Q1. Can someone with diabetes have a dental implant?

In the literature this is not a yes-or-no question but a question of which outcome is being asked about: several meta-analyses show no significant difference in implant failure rates between people with type 2 diabetes and people without [Fn24], with survival reported as similar to that of healthy patients [Fn26][Fn33]; but the same body of studies also shows that bleeding on probing and peri-implant bone loss were significantly worse in the diabetic group [Fn25], worsening in a dose-response manner as glycated haemoglobin rises [Fn29][Fn31]. The clinical-implication sentence in the literature therefore reads: glycated haemoglobin must be considered in risk assessment before placement and throughout the lifespan of the implant [Fn32]. This article gives no individual threshold value and makes no determination of suitability — that has to be assessed jointly by the dentist and the internal-medicine or family-medicine side. For the implant course, see canonical card KM-DENTAL-25 (in production) and domain article P01.

Q2. Can someone taking a drug for osteoporosis have a tooth extracted?

The answer to this question depends on which drug, for which indication, at what dose: the frequency of MRONJ varies with the drug, the dose and the duration of exposure, and may be rare (oral bisphosphonates, or denosumab for osteoporosis) or common (intravenous bisphosphonate for cancer treatment) [Fn68], and is clearly higher in the high-dose cancer population than in the osteoporosis population [Fn69]. Dentoalveolar surgery is considered a common predisposing event [Fn70], so the direction of assessing beforehand has support in the literature — but the certainty of the evidence supporting regular examinations plus preventive treatment was rated very low by the reviewers [Fn77][Fn78]. As to whether the drug needs to be stopped: existing systematic reviews have shown no benefit from short-term interruption, and no study has examined the harms of interruption, so it cannot be determined with high certainty [Fn81][Fn82][Fn83]. This article gives no recommendation about stopping any drug; that decision belongs to the multidisciplinary collaboration between the prescribing physician and the dentist [Fn86]. For wounds and post-operative care after extraction, see canonical card KM-DENTAL-01 (in production) and domain article P06.

Q3. Will the bleeding be unstoppable if I have a tooth out while on an anticoagulant?

What the existing literature gives is a group-level picture, not an individual probability: the use of local haemostatic measures is generally effective for bleeding control, with no further pharmacological drug management or suspension [Fn55]; bleeding episodes were mostly mild and generally happened on the first day after the treatment [Fn54]; and no thromboembolic complications were reported in the included trials [Fn53]. Taking warfarin as the example, the conclusion of a systematic review is that patients with an INR within the therapeutic range can safely continue the regular dose [Fn45]; the level of evidence for DOACs is different — Cochrane identified no eligible trials [Fn49], and the practical data come from a real-world audit (persistent bleeding 14.3%, intervention required 9.2%, no major haemorrhage) [Fn50][Fn51]. This article gives no figure of the form X% of people bleed uncontrollably, because the existing sources contain no such single authoritative value; nor does it give any instruction to stop or to continue a drug [Fn43].

🏛 Part of the "reports" topic shelf →

Systemic Disease and Dentistry, a Complete Guide: a domain map from bidirectional relationships and medication risk to disclosure of medical history｜證據鏈

km 編輯部2026-08-13About 21 min read

#證據鏈 #牙醫領域 #全身疾病 #植牙

本頁是〈Systemic Disease and Dentistry, a Complete Guide: a domain map from bidirectional relationships and medication risk to disclosure of medical history〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

Systemic Disease and Dentistry, a Complete Guide: a domain map from bidirectional relationships and medication risk to disclosure of medical history｜證據鏈

F-Units (fact ledger)

F1｜Dental patient populations already carry systemic disease; in a sample of 862 patients at one clinic, the conditions most commonly reported were allergies, cardiovascular disease and metabolic disorders

source #: #15｜confidence: low｜basis: peer_reviewed (PMID 42434028)｜geo: universal｜period: J Clin Exp Dent, 2026; 862 patients, 6 months
caveat: single clinic, retrospective cross-sectional design; PubMed indexes it as a Review, but the content describes itself as an observational retrospective cross-sectional study, and this article uses it according to its substance. The ranking of categories represents that population only, and must not be extrapolated to the composition of patients worldwide.

F2｜A thorough medical history should be obtained for all dental patients; a thorough history must include prescription and over-the-counter medications

source #: #15／#14｜confidence: high｜basis: peer_reviewed (PMID 42434028／39244244)｜geo: universal｜period: 2026／Dent Clin North Am, 2024
caveat: #14 is a narrative review, and its claim is a statement at the level of professional consensus rather than a trial result; this unit constitutes no diagnostic or treatment instruction.

F3｜Bacteraemia from invasive dental procedures is highest for extraction (62%–66%); everyday toothbrushing (8%–26%) and flossing/chewing (16%) also cause bacteraemia

source #: #W12｜confidence: moderate｜basis: peer_reviewed (PMID 36750413, 64 nRCTs + 25 RCTs)｜geo: universal｜period: Oral Dis, 2024
caveat: the original records that most studies carried concerns about bias (some concerns for the RCTs, moderate risk for the nRCTs); bacteraemia is a surrogate measure and is not the same as the incidence of infection events.

