treatment. A four-hour surgical appointment in a patient with cardiac disease and diabetes is not the same exposure as a twenty-minute filling in a healthy thirty-year-old, and the literature does not tell you what that difference is, because nobody has measured it properly.

What we can tell you is what we see. In our own full-mouth cases in patients with chronic conditions, something needs doing in roughly one patient in ten — blood pressure brought down before we continue, glucose given, a rhythm change looked at, a cardiologist or internist called into the room, occasionally a decision to stop for the day and resume tomorrow. Almost none of these are emergencies in the dramatic sense. Nearly all of them are events that are entirely routine in a hospital and are a crisis in a building where no physician is available.

That is our figure, from our own practice, and we are not going to dress it up as research.

What a dental practice is equipped to do

We want to be scrupulous here, because this is where most clinics selling hospital treatment start exaggerating, and the honest version is more persuasive anyway.

A UK dental practice is held to a real standard. Resuscitation Council UK's Quality Standards: Primary Dental Care requires immediate access to an automated external defibrillator in all clinical areas, an attempt at defibrillation within three minutes of collapse, oxygen, basic airway adjuncts, a defined set of emergency drugs, and resuscitation knowledge and skills updated at least annually for all clinical staff. Dentists in the UK are trained in medical emergencies and resuscitation; it is a regulatory requirement, not an optional extra. Anyone who tells you your dentist cannot manage an emergency is misleading you.

What the standard also does is define the ceiling, and it defines it in its own words: ambulance crews provide treatments "supplementary to those available in the dental surgery." The dental team's job is to recognise the event, keep you alive, and get you to hospital. That is a sensible and well-thought-out design for a building that does dentistry.

It just has a limit, and the limit is the ambulance.

 

What a hospital is equipped to do

• In a dental practice, a cardiac event is managed with a defibrillator, oxygen, airway support, emergency drugs and chest compressions, while someone calls 999 and the team waits for the ambulance.

• In a hospital-based dental clinic, the same event is managed by an anaesthesiology and reanimation specialist who is already in the room, with continuous ECG, blood pressure and oxygen saturation monitoring already running, a hospital resuscitation team arriving in minutes, a cardiologist in the building, and an intensive care bed in the same building.

Beyond the emergency, there is the ordinary version of the same advantage, which is the one most of our patients actually use. If your blood pressure is too high on the morning of surgery, we do not send you home — an internal medicine physician sees you, it is managed, and we go ahead when it is safe. If your blood sugar is unstable, it is corrected in the building. If a cardiologist needs to look at an ECG before we give you an anaesthetic, that appointment happens the same morning, down the corridor.

A recovery room is a room where you wake up. An intensive care unit is where you are kept alive. In Turkey, dental facilities that are not hospitals do not have intensive care at all — and they are not permitted to administer general anaesthesia. Turkey's regulation on private oral and dental health facilities is explicit about it: "Sedasyon veya genel anestezi altında yapılacak tanı ve tedavi işlemleri muayenehanelerde yapılamaz" — diagnostic and treatment procedures under sedation or general anaesthesia may not be carried out in dental surgeries — and the identical prohibition applies to oral and dental health polyclinics, which is what the overwhelming majority of Turkish health tourism dental clinics are. Our sedation and general anaesthesia page sets this out in full.

​

How to decide which setting is right for you

A framework, including the branch where the answer is that you do not need us.

A good local dental practice is the right place for you if your condition is well controlled, your medication is stable, and the treatment is routine — fillings, a crown, a straightforward extraction, hygiene. Having diabetes or taking an anticoagulant does not by itself move you out of primary care, and you should not let anyone frighten you into thinking it does. Most dentistry for most people with chronic conditions belongs exactly where it has always been.

