In addition to desired therapeutic effects, certain medical treatments cause an increased risk of infectious complications. Patients facing such medical treatments therefore oftentimes undergo what is known as a pre-medical dental evaluation. The purpose thereof is to identify and eliminate oral findings that may compromise the upcoming medical treatment or cause infectious sequelae owing to the effects of the medical treatment. However, scientific evidence is limited regarding the importance of pre-medical dental evaluations and the effect of infection control measures. Guidelines for which oral findings that require treatment prior to various medical interventions are often general and open to interpretation. One specific oral finding whose management is frequently discussed, even in medically healthy patients, is asymptomatic apical periodontitis associated with root-canal–filled teeth. The overall aim of this thesis was therefore, with particular emphasis on root-canal–filled teeth with asymptomatic apical periodontitis, to contribute new knowledge that could support the clinical practice of dentists involved in pre-medical dental care.

The thesis comprises four studies. In a survey among hospital-affiliated dentists in Sweden, the pre-medical dental management of various oral conditions was examined. In a follow-up interview study, the decision-making process regarding the pre-medical management of root-canal–filled teeth with asymptomatic apical periodontitis was explored. In the third study, a systematic review of the literature was conducted regarding the impact of oral foci of infection and pre-transplant dental treatment on adverse events in adult patients undergoing solid organ transplantation. The fourth and final study investigated whether clinically available factors reflect the degree of inflammation in apical periodontitis associated with root-canal–filled teeth.

The results showed that hospital-affiliated dentists in Sweden agreed on the pre-medical management of several oral conditions. Patients are therefore generally likely to receive similar and consistent care regardless of provider. This does however not apply to root-canal–filled teeth with asymptomatic apical periodontitis, where consensus for management was low. The decision-making process for this condition involved multiple aspects, where uncertainty regarding the risk–benefit balance of treatment versus no treatment played an important role. However, factors such as the age and quality of root canal filling and features of the apical radiolucency should be interpreted with prudence when assessing lesion severity, as they do not seem to reliably reflect the degree of inflammation in apical periodontitis in root-canal–filled teeth. Furthermore, oral infectious foci at time of transplantation and pre-medical dental treatment might impact infection-related outcomes but appear to lack impact on the risk of mortality or graft rejection in solid organ transplant patients. In conclusion, this thesis contributes new knowledge on current practices and optimal approaches to when, why, and how pre-medical dental care is provided.