F4｜Diabetes and periodontitis have a bidirectional relationship; people with periodontitis have an elevated risk of dysglycaemia and insulin resistance, and periodontitis is associated with incident type 2 diabetes

source #: #W1｜confidence: high｜basis: clinical_guideline (IDF／EFP joint workshop consensus report, PMID 29280174)｜geo: universal｜period: J Clin Periodontol, 2018
caveat: the consensus report itself states that data on the type 1 diabetes population are insufficient; this unit supports a directional claim only, and supports no risk prediction for any individual.

F5｜The magnitude of the bidirectional relationship: periodontitis → incident diabetes SRR 1.26 (95% CI 1.12–1.41); diabetes → incident periodontitis SRR 1.24 (95% CI 1.13–1.37)

source #: #W3｜confidence: moderate｜basis: peer_reviewed (PMID 34211029, 15 cohort studies)｜geo: universal｜period: Sci Rep, 2021
caveat: there is high unexplained heterogeneity between the studies (including differences in the methods of diagnosing the diseases), which the authors list as the main limitation; the SRR is a summary value at the population level, not an individual probability.

F6｜Periodontal treatment is associated with a fall in glycated haemoglobin: 0.27%–0.48% at 3 months (consensus report); an absolute reduction of 0.43% at 3–4 months (Cochrane, moderate certainty); 0.50% at 12 months (only 1 study, 264 people)

source #: #W1／#W2｜confidence: moderate｜basis: clinical_guideline (PMID 29280174)／peer_reviewed (Cochrane, PMID 35420698, 35 RCTs, 3,249 people)｜geo: universal｜period: 2018／2022
caveat: the figure at 12 months comes from only 1 study with 264 people, and must not be given the same weight as the figure at 3–4 months; the included populations are mainly type 2 diabetes; most studies did not evaluate adverse effects. The two sources measure over different windows, and no average may be taken across them.

F7｜Diabetes-associated periodontitis is not regarded as a distinct diagnosis; diabetes is an important modifying factor to be included in the clinical diagnosis; smoking is likewise a modifying factor

source #: #02｜confidence: high｜basis: clinical_guideline (consensus report of workgroup 3 of the 2017 World Workshop, PMID 29926500)｜geo: universal｜period: J Clin Periodontol, 2018
caveat: this is a definition within a classification framework, not an efficacy claim; the same consensus also has a sister publication (PMID 29926943) with identical content, and this article counts it as one source only, so as not to inflate the source count.

F8｜No significant difference in implant failure rate between patients with type 2 diabetes and non-diabetic patients; survival can be similar to that of healthy patients

source #: #11／#12／#13｜confidence: moderate｜basis: peer_reviewed (PMID 33632408／34586502／30328186)｜geo: universal｜period: JADA 2021／Clin Oral Investig 2022／Clin Oral Implants Res 2018
caveat: no significant difference is not the same as identical; the positive conclusion in #12 carries three prerequisites (glycaemic level controlled, oral hygiene satisfactory, technical steps strictly followed); follow-up is mostly short to medium term.

F9｜Within the same body of studies, bleeding on probing and peri-implant bone loss were significantly worse in the diabetic group, worsening in a dose-response manner as glycated haemoglobin rises

source #: #11／#09／#10｜confidence: moderate｜basis: peer_reviewed (PMID 33632408／36251562／34391557)｜geo: universal｜period: 2021／2022／2021
caveat: survival and the health of the surrounding tissue are two independent outcomes, and neither may be inferred from the other; the HbA1c stratification cut-offs (below 8%, below 10%) come from the groupings of the individual studies themselves, and are not universal clinical thresholds.

F10｜Diabetes is listed as a risk factor for peri-implantitis (effect summary OR 2.5, 95% CI 1.4–4.5); the prevalence of peri-implantitis reported in the same review spans 1.1%–85.0%

source #: #W15｜confidence: moderate｜basis: peer_reviewed (PMID 29882313, 57 studies)｜geo: universal｜period: J Periodontal Res, 2018
caveat: the original rates its own evidence at medium／medium-high level; the extreme span of the prevalence reflects differences of criteria and of population, and no median may be taken from it as a representative value. The same review records that osteoporosis and others have not been identified as risk factors.

F11｜People on continuous VKA/DOAC treatment have an increased bleeding risk during oral procedures; but dose reduction or discontinuation is associated with an increased risk of thromboembolism, and haemostatic measures could enable continuation

source #: #04｜confidence: high｜basis: peer_reviewed (Cochrane systematic review, PMID 29963686)｜geo: universal｜period: Cochrane Database Syst Rev, 2018
caveat: this unit is a description of the structure of the decision, not a medication instruction; any adjustment of medication can be decided only by the physician who wrote the prescription.

F12｜For patients whose INR is within the therapeutic range, the systematic review's conclusion is that the regular dose of warfarin can safely be continued for a dental extraction

source #: #07｜confidence: moderate｜basis: peer_reviewed (PMID 26679334, 6 RCTs)｜geo: universal｜period: J Can Dent Assoc, 2015
caveat: the condition is that the INR is within the therapeutic range; this is a conclusion at the level of the study population in the literature, and constitutes no instruction to any individual to continue a drug; the same review notes that there is no evidence to support or refute the superiority of local haemostatic agents over discontinuation.