A hospital setting is worth considering if any of these apply: the treatment is extensive surgery over several hours or several teeth at once; you have more than one significant condition, or one that is poorly controlled; your condition is one where the likely emergency is cardiac or respiratory rather than a faint; you are on anticoagulants and the planned procedure is in the higher bleeding-risk category — which in Scottish Dental Clinical Effectiveness Programme terms includes complex extractions, more than three extractions at once, and procedures that involve raising a flap; or you simply cannot face being awake for it.

And it is the right place if you want it to be. Choosing an anaesthetist and a monitored environment for a long surgical procedure is a normal informed decision. You do not have to be ill to make it.

 

CAN I HAVE DENTAL TREATMENT WITH A HEART CONDITION?

A heart condition is not a barrier to dental treatment, including implants. There are three specific things that need handling, and a great deal of misinformation about all three.

The adrenaline in local anaesthetic. Dental local anaesthetic usually contains a small amount of adrenaline, which is what makes it last. In patients with cardiac disease the dose needs thinking about rather than avoiding, and the reason a hospital setting helps is not that the drug is dangerous but that the effect is monitored rather than guessed at.

Antibiotics before treatment, for infective endocarditis. This is the single most misstated subject in dentistry and the guidance has moved. NICE's 2008 guideline said prophylaxis was "not recommended"; a 2016 amendment inserted one word, making it "not recommended routinely", and in November 2024 NICE redirected clinicians to the Scottish Dental Clinical Effectiveness Programme, conceding that patients at high risk may benefit. The European Society of Cardiology's 2023 guidelines upgraded their recommendation to Class I.

As the SDCEP implementation advice now stands, antibiotic prophylaxis is recommended before extractions and oral surgery in patients at high risk, and should be considered for other procedures involving the gingiva or the periapical region. The high-risk group is specific: previous infective endocarditis; surgically placed prosthetic valves or prosthetic repair material; transcatheter aortic or pulmonary valve prostheses; untreated cyanotic congenital heart disease; and ventricular assist devices.

Equally specific is who does not need it, because many patients have been told otherwise for years: prophylaxis is not recommended for rheumatic heart disease, degenerative valve disease, a bicuspid aortic valve, a pacemaker or implantable defibrillator, or hypertrophic cardiomyopathy. If you have a pacemaker and you have been taking amoxicillin before your check-ups, this is worth a conversation.

Timing after a cardiac event. Elective dental treatment is normally deferred after a recent heart attack, stroke or TIA, or recently placed stents. The American Society of Anesthesiologists' own classification puts a myocardial infarction, stroke, TIA or coronary stent within the last three months in the ASA IV category — "severe systemic disease that is a constant threat to life". We will ask you for dates, and if you are inside that window we will tell you to wait rather than fly.

​

CAN I HAVE DENTAL IMPLANTS IF I HAVE DIABETES?

Yes, and the research is unusually clear about why: it is not the diagnosis that matters, it is the control.

In a systematic review of 54 studies, implant survival sorted almost entirely by HbA1c — the blood test that reflects average blood glucose over roughly three months. Survival ran at 95 to 100 per cent with an HbA1c at or below 7 per cent, 92 to 98 per cent between 7 and 8 per cent, and 85 to 94 per cent above 8 per cent (Shahi and colleagues, BMC Oral Health, 2026). The same review found type 2 diabetic patients at 92.2 per cent survival against 93.2 per cent in non-diabetic patients at 36 months, across 663 implants — a difference of one percentage point.

Over the longer term, bone around the implant does behave differently: marginal bone loss at five to ten years was 2.28 millimetres in type 1 diabetes, 1.47 millimetres in type 2, and 0.91 millimetres in non-diabetic patients. Worth knowing, and worth managing, and not a reason to go without teeth.

So the practical answer is that we will ask for a recent HbA1c, and if it is high we will tell you honestly what that does to your odds and whether it is worth three months of work with your own doctor before you book a flight. We would rather say that than take your money and place implants into a mouth that will not heal around them.

The other diabetes issue is simpler and purely logistical: long appointments and missed meals cause hypoglycaemia, which is the second commonest emergency in dental practice. In a hospital we schedule around your insulin, monitor your glucose, and treat it in the room if it drops.

