Nz guide
GP medical fitness letter for dental surgery abroad
When New Zealand patients need a GP clearance letter before implant surgery or All-on-4 in Vietnam, what the letter should contain, which medications to disclose, and how to send it to Picasso.
Picasso Dental Clinic requires a GP medical fitness letter for All-on-4 and major arch reconstruction patients, and for anyone with cardiac history, diabetes, anticoagulant therapy, or bisphosphonate use — as of May 2026, healthy adults having veneers or single crowns usually do not require one.
A GP medical fitness letter is a short clinical document confirming that your general health is suitable for elective dental surgery. It is not a new concept — NZ hospitals routinely require them before elective procedures — but many dental tourism patients do not know it is required, or leave it too late.
This page explains who needs one, what it should contain, and how to handle it efficiently.
Who needs a medical fitness letter
Not every patient needs a GP letter. The requirement is proportionate to surgical complexity and medical risk.
| Treatment / patient profile | GP letter required? |
|---|---|
| All-on-4 or full-arch reconstruction | Almost always |
| Multiple implants under IV sedation | Required |
| Single implant, healthy adult, no medication | Usually not — confirm with coordinator |
| Veneers or crowns only | Rarely required |
| Any patient with cardiac history | Required |
| Diabetes (especially poorly controlled) | Required |
| Anticoagulant therapy | Required |
| Bisphosphonate use (any history) | Required |
| Immunosuppression or recent chemotherapy | Required |
| Pregnancy | Required; timing constraints apply |
| Age over 70 with multiple comorbidities | Case by case — coordinator will advise |
If you are uncertain whether your health history triggers this requirement, contact Picasso’s coordinator with your medical summary before your treatment plan is finalised. It is better to confirm early than to arrive in Vietnam with an incomplete pre-operative file.
Conditions that trigger the requirement
The following medical conditions are particularly relevant to elective oral surgery and require documented GP assessment before Picasso will proceed with booking:
Cardiovascular conditions: Heart disease in any form — coronary artery disease, previous myocardial infarction, heart failure, pacemaker or ICD implantation, valve replacement, or recent cardiac intervention. These conditions affect anaesthetic risk, bleeding risk, and healing.
Diabetes: Both Type 1 and Type 2 diabetes affect wound healing and infection risk. Poorly controlled diabetes (HbA1c above 8%) significantly increases surgical risk and may result in the clinic recommending optimisation before proceeding.
Anticoagulant therapy: Warfarin, rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran, and other anticoagulants increase bleeding risk during and after surgery. Stopping these medications without medical supervision carries its own risks (stroke, clot) — the protocol must be agreed between your GP and the surgical team.
Bisphosphonate use: Oral bisphosphonates (alendronate/Fosamax, risedronate/Actonel) used for osteoporosis, and IV bisphosphonates used in oncology treatment, are associated with medication-related osteonecrosis of the jaw (MRONJ). This is a significant implant risk factor. Any history of bisphosphonate use — past or present — must be disclosed before implant planning.
Immunosuppression: Including organ transplant recipients on immunosuppressants, patients on long-term corticosteroids, and patients receiving biological therapies for autoimmune conditions.
Recent chemotherapy or radiation: Particularly head and neck radiation, which impairs bone vascularity and increases complication risk for implants.
Pregnancy: Elective surgery under anaesthesia is generally avoided during pregnancy, particularly in the first trimester. Timing constraints apply to any treatment planning.
What the letter should contain
A useful GP medical fitness letter for overseas elective dental surgery should include:
- Patient identification: Full name, date of birth, date of the letter
- Relevant medical history: Active conditions relevant to surgery and anaesthesia — not a complete medical summary, but a clinically relevant summary
- Current medications with doses: Including all prescription medications, with particular attention to anticoagulants, bisphosphonates, insulin, steroids, and antiplatelets
- Fitness assessment: A clear statement that the patient is (or is not) fit for elective dental surgery under local anaesthesia with or without IV sedation
- INR result: If the patient is on warfarin, a recent INR result is essential for surgical planning
- Antibiotic prophylaxis recommendation: For patients with valve conditions, joint replacements, or immunosuppression, the GP should state whether prophylactic antibiotics are recommended
- GP contact details: Name, practice address, and phone number for follow-up queries from the overseas surgical team
A letter that simply says “patient is well and cleared for dental surgery” without specifics is not sufficient for complex cases. Your GP should be willing to provide clinical detail relevant to the procedure.
How to ask your GP — sample points
When you contact your GP practice to request the letter, be clear about what the procedure involves. Useful framing:
“I am planning elective dental surgery in Vietnam — specifically [All-on-4 / multiple implants / full arch reconstruction]. The procedure is performed under local anaesthesia with possible IV sedation. I need a medical fitness letter confirming my suitability for this procedure, including a note on my current medications and whether antibiotic prophylaxis is recommended. I also need this issued in time to be reviewed by the overseas clinic before they confirm my surgical booking.”
Allow at least two weeks from request to receipt. If you have a Picasso treatment plan already, bring it to the GP appointment — it helps the GP understand the specific surgical steps involved.
Your GP may wish to order blood tests or consult a specialist (cardiologist, endocrinologist) before issuing the letter. Respect that process — it is in your interest.