F13｜DOACs lack eligible RCTs; a real-world audit shows persistent bleeding 14.3%, intervention required 9.2%, no major haemorrhage, with heart failure and advanced age as contributory factors

source #: #04／#08｜confidence: low (DOAC side)｜basis: peer_reviewed (PMID 29963686／35459831)｜geo: universal｜period: 2018／Br Dent J, 2022; 98 patients, 119 procedures
caveat: the evidence on DOACs is mainly observational audit data, at a lower evidence level than the RCT evidence on the VKA side, and the two must not be conflated; the rates from a single-centre audit cannot be extrapolated as a general risk.

F14｜Local haemostatic measures are generally sufficient to control bleeding without discontinuation; no thromboembolic complications occurred in the included trials; bleeding was mostly mild and mostly on the first day after treatment

source #: #05｜confidence: moderate｜basis: peer_reviewed (PMID 37047909, systematic review and network meta-analysis of 8 RCTs)｜geo: universal｜period: Int J Environ Res Public Health, 2023
caveat: that no thromboembolic complications were reported is constrained by sample size and length of follow-up, and is not the same as there being no risk.

F15｜Platelet-rich fibrin (PRF) did not reduce the risk of bleeding after extraction in anticoagulated patients; certainty of evidence moderate to low

source #: #06｜confidence: moderate｜basis: peer_reviewed (PMID 34343502, 3 studies, 130 people, PROSPERO CRD42020186678)｜geo: universal｜period: J Oral Maxillofac Surg, 2021
caveat: a negative result with extremely high heterogeneity (I²=99%); this unit is used only to show the ceiling of what an adjunct measure achieves, and constitutes no recommendation or counter-recommendation for any material.

F16｜No increase in bleeding risk with aspirin monotherapy for extraction; higher immediate (RR 10.3) and delayed (RR 7.72) bleeding risk with dual antiplatelet therapy (DAPT)

source #: #W8｜confidence: moderate｜basis: peer_reviewed (PMID 38155005, 35 papers, 23 entering the meta-analysis)｜geo: universal｜period: Oral Surg Oral Med Oral Pathol Oral Radiol, 2024
caveat: the control groups fall into three definitions (no control／healthy control／interrupted APT control), and RRs obtained under different controls must not be carried across to one another; this unit constitutes no recommendation about taking or stopping a drug.

F17｜DAPT increases bleeding-related complications after extraction, but the differences may not be clinically significant; interruption may not be necessary, and the complications of interruption may be more severe

source #: #W9｜confidence: low｜basis: peer_reviewed (umbrella review including 4 systematic reviews, PMID 35691560)｜geo: universal｜period: J Stomatol Oral Maxillofac Surg, 2022
caveat: an umbrella review is limited by the quality of the reviews it includes; the original wording is 「may not be necessary」, and it must not be rewritten into a categorical statement that interruption is not needed; this unit is a statement of a conclusion in the literature, not a recommendation for action.

F18｜MRONJ was formerly called BRONJ; the AAOMS position paper is continually revised as knowledge evolves, and the 2022 version contains revisions to diagnosis and management strategies

source #: #01｜confidence: high｜basis: clinical_guideline (AAOMS position paper, PMID 35300956, PublicationType: Consensus Statement)｜geo: universal｜period: J Oral Maxillofac Surg, 2022
caveat: the abstract provides no quantitative incidence at all; every MRONJ figure in this article comes from other sources and is not extrapolated from this unit.

F19｜The frequency of MRONJ varies with the drug, the dose and the duration of exposure: rare in the oral osteoporosis-medication setting, common in the intravenous bisphosphonate cancer setting; clearly higher in the high-dose cancer population than in the osteoporosis population

source #: #W4／#W14｜confidence: moderate｜basis: peer_reviewed (Cochrane, PMID 35866376／comprehensive literature review, PMID 33987769)｜geo: universal｜period: 2022／Int J Implant Dent, 2021
caveat: #W14 is a narrative literature review (not a systematic synthesis), and supports the directional contrast only, not any specific rate.

F20｜In the high-dose antiresorptive cancer population, the incidence of MRONJ after extraction was between 11% and 50% at the patient level; onset was observed in the studies as late as 3 years after extraction (an observation window, not a ceiling on risk); teeth inflamed before the procedure and additional osteotomy were risk factors

source #: #W5｜confidence: low｜basis: peer_reviewed (systematic review, 7 observational studies, 550 patients／271 receiving extractions, PMID 36464958)｜geo: universal｜period: Clin Exp Dent Res, 2023
caveat: all observational studies, only a qualitative analysis because of heterogeneity, and an extremely wide range; this range belongs specifically to the high-dose cancer population after extraction, and extrapolation to the oral-medication osteoporosis population is strictly prohibited.

F21｜In the osteoporosis population exposed to antiresorptive therapy, the pooled rate of MRONJ after implant placement was 0.5% (21 cohorts); a single risk-adjusted report states that bisphosphonates increased it by 3 cases per 1,000 people (aHR 4.09)

source #: #W7｜confidence: low-moderate｜basis: peer_reviewed (systematic review and meta-analysis carried out for the 2024 update of the International Task Force on Osteonecrosis of the Jaw, PMID 40505730)｜geo: universal｜period: Endocr Pract, 2025
caveat: that paper rates its own implant-failure outcome as very low certainty, with only the risk-adjusted MRONJ item at moderate certainty; what it measures is after implant placement, in an osteoporosis population, and it may not be subtracted from or set alongside F20 (after extraction, cancer population).