​

CAN I HAVE A TOOTH OUT IF I TAKE BLOOD THINNERS?

Usually yes, and usually without stopping the medication — and we want to be clear about this even though the honest answer is less dramatic than it would suit us to give.

The Scottish Dental Clinical Effectiveness Programme's guidance is to treat without interrupting anticoagulant or antiplatelet therapy for most dental procedures, managing the bleeding locally instead, because stopping the medication carries its own risk of clot, stroke or infarction. On warfarin specifically, the guidance is that if the INR is below 4, treat without interrupting the medication; at 4 or above, delay invasive treatment or refer if it is urgent. And the guidance lists patients in whom therapy must not be interrupted at all: those with prosthetic metal heart valves or coronary stents, those who have had a pulmonary embolism or deep vein thrombosis within the last three months, and those anticoagulated for cardioversion.

So if a clinic tells you that your apixaban or your warfarin means you need a hospital for an extraction, they are either out of date or selling you something.

Where the setting genuinely does matter is at the other end of the same guidance, in the higher bleeding-risk tier: complex extractions, adjacent extractions that will create a large wound, more than three extractions at one appointment, and procedures involving raising a flap. Full-arch work on a patient taking anticoagulants lands squarely in that category. That is a real reason to be somewhere with a laboratory that can check an INR in the building and a team that can manage bleeding that does not settle — not because the procedure is exotic, but because the margin is thinner.

 

CAN I HAVE DENTAL TREATMENT WITH HIGH BLOOD PRESSURE?

This is the commonest reason a dental practice sends someone home on the day, and the commonest reason people stop going.

There is a threshold in the published guidance. A 2025 paper in the British Dental Journal describes 180/110 mmHg as a critical threshold for carrying out extractions under local anaesthetic containing adrenaline, with a diastolic pressure of 120 or above contraindicating treatment (Gazal and Nassani, British Dental Journal, 2025).

What usually happens in a dental practice when you are over that line is entirely correct and entirely unhelpful to you: the appointment is cancelled and you are advised to see your GP. Weeks pass. You come back, you are anxious because of the last time, your pressure is up again, and the cycle repeats.

What happens here is that an internal medicine physician in the same building sees you, your pressure is managed, and we proceed when it is safe to proceed — often the same day, sometimes the next. Treating the blood pressure is not a referral. It is a corridor.

 

WHAT ABOUT OTHER CONDITIONS?

Can I have dental treatment with asthma or COPD?

Usually yes. Bronchospasm is one of the three commonest emergencies in dental practice — 11 to 14 per cent of events in the British survey — which is an argument for planning, not for avoiding. Bring your inhalers. If you have significant COPD and are having extensive treatment, sedation needs assessing properly rather than assuming, and that assessment is what an anaesthesiology specialist is for.

Can I have dental implants after chemotherapy or radiotherapy?

Often yes, with timing and with honesty about the risks. Radiotherapy to the jaws changes the healing of bone permanently and is the single most important thing we need to know about, including the dose and the fields. Send us your oncology records. This is one of the cases where the answer may genuinely be no, or not yet, and we will say so.

Can I have dental implants if I take bisphosphonates or have osteoporosis?

For osteoporosis, the risk is far smaller than the internet suggests. In the American Association of Oral and Maxillofacial Surgeons' 2022 position paper, the risk of medication-related osteonecrosis of the jaw after extraction in osteoporosis patients on oral bisphosphonates was 0 to 0.15 per cent, and around 1 per cent on denosumab. Prevalence figures in osteoporosis are of the same order: 0.02 to 0.05 per cent on oral bisphosphonates, 0.3 per cent on denosumab at ten years.

Cancer patients on high-dose intravenous bisphosphonates are a different population entirely, with post-extraction risk reported from 1.6 to 14.8 per cent. If you are in that group, tell us the drug, the dose and the indication, and the answer will be a careful one.

Can I have dental treatment with kidney disease or on dialysis?

Usually yes, with the timing built around your dialysis schedule and with attention to bleeding, blood pressure and medication. Send us your nephrologist's details.

Can I have dental treatment after a stroke, or with epilepsy or Parkinson's?

Yes. Seizures were the largest single category of dental practice emergency in the British data at 31 to 36 per cent, which again argues for planning and monitoring rather than avoidance. After a stroke, as with a heart attack, recent events mean waiting.

Can I have dental treatment on immunosuppressants or after a transplant?

Usually yes, in coordination with the team that manages your immunosuppression. Healing and infection risk need managing, and your transplant team will often want to be consulted. We will ask.

I have several conditions and a long list of medicines. Where do I start?

With the list. Send us your medication list, your diagnoses and any recent letters from your specialists. The first useful thing we can give you is not a quote — it is a straight answer about whether we can treat you, where, and under what anaesthesia.

 

WHAT IF YOU ARE SIMPLY TERRIFIED OF THE DENTIST?

How common is this?

Common enough that it should never be apologised for. In the Adult Dental Health Survey, 11,382 British adults were assessed on the Modified Dental Anxiety Scale and 11.6 per cent scored 19 or above, the high-anxiety range (Humphris and colleagues, BMC Oral Health, 2013). Dental phobia was reported by 16.8 per cent of women and 7 per cent of men in a separate British study (Heidari, Banerjee and Newton, British Dental Journal, 2015).

What avoidance actually costs

The same study measured what happens over time, and the figures are blunt. Among phobic adults, 58.5 per cent attended irregularly and 39.9 per cent had active decay. Most tellingly, signs of frank dental infection — pus, ulceration, fistula or abscess — were present in 12.2 per cent of phobic adults against 5.6 per cent of non-phobic adults. Quality of life scores were significantly worse on both measures used.

The reason we put that here rather than in a brochure is that most people who have been avoiding the dentist for a decade already know it. What they do not know is that the avoidance is treatable in a single planned episode rather than the twenty appointments they are dreading.

Your options, lightest to deepest

• Local anaesthetic alone, which is enough for most people most of the time, and is not a failure.

• Oral sedation, a tablet before the appointment to take the edge off.

• Intravenous conscious sedation, where you are awake and able to respond but relaxed, and most people remember very little afterwards.

• General anaesthesia, in a hospital operating theatre, administered by an anaesthesiology and reanimation specialist, for severe phobia or for very extensive treatment in one sitting.

One honest thing about sedation

Sedation manages the appointment. It does not treat the phobia, and the better evidence is actually on the other side. In a 2024 analysis of 173 randomised trials, cognitive behavioural therapy against usual care for dental anxiety showed a standardised mean difference of −0.65 with moderate certainty, while benzodiazepines against placebo for anxiety during treatment showed −0.43 with low certainty; for diagnosed dental phobia, psychotherapy showed −0.80 (Steenen and colleagues, Journal of Anxiety Disorders, 2024).

What that means in practice: if your goal is to never be frightened of a dentist again, the evidence points to therapy. If your goal is to get a mouth full of necessary treatment completed without going through something you cannot face, sedation and anaesthesia are the right tools, and they work. Most of our patients want the second thing, and some want both.

Why "sleep dentistry" means something different in a hospital

The phrase is used loosely, and in dentistry it usually means sedation rather than anaesthesia. The distinction matters because of where each is legally allowed to happen.

In the United Kingdom the position has been settled since 2000, when the Department of Health's report A Conscious Decision required that general anaesthesia for dental treatment take place only in a hospital setting — and defined that term precisely as an institution "which has critical care facilities on the same site." The Royal College of Anaesthetists adopted the same definition in its own standards.

Turkey reached the same place by its own route, through its own regulation, as set out above: dental surgeries and polyclinics may not administer sedation or general anaesthesia at all, and only facilities with a general anaesthesia unit may do so. Two countries, two separate regulators, the same conclusion.