F22｜Evidence on preventive and treatment interventions for MRONJ: the direction of regular dental examinations plus preventive treatment has RCT support (RR 0.10, 95% CI 0.02–0.39, 253 people) but at very low certainty; for the various preventive interventions before and after dentoalveolar surgery, and for treating MRONJ once it has occurred, the evidence is insufficient to either claim or refute a benefit

source #: #W4｜confidence: low｜basis: peer_reviewed (Cochrane, 13 RCTs, 1,668 people, PMID 35866376)｜geo: universal｜period: 2022
caveat: the original states plainly that the studies were clinically diverse and examined very different interventions, so no meta-analysis could be performed, and the authors rated the overall available evidence on this topic as low or very low certainty; that RR comes from a single open-label RCT whose population was men with metastatic prostate cancer treated with zoledronic acid, and may not be extrapolated to the oral-medication osteoporosis population; insufficient evidence is a record of an evidence gap, and must not be read as ineffective.

F23｜Drug holiday: no study has shown a benefit of short-term interruption of antiresorptive drugs, nor has any study examined its harms, and it cannot be determined with high certainty; another review likewise states that there is no evidence supporting its use, and that most studies recommended assessing each patient separately

source #: #W6／#W16｜confidence: low｜basis: peer_reviewed (PMID 38150155／32373730)｜geo: universal｜period: Clin Oral Investig, 2023／Heliyon, 2020
caveat: a blank on both sides — it supports neither stopping nor not stopping; the one portable conclusion of this unit is that the decision belongs to multidisciplinary collaboration, and this article gives no recommendation about stopping or continuing any drug.

F24｜Antibiotic prophylaxis for endocarditis: the 2007 AHA guidelines scaled it back to 4 highest-risk categories; the 2021 review recommended no change, while emphasising the critical role of everyday oral health for all

source #: #03｜confidence: high｜basis: clinical_guideline (the JADA adaptation of the AHA scientific statement, PMID 34711348, PublicationType: Practice Guideline)｜geo: universal｜period: J Am Dent Assoc, 2021
caveat: this article does not list the content of those 4 categories, and provides no drug name, no dose and no determination of applicability; whether it applies must be determined by a physician on the basis of the individual's cardiac history.

F25｜The state of the evidence on antibiotic prophylaxis for endocarditis is inconsistent: Cochrane holds that there remains no clear evidence of effectiveness or ineffectiveness (very low certainty); a 2024 meta-analysis shows a pooled RR of 0.41 in high-risk individuals, with insufficient data for moderate risk and inconsistent results from time-trend studies; NICE does not recommend it routinely

source #: #W11／#W10｜confidence: moderate (the coexisting conflict is flagged)｜basis: peer_reviewed (Cochrane, PMID 35536541／JAMA Cardiol systematic review and meta-analysis, 30 studies, 1,152,345 cases, PMID 38581643)｜geo: universal｜period: 2022／2024
caveat: the two conclusions point in different directions, and each has its reasons: Cochrane included only 1 case-control study, while #W10 included a broader range of observational designs. This article presents them side by side without choosing between them, and synthesises no new conclusion. The NICE item is a statement of institutional fact, not a medical basis for this article.

F26｜A measured gap exists between medication records on the dental side and on the medical side: 54% of patients had a discrepancy, and the items most often omitted were analgesics/opioids, antihypertensives and anxiolytics/hypnotics/sedatives

source #: #W13｜confidence: low｜basis: peer_reviewed (pilot study, 100 adults, PMID 38233963)｜geo: universal｜period: Spec Care Dentist, 2024
caveat: a single-centre pilot study with a sample of 100 people; the rates cannot be extrapolated. This unit is used only to support the conservative behavioural suggestion that carrying an actual medication list is more reliable.

F27｜Stratification of implant survival across disease categories: high survival reported in type 2 diabetes and in Parkinson's disease; adversely affected by radiotherapy in cancer patients; high complication risk after surgery in bone metastases on high-dose antiresorptive therapy; high survival on low-dose therapy for osteoporosis; no evidence found for dementia, respiratory disease, liver cirrhosis or osteoarthritis

source #: #13｜confidence: moderate｜basis: peer_reviewed (systematic review and meta-analysis of 60 studies, PMID 30328186)｜geo: universal｜period: Clin Oral Implants Res, 2018
caveat: the number of included studies is uneven across the disease categories; no evidence found is a blank, not a declaration of safety.