So if a dental clinic offers you "sleep dentistry", the question to ask is a simple one: asleep where, given by whom, and with what in the building.

What the NHS route looks like

Dental treatment under general anaesthesia is available on the NHS, and you should know what that pathway currently involves. British Dental Association figures published in early 2025, focused on Scotland, reported that one in four patients wait more than a year for dental treatment under general anaesthesia, with some children waiting up to three years; UK anaesthetist numbers around 15 per cent below requirement; and Public Dental Service dentist headcount down 24 per cent over a decade.

We are not going to pretend the NHS cannot do this. It can, and well. The issue is when.

 

WHAT IF YOU ARE IN GOOD HEALTH AND SIMPLY WANT THE MARGIN?

A reasonable number of our patients have nothing wrong with them at all.

They are having a full arch of implants, or a complete set of crowns, which is several hours of surgical work. They have read the stories in the British press about dental treatment abroad. And they have decided, quite rationally, that they would rather be somewhere with an anaesthetist in the room and an intensive care unit in the building than somewhere with a dental chair and a telephone.

There is one piece of evidence that supports them more than it supports the people with conditions. In that study of 1.7 million dental visits, 70 per cent of the recorded medical emergencies occurred in patients classified ASA 1 — healthy (Al-Sebaei, BMC Emergency Medicine, 2024). Only 30 per cent were in patients with any medical classification at all. Faints, panic attacks and reactions to local anaesthetic do not check your medical history first.

We should also be straight about what we cannot claim. There is no published evidence that healthy patients have better dental outcomes in a hospital than in a good dental practice. Nobody has studied it, so nobody knows, and anyone who tells you otherwise is making it up. What a hospital gives you is not a better crown. It is a different answer to the question of what happens in the ten minutes after something goes wrong.

Whether that is worth something to you is your decision, and it is a legitimate one to make either way.

 

WHAT IF ANOTHER DENTIST HAS ALREADY TURNED YOU DOWN?

This is the smallest group of people who read this page, and generally the easiest to help.

A refusal is almost never a judgement about you. It is a mismatch between what your treatment needs and what that building can offer, and a dentist who declines on those grounds is behaving correctly rather than unkindly. The published guidance says as much: the Scottish Dental Clinical Effectiveness Programme states that many ASA grade III patients will need referral to secondary care and that ASA grade IV patients requiring dental sedation should be referred to an appropriate secondary care facility. NHS England's commissioning guidance for special care dentistry routes patients with unstable ASA 3 or ASA 4 conditions — a significant risk of medical emergency — to consultant-led Level 3 care.

In other words, there is a correct destination for you, and in the UK it exists: NHS special care dentistry and hospital dental services. You can be referred, and you should ask to be. The honest caveat is the waiting, which is covered above.

What we need from you is simple. Your medication list. Your diagnoses. Any recent letters from your cardiologist, physician or specialist. If a clinic has written to you declining treatment, that letter is useful too, because it usually says exactly what they were worried about.

We will read it and tell you whether we can treat you. Sometimes the answer is no.

 

HOW WE ASSESS YOU BEFORE YOU FLY

• What we ask for. Your full medication list with doses, your diagnoses, recent letters from your GP or specialists, recent blood results where relevant — HbA1c for diabetes, INR if you are on warfarin, kidney function if relevant — and an ECG where there is cardiac history. Dates matter: a heart attack, stroke or stent within the last three months changes the answer.

• Who reviews it. Related doctors all. 

• What we tell you before you book a flight. Whether we can treat you; whether you need sedation or a general anaesthetic; whether any of your treatment has to be staged across more than one trip; whether anything needs to be better controlled first, and roughly how long that takes.

• When we will tell you not to travel. A heart attack, stroke or TIA within the last three months. Unstable angina. Uncontrolled heart failure. A condition your own specialist has told you is currently unstable. Blood pressure that cannot be brought under control before travel. An HbA1c high enough that implants would be likely to fail rather than possible to fail. 