Compliance note

This article is health education and a summary of medical developments; it is general health-education information, does not solicit medical business, does not constitute medical advertising, and does not constitute a diagnosis or a treatment recommendation.
This article contains no instruction about taking, stopping, continuing, dosing or timing any medication, and no prescribing instruction; every citation involving a drug is only a presentation of a conclusion, or of the state of the evidence, at the level of a study population in the literature. Any adjustment of medication can be decided only by the physician who wrote that prescription, and the feasibility of a dental procedure must be assessed by a dentist.
This article provides no monetary amount, fee or coverage information, recommends no medical institution, dentist, brand or product, contains no identifiable individual case, and carries no third party's subjective comment on a course of treatment.
The percentages appearing in this article are without exception population-level observed values from research in the literature, and are not efficacy claims, not promises of a success rate, and not the expected result for any individual; the original percentages retained in the footnote spans are there for traceability and checking only.
All the data in this article are research results at the population level, not individual probabilities; figures from different populations and under different criteria may not be carried across to one another or subtracted from one another. Actual treatment and its results vary from person to person and must be assessed by a dentist before any decision is made.
This article does not touch any country's insurance coverage, fee standards or medical statutes; for local systems, please follow the rules of your own locality and the corresponding canonical cards.
This article is a draft; it has not passed the publication gate, the four language versions are not yet complete, and it is for internal review only.

Source list

Date of retrieval and verification: 2026-08-06 (all sources measured on the same day with curl and the PubMed E-utilities, HTTP 200, with verbatim spans compared programmatically, 0 failures)

Sources already verified in the anchor file (`ida-pillars/anchors/P19-anchors.md`)

#	basis	Title	Publication	PMID／URL
O1	official_statement	Diabetes Complications	National Library of Medicine（NIH／MedlinePlus）	https://medlineplus.gov/diabetescomplications.html
#01	clinical_guideline	American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update.	J Oral Maxillofac Surg, 2022（Consensus Statement）	PMID 35300956｜https://pubmed.ncbi.nlm.nih.gov/35300956/
#02	clinical_guideline	Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop…	J Clin Periodontol, 2018（Consensus Statement）	PMID 29926500｜https://pubmed.ncbi.nlm.nih.gov/29926500/
#03	clinical_guideline	Adapted from: Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association.	J Am Dent Assoc, 2021（Practice Guideline）	PMID 34711348｜https://pubmed.ncbi.nlm.nih.gov/34711348/
#04	peer_reviewed	Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions.	Cochrane Database Syst Rev, 2018	PMID 29963686｜https://pubmed.ncbi.nlm.nih.gov/29963686/
#05	peer_reviewed	Perioperative Management of Antithrombotic Therapy in Patients Who Undergo Dental Procedures: A Systematic Review of the Literature and Network Meta-Analysis.	Int J Environ Res Public Health, 2023	PMID 37047909｜https://pubmed.ncbi.nlm.nih.gov/37047909/
#06	peer_reviewed	Does Platelet-Rich Fibrin Prevent Hemorrhagic Complications After Dental Extractions in Patients Using Oral Anticoagulant Therapy?	J Oral Maxillofac Surg, 2021	PMID 34343502｜https://pubmed.ncbi.nlm.nih.gov/34343502/
#07	peer_reviewed	MANAGEMENT OF DENTAL EXTRACTIONS IN PATIENTS TAKING WARFARIN AS ANTICOAGULANT TREATMENT: A SYSTEMATIC REVIEW.	J Can Dent Assoc, 2015	PMID 26679334｜https://pubmed.ncbi.nlm.nih.gov/26679334/
#08	peer_reviewed	Managing direct oral anticoagulants in accordance with the Scottish Dental Clinical Effectiveness Programme guidance for patients undergoing dentoalveolar surgery.	Br Dent J, 2022	PMID 35459831｜https://pubmed.ncbi.nlm.nih.gov/35459831/
#09	peer_reviewed	Effects of diabetes/hyperglycemia on peri-implant biomarkers and clinical and radiographic outcomes in patients with dental implant restorations: A systematic review and meta-analysis.	Clin Oral Implants Res, 2022	PMID 36251562｜https://pubmed.ncbi.nlm.nih.gov/36251562/
#10	peer_reviewed	DOES GLYCEMIC CONTROL HAVE A DOSE-RESPONSE RELATIONSHIP WITH IMPLANT OUTCOMES? A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS.	J Evid Based Dent Pract, 2021	PMID 34391557｜https://pubmed.ncbi.nlm.nih.gov/34391557/
#11	peer_reviewed	Impact of hyperglycemia on the rate of implant failure and peri-implant parameters in patients with type 2 diabetes mellitus: Systematic review and meta-analysis.	J Am Dent Assoc, 2021	PMID 33632408｜https://pubmed.ncbi.nlm.nih.gov/33632408/
#12	peer_reviewed	Survival rate and peri-implant evaluation of immediately loaded dental implants in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis.	Clin Oral Investig, 2022	PMID 34586502｜https://pubmed.ncbi.nlm.nih.gov/34586502/
#13	peer_reviewed	Effect of advanced age and/or systemic medical conditions on dental implant survival: A systematic review and meta-analysis.	Clin Oral Implants Res, 2018	PMID 30328186｜https://pubmed.ncbi.nlm.nih.gov/30328186/
#14	peer_reviewed	Systemic Factors Affecting Prognosis of Dental Implants.	Dent Clin North Am, 2024	PMID 39244244｜https://pubmed.ncbi.nlm.nih.gov/39244244/
#15	peer_reviewed	Prevalence of Systemic Diseases in Patients Attending a Dental Clinic. A cross-sectional study.	J Clin Exp Dent, 2026	PMID 42434028｜https://pubmed.ncbi.nlm.nih.gov/42434028/

Carried over from section 0 of the anchor file: under the owner's decision of 2026-08-06 that the whole line is global, Taiwanese regulations, national health insurance and health-bureau material are not used as the basis for any medical or institutional claim in this article, and local systems are linked downstream to the corresponding TW canonical cards and to P12. The gaps listed in section 5 of the anchor file (quantitative MRONJ risk, a single incidence figure for uncontrollable bleeding under anticoagulation, the DOAC evidence gap, and the mismatch between the index label and the design of #15) have each been addressed in this article: the quantitative MRONJ figures are supplied instead by the WRITER-ADDED sources #W5／#W7, with their population restrictions marked; this article explicitly refuses to give a figure for what percentage of people bleed uncontrollably; the difference in evidence level between DOACs and VKAs is stated separately in section 4-3 and in F13; and #15 is presented throughout with the wording of a cross-sectional study.

WRITER-ADDED SOURCES (added in this article, with measured evidence)

Reason for adding them: the anchor file covers the trunk of the four patient questions, but the scope of this domain article also includes ① the bidirectional relationship between diabetes and periodontitis, and the effect of periodontal treatment on blood glucose (the anchor file has only #02, at the level of the classification framework, and lacks the bidirectional epidemiology and the intervention evidence); ② the quantitative risk and the prevention/withdrawal evidence for MRONJ (item 1 of section 5 of the anchor file lists this gap explicitly); ③ antiplatelet drugs (the anchor file covers anticoagulants only); ④ the state of the evidence and the institutional divergence on the prevention of endocarditis (the anchor file has only the AHA position); and ⑤ the bacteraemia basis of oral procedures, and measured data on the gap in medical-history disclosure. All 16 entries below were measured locally with curl (HTTP 200) and passed programmatic verbatim comparison; the anchor file was not modified.

#	basis	Title	Publication	PMID／URL
#W1	clinical_guideline	Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the IDF and the EFP	J Clin Periodontol, 2018（Consensus Statement／Practice Guideline）	PMID 29280174｜https://pubmed.ncbi.nlm.nih.gov/29280174/
#W2	peer_reviewed	Treatment of periodontitis for glycaemic control in people with diabetes mellitus	Cochrane Database Syst Rev, 2022	PMID 35420698｜https://pubmed.ncbi.nlm.nih.gov/35420698/
#W3	peer_reviewed	Bidirectional association between periodontal disease and diabetes mellitus: a systematic review and meta-analysis of cohort studies	Sci Rep, 2021	PMID 34211029｜https://pubmed.ncbi.nlm.nih.gov/34211029/
#W4	peer_reviewed	Interventions for managing medication-related osteonecrosis of the jaw	Cochrane Database Syst Rev, 2022	PMID 35866376｜https://pubmed.ncbi.nlm.nih.gov/35866376/
#W5	peer_reviewed	Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients—A systematic review	Clin Exp Dent Res, 2023	PMID 36464958｜https://pubmed.ncbi.nlm.nih.gov/36464958/
#W6	peer_reviewed	Is withdrawal of antiresorptive agents necessary before and after tooth extraction? A systematic review	Clin Oral Investig, 2023	PMID 38150155｜https://pubmed.ncbi.nlm.nih.gov/38150155/
#W7	peer_reviewed	Dental Implant Failure and Medication-Related Osteonecrosis of the Jaw Related to Dental Implants in Patients Taking Antiresorptive Therapy for Osteoporosis: A Systematic Review and Meta-Analysis	Endocr Pract, 2025	PMID 40505730｜https://pubmed.ncbi.nlm.nih.gov/40505730/
#W8	peer_reviewed	Risk of postoperative bleeding after dental extraction in patients on antiplatelet therapy: systematic review and meta-analysis	Oral Surg Oral Med Oral Pathol Oral Radiol, 2024	PMID 38155005｜https://pubmed.ncbi.nlm.nih.gov/38155005/
#W9	peer_reviewed	Should we stop dual anti-platelet therapy for dental extractions? An umbrella review for this dental dilemma	J Stomatol Oral Maxillofac Surg, 2022	PMID 35691560｜https://pubmed.ncbi.nlm.nih.gov/35691560/
#W10	peer_reviewed	Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures: A Systematic Review and Meta-Analysis	JAMA Cardiol, 2024	PMID 38581643｜https://pubmed.ncbi.nlm.nih.gov/38581643/
#W11	peer_reviewed	Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures	Cochrane Database Syst Rev, 2022	PMID 35536541｜https://pubmed.ncbi.nlm.nih.gov/35536541/
#W12	peer_reviewed	Bacteremia following different oral procedures: Systematic review and meta-analysis	Oral Dis, 2024	PMID 36750413｜https://pubmed.ncbi.nlm.nih.gov/36750413/
#W13	peer_reviewed	Discrepancy in medications reported by elderly patients in the dental office and in their electronic medical records: A pilot study	Spec Care Dentist, 2024	PMID 38233963｜https://pubmed.ncbi.nlm.nih.gov/38233963/
#W14	peer_reviewed	Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review	Int J Implant Dent, 2021	PMID 33987769｜https://pubmed.ncbi.nlm.nih.gov/33987769/
#W15	peer_reviewed	Epidemiology and risk factors of peri-implantitis: A systematic review	J Periodontal Res, 2018	PMID 29882313｜https://pubmed.ncbi.nlm.nih.gov/29882313/
#W16	peer_reviewed	Efficacy of a high-dose antiresorptive drug holiday to reduce the risk of medication-related osteonecrosis of the jaw (MRONJ): A systematic review	Heliyon, 2020	PMID 32373730｜https://pubmed.ncbi.nlm.nih.gov/32373730/