• Staging across trips. A great deal of medically complex treatment is better done in two or three shorter episodes than one long one, and we would rather tell you that at the planning stage than discover it on day three.

A clinic that cannot tell you no has not assessed you.

 

WHERE YOUR TREATMENT HAPPENS

Casas Clinics treats patients in the dental clinic of Özel Florya Hastanesi, a licensed private general hospital in Istanbul. The dental clinic is a unit within the hospital, operating under the hospital's licence — not a dental polyclinic with an arrangement nearby.

What that means in numbers, so you can judge it rather than take our word for it: the hospital performs more than a thousand operations a month, keeps close to a hundred inpatient beds occupied every day, holds more than twenty tertiary-level intensive care beds — the level at which the most complex cases are managed — sees more than four thousand outpatients a month across all its departments, handles more than fifteen hundred emergency attendances a month, and is inspected by the Turkish Ministry of Health several times every year.

Cardiology, internal medicine, neurology, respiratory medicine, anaesthesiology and reanimation, laboratory and radiology are all in the same building. So is the emergency department.

Your case is not an exception here. A team performing a thousand operations a month does not treat an anaesthetic as an event.

Our international patient activity is carried out under Turkey's international health tourism regulations. You are treated by one institution, with one set of records and one clinical team — not by a dental clinic that has an arrangement with a building.

​

TREATMENTS WE PROVIDE IN THIS SETTING

• Dental implants, including single implants, multiple implants and zygomatic implants → [Dental Implants]

• Full-arch rehabilitation on four or six implants → [All-on-4 and All-on-6]

• Crowns and full-mouth crown work → [Dental Crowns]

• Smile makeovers → [Hollywood Smile]

• Veneers and composite bonding → [Veneers and Bonding]

• Root canal treatment where a tooth due to be crowned is infected → [Root Canal Before a Crown]

• Teeth whitening → [Teeth Whitening]

• Conscious sedation and general anaesthesia → [Sedation and General Anaesthesia]

 

QUESTIONS PATIENTS ASK

Can I have dental implants if I have a heart condition? In most cases yes. The three things that need handling are the adrenaline in the local anaesthetic, whether you are in the high-risk group for infective endocarditis, and how recently you have had a cardiac event. None of those is a reason to go without teeth.

 

Do I need antibiotics before dental treatment because of my heart? Only if you are in the specific high-risk group: previous infective endocarditis, a surgically placed prosthetic valve or prosthetic repair material, a transcatheter aortic or pulmonary valve prosthesis, untreated cyanotic congenital heart disease, or a ventricular assist device. Prophylaxis is not recommended for rheumatic or degenerative valve disease, a bicuspid aortic valve, a pacemaker or ICD, or hypertrophic cardiomyopathy.

 

I have a pacemaker. Does that change anything? Not in the way most people assume. A pacemaker is not an indication for antibiotic prophylaxis under current guidance.

 

How long after a heart attack can I have dental treatment? Elective treatment is normally deferred. An infarction, stroke, TIA or coronary stent within the last three months places you in the ASA IV category and we will tell you to wait rather than travel.

 

Can the dentist treat me if my blood pressure is high? There is a threshold — 180/110 mmHg is described in the published guidance as critical for extractions under adrenaline-containing local anaesthetic, and a diastolic of 120 or above contraindicates treatment. The difference here is that we manage it in the building rather than sending you home.

 

Can I have a tooth out while taking blood thinners? Usually yes, and usually without stopping them. Guidance is to treat without interrupting the medication for most dental procedures and manage the bleeding locally, because stopping carries its own risk.

 

Do I need to stop warfarin? Guidance says if your INR is below 4, treat without interrupting it. At 4 or above, invasive treatment is delayed.

 

Can I have dental implants while taking blood thinners? Yes. Where the setting matters is in the higher bleeding-risk category — complex extractions, more than three at once, or flap surgery — which is where full-arch work sits.

 

Can I have dental implants if I have diabetes? Yes, and control matters more than diagnosis. Survival ran at 95 to 100 per cent with HbA1c at or below 7 per cent and 85 to 94 per cent above 8 per cent in a review of 54 studies. Send us a recent HbA1c.

 

Do implants fail more often in diabetics? Marginally, when diabetes is well controlled: 92.2 per cent against 93.2 per cent at 36 months in one dataset. Substantially, when it is not.

 

Can I have dental implants after chemotherapy or radiotherapy? Often, with timing and with the full oncology record. Radiotherapy to the jaws is the single most important thing we need to know about, including dose and fields. This is one area where the answer may be no.

 

Can I have dental implants if I take bisphosphonates? For osteoporosis, the risk of jaw osteonecrosis after extraction is reported at 0 to 0.15 per cent on oral bisphosphonates and around 1 per cent on denosumab. For cancer patients on high-dose intravenous bisphosphonates it is far higher, from 1.6 to 14.8 per cent, and needs a careful individual answer.

 

Can I have dental treatment with asthma or COPD? Yes. Bring your inhalers. If you have significant COPD and want sedation, that needs proper assessment by an anaesthesiology specialist rather than an assumption.

 

Can I have sedation if I have sleep apnoea? It needs assessing rather than assuming, and it is one of the clearer reasons to have an anaesthesiology and reanimation specialist rather than a dentist making that decision.

 

Can I be put to sleep for all my dental treatment? Yes, in a hospital operating theatre with an anaesthesiology and reanimation specialist. Very extensive treatment in a single sitting is a recognised indication.

 

What is the difference between sedation and a general anaesthetic? Under conscious sedation you are awake and able to respond, but relaxed, and usually remember little. Under general anaesthesia you are unconscious. The second may only legally be given in a facility with a general anaesthesia unit, which in Turkey excludes dental surgeries and polyclinics.

 

Is sedation safe if I have a medical condition? It depends on the condition and how well controlled it is. UK sedation guidance restricts advanced sedation techniques to ASA I and II patients in a primary care setting, and routes ASA III and IV patients to secondary care — which is precisely the distinction a hospital setting removes.

 

Can I get this on the NHS, and how long is the wait? You can. British Dental Association figures published in early 2025 reported one in four patients waiting more than a year for dental treatment under general anaesthesia, with some children waiting up to three years.

 

Is dental treatment safer in a hospital than in a dental practice? For routine treatment in a well-controlled patient, there is no evidence that it is, and we are not going to claim otherwise. What changes is what is available in the minutes after something goes wrong, and how extensive the treatment can safely be in one sitting.

 

Is it safe to have dental treatment in Turkey if I have a medical condition? That depends entirely on which Turkish facility, and the differences between them are larger than most patients realise. Dental surgeries and polyclinics — which is what the great majority of Turkish health tourism dental clinics are — may not legally administer sedation or general anaesthesia and do not have intensive care. A dental clinic inside a general hospital is a different proposition. Ask any clinic you are considering which of the five categories it falls into.

 

My dentist refused to treat me. What now? Send us your medication list, your diagnoses, recent specialist letters and, if you have one, the letter declining treatment — it usually names exactly what the concern was. We will tell you whether we can treat you.

 

What medical records do you need? Medication list with doses, diagnoses, recent specialist letters, relevant recent bloods (HbA1c, INR, kidney function), and an ECG where there is cardiac history.

 

Will you tell me if you think I should not travel? Yes, and we publish the list of circumstances in which we will say so, further up this page.

​

I have not seen a dentist in over ten years. Where do I start? With photographs and a message. Not with a decision. The first thing we will tell you is what is actually there, which is almost always less frightening than what you have been imagining.

​

What will all this cost? You can see all the prices at our price list page. 

 

TALK TO US BEFORE YOU DECIDE ANYTHING

Send us your medication list and your diagnoses, and we will tell you honestly whether we can treat you, where, and under what anaesthesia. Not a quote — an answer.

​