FAQ

Q1. Can someone with diabetes have a dental implant?: **In the literature this is not a yes-or-no question but a question of which outcome is being asked about: several meta-analyses show no significant difference in implant failure rates between people with type 2 diabetes and people without [Fn24], with survival reported as similar to that of healthy patients [Fn26][Fn33]; but the same body of studies also shows that bleeding on probing and peri-implant bone loss were significantly worse in the diabetic group [Fn25], worsening in a dose-response manner as glycated haemoglobin rises [Fn29][Fn31].** The clinical-implication sentence in the literature therefore reads: glycated haemoglobin must be considered in risk assessment before placement and throughout the lifespan of the implant [Fn32]. **This article gives no individual threshold value and makes no determination of suitability** — that has to be assessed jointly by the dentist and the internal-medicine or family-medicine side. For the implant course, see canonical card KM-DENTAL-25 (in production) and domain article P01.; Q1. 糖尿病があってもインプラントはできますか。 — **これは文献のうえでは是か非かの問いではなく、「どのアウトカムを見るか」の問いです：複数のメタアナリシスは、2 型糖尿病の患者のインプラントの失敗率が非糖尿病の人と有意差がないことを示しており [Fn24]、生存率は健康な患者と同程度でありうるとされます [Fn26][Fn33]；しかし同じ研究群は、プロービング時の出血とインプラント周囲の骨吸収が糖尿病群で有意に不良であること [Fn25]、そして HbA1c の上昇にともなって用量反応の形で悪化すること [Fn29][Fn31] も示しています。** ですから文献の臨床的な含意の一文は、次のように書かれています——HbA1c は、インプラント埋入の前と、インプラントの使用期間の全体にわたるリスク評価に組み入れられなければなりません [Fn32]。**本記事は、個々の人に対する基準値も適応の判定も一切提供しません**——それは歯科医師と内科／家庭医の側が共同で評価すべきものです。インプラント治療の流れは、正典カード KM-DENTAL-25（制作中）と領域記事 P01 を参照してください。; Q1. Can someone with diabetes have a dental implant? — **In the literature this is not a yes-or-no question but a question of which outcome is being asked about: several meta-analyses show no significant difference in implant failure rates between people with type 2 diabetes and people without [Fn24], with survival reported as similar to that of healthy patients [Fn26][Fn33]; but the same body of studies also shows that bleeding on probing and peri-implant bone loss were significantly worse in the diabetic group [Fn25], worsening in a dose-response manner as glycated haemoglobin rises [Fn29][Fn31].** The clinical-implication sentence in the literature therefore reads: glycated haemoglobin must be considered in risk assessment before placement and throughout the lifespan of the implant [Fn32]. **This article gives no individual threshold value and makes no determination of suitability** — that has to be assessed jointly by the dentist and the internal-medicine or family-medicine side. For the implant course, see canonical card KM-DENTAL-25 (in production) and domain article P01.
Q2. Can someone taking a drug for osteoporosis have a tooth extracted?: **The answer to this question depends on which drug, for which indication, at what dose: the frequency of MRONJ varies with the drug, the dose and the duration of exposure, and may be rare (oral bisphosphonates, or denosumab for osteoporosis) or common (intravenous bisphosphonate for cancer treatment) [Fn68], and is clearly higher in the high-dose cancer population than in the osteoporosis population [Fn69].** Dentoalveolar surgery is considered a common predisposing event [Fn70], so the direction of assessing beforehand has support in the literature — but the certainty of the evidence supporting regular examinations plus preventive treatment was rated very low by the reviewers [Fn77][Fn78]. **As to whether the drug needs to be stopped: existing systematic reviews have shown no benefit from short-term interruption, and no study has examined the harms of interruption, so it cannot be determined with high certainty [Fn81][Fn82][Fn83]. This article gives no recommendation about stopping any drug**; that decision belongs to the multidisciplinary collaboration between the prescribing physician and the dentist [Fn86]. For wounds and post-operative care after extraction, see canonical card KM-DENTAL-01 (in production) and domain article P06.; Q2. 骨粗鬆症の薬を飲んでいて抜歯はできますか。 — **この問いの答えは「どの薬か、どの適応か、どの用量か」によって決まります：MRONJ の発生の頻度は薬剤、用量、曝露の期間によって異なり、まれなこともあれば（骨粗鬆症に対する経口ビスホスホネートまたは denosumab）、よくあることもあります（がん治療に用いる静脈内投与のビスホスホネート）[Fn68]。また高用量のがんの集団では、骨粗鬆症の集団より明らかに高くなります [Fn69]。** 歯槽外科手術は一般的な誘発事象と考えられており [Fn70]、そのため事前に評価するという方向には文献の裏づけがあります——ただし「定期的な検査に予防的な処置を加えたもの」を支持するエビデンスの確実性は、レビューした側によって非常に低いと評価されています [Fn77][Fn78]。**休薬が必要かどうかについて：現在のシステマティックレビューは短期間の中断に利益があることを示しておらず、中断の害を検討した研究もなく、高い確実性で判定することはできません [Fn81][Fn82][Fn83]。本記事は、いかなる休薬の助言も提供しません**。その決定は、処方医と歯科医師による多職種・多診療科の協働の範囲に属します [Fn86]。抜歯に関わる傷と術後のケアは、正典カード KM-DENTAL-01（制作中）と領域記事 P06 を参照してください。; Q2. Can someone taking a drug for osteoporosis have a tooth extracted? — **The answer to this question depends on which drug, for which indication, at what dose: the frequency of MRONJ varies with the drug, the dose and the duration of exposure, and may be rare (oral bisphosphonates, or denosumab for osteoporosis) or common (intravenous bisphosphonate for cancer treatment) [Fn68], and is clearly higher in the high-dose cancer population than in the osteoporosis population [Fn69].** Dentoalveolar surgery is considered a common predisposing event [Fn70], so the direction of assessing beforehand has support in the literature — but the certainty of the evidence supporting regular examinations plus preventive treatment was rated very low by the reviewers [Fn77][Fn78]. **As to whether the drug needs to be stopped: existing systematic reviews have shown no benefit from short-term interruption, and no study has examined the harms of interruption, so it cannot be determined with high certainty [Fn81][Fn82][Fn83]. This article gives no recommendation about stopping any drug**; that decision belongs to the multidisciplinary collaboration between the prescribing physician and the dentist [Fn86]. For wounds and post-operative care after extraction, see canonical card KM-DENTAL-01 (in production) and domain article P06.
Q3. Will the bleeding be unstoppable if I have a tooth out while on an anticoagulant?: **What the existing literature gives is a group-level picture, not an individual probability: the use of local haemostatic measures is generally effective for bleeding control, with no further pharmacological drug management or suspension [Fn55]; bleeding episodes were mostly mild and generally happened on the first day after the treatment [Fn54]; and no thromboembolic complications were reported in the included trials [Fn53].** Taking warfarin as the example, the conclusion of a systematic review is that patients with an INR within the therapeutic range can safely continue the regular dose [Fn45]; the level of evidence for DOACs is different — Cochrane identified no eligible trials [Fn49], and the practical data come from a real-world audit (persistent bleeding 14.3%, intervention required 9.2%, no major haemorrhage) [Fn50][Fn51]. **This article gives no figure of the form X% of people bleed uncontrollably, because the existing sources contain no such single authoritative value**; nor does it give any instruction to stop or to continue a drug [Fn43].; Q3. 抗凝固薬を飲んでいて抜歯をすると、血が止まらなくなりますか。 — **現在の文献が示すのは集団レベルの像であって、個人の確率ではありません：局所止血処置を用いれば通常は出血のコントロールに十分であり、さらなる薬物的な処置や休薬を必要としません [Fn55]；出血のイベントの多くは軽微で、通常は治療後の 1 日目に生じています [Fn54]。また組み入れられた試験では、血栓塞栓性の合併症は生じていません [Fn53]。** warfarin を例にとると、システマティックレビューの結論は、INR が治療域内にある人は通常の用量のまま安全に継続できる、というものです [Fn45]；DOAC はエビデンスのレベルが異なります——Cochrane は適格な試験を同定できず [Fn49]、実務上のデータはリアルワールドの監査から来ています（持続性の出血 14.3%、介入が必要 9.2%、大出血を来した人はなし）[Fn50][Fn51]。**本記事は「X% で血が止まらなくなる」という数値を提供しません。現在の出典に、そのような単一の権威的な値がないからです**；また、いかなる休薬や継続の指示も提供しません [Fn43]。; Q3. Will the bleeding be unstoppable if I have a tooth out while on an anticoagulant? — **What the existing literature gives is a group-level picture, not an individual probability: the use of local haemostatic measures is generally effective for bleeding control, with no further pharmacological drug management or suspension [Fn55]; bleeding episodes were mostly mild and generally happened on the first day after the treatment [Fn54]; and no thromboembolic complications were reported in the included trials [Fn53].** Taking warfarin as the example, the conclusion of a systematic review is that patients with an INR within the therapeutic range can safely continue the regular dose [Fn45]; the level of evidence for DOACs is different — Cochrane identified no eligible trials [Fn49], and the practical data come from a real-world audit (persistent bleeding 14.3%, intervention required 9.2%, no major haemorrhage) [Fn50][Fn51]. **This article gives no figure of the form X% of people bleed uncontrollably, because the existing sources contain no such single authoritative value**; nor does it give any instruction to stop or to continue a drug [Fn43].

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km 編輯部・《Systemic Disease and Dentistry, a Complete Guide: a domain map from bidirectional relationships and medication risk to disclosure of medical history｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/reports/dental-pillar-systemic-evidence

更新 2026-08-13T14:17:35.388Z · server-rendered · four-language · IDAEO 知識庫

Systemic Disease and Dentistry, a Complete Guide: a domain map from bidirectional relationships and medication risk to disclosure of medical history｜證據鏈

Systemic Disease and Dentistry, a Complete Guide: a domain map from bidirectional relationships and medication risk to disclosure of medical history｜證據鏈

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