Medications to disclose to Picasso (and your GP)
When you complete your /free-quote/ form or make initial contact with Picasso, disclose all medications. The following require specific surgical planning discussion:
Blood thinners (anticoagulants and antiplatelets): Warfarin, rivaroxaban, apixaban, dabigatran, clopidogrel, aspirin at therapeutic doses. Never stop these without GP guidance — the holding protocol (when and how to pause) must be medically supervised.
Bisphosphonates: Any history — oral or IV, past or present. Picasso’s surgical team will assess MRONJ risk individually. Some patients on oral bisphosphonates for osteoporosis can safely have implants; others cannot. Do not assume — disclose.
Insulin and diabetes medications: Fasting requirements before sedation require coordination with your diabetes management plan. Metformin is generally continued up to surgery in most protocols, but this is GP-directed.
Corticosteroids: Long-term steroid use (prednisolone, dexamethasone) suppresses adrenal function and may require a steroid stress dose protocol around surgery. Discuss with your GP.
SSRIs and SNRIs: Some antidepressants (particularly SSRIs) impair platelet aggregation and increase bleeding tendency. Disclose these to both GP and Picasso.
Immunosuppressants: Tacrolimus, mycophenolate, azathioprine, and biologics all affect infection and healing risk. Disclose and coordinate with the prescribing specialist if relevant.
If your GP recommends against surgery
If your GP assesses that you are not fit for elective oral surgery at this time, this recommendation should be respected. Common reasons include:
- Recent cardiac event requiring a waiting period (typically 6–12 months before elective surgery)
- Poorly controlled diabetes requiring HbA1c optimisation
- A bleeding disorder requiring specialist haematology input
- Active infection or illness
This is not a dead end — it is a timing issue in most cases. Picasso’s coordinator can hold your treatment plan while you address the underlying concern and obtain clearance at a later date.
For the broader safety picture, see /is-it-safe/ and /safety/honest-risks/.
How to send it to Picasso
Once your GP letter is in hand, email it to [email protected]. Include:
- Your full name and date of birth
- Your booking reference (if already assigned)
- The name of the Picasso coordinator you have been communicating with
Your coordinator will confirm receipt, review the letter with the clinical team, and advise whether your surgical booking can proceed or whether additional information is required. Allow 2–3 business days for clinical review.
Next step
For major procedures including /dental-implants/, /all-on-4/, and /full-mouth-reconstruction/, requesting your GP letter should be one of the first steps after receiving your treatment plan — not the last step before flying. Start the free quote process at /free-quote/ to receive your written treatment plan, then initiate the GP letter process in parallel with booking travel.
About this page
Medically reviewed by
Dr. Emily Nguyen
Founding Clinical Director, Picasso Dental Clinic
DDS · Founder and Clinical Director, Picasso Dental Clinic group
Clinical focus: Cosmetic dentistry · Veneers · Smile design
Dr. Emily Nguyen founded Picasso Dental Clinic in 2013 (originally Serenity International Dental Clinic) and led its 2023 rebrand. She sets clinical standards across the group's six branches in Hanoi, Da Nang, Ho Chi Minh City, and Da Lat, and personally reviews cosmetic protocols including the Portrait Sitting workflow for veneers and smile makeovers.
Frequently asked questions
Do I need a GP letter for veneers at Picasso?
In most cases, no. Healthy adults without significant medical history undergoing veneer preparation and bonding — a non-surgical procedure performed under local anaesthesia — do not require a formal GP medical fitness letter. Confirm with your Picasso coordinator if you are uncertain.
Do I need a GP letter for dental implants or All-on-4?
For All-on-4 and full-arch reconstructions, a GP medical fitness letter is almost always required before surgical booking is confirmed. For patients receiving multiple implants under IV sedation, a letter is required. For single implants in healthy adults without medical history, confirm with your coordinator.
What medical conditions trigger the requirement for a GP letter?
Heart disease (including pacemakers, recent MI, or valve replacement), diabetes (particularly poorly controlled), anticoagulant therapy (warfarin, rivaroxaban, apixaban), bisphosphonate use, immunosuppression, recent chemotherapy, severe bleeding disorders, and pregnancy all trigger the requirement for GP clearance before surgery.
What should a GP medical fitness letter contain?
Patient identity and date; list of medical conditions relevant to surgery; current medications with doses; a statement of fitness (or otherwise) for elective dental surgery under local anaesthesia with or without IV sedation; INR result if the patient is on warfarin; recommendation on antibiotic prophylaxis; and GP contact details for follow-up.
How much notice should I give my GP?
Give your GP at least two weeks' notice. GPs need time to review your records, consult relevant specialists if needed, and draft the letter. Requesting a letter the week before your flight is unrealistic and may result in delays.
I am on bisphosphonates for osteoporosis — can I still have implants?
Bisphosphonate use is a significant consideration for dental implants because of the risk of medication-related osteonecrosis of the jaw (MRONJ). This risk requires individual clinical assessment by your GP and Picasso's surgeon. You must disclose bisphosphonate use — oral or IV — before any implant planning proceeds. The decision is made case by case.
I am on blood thinners — do I need to stop before surgery?
Do not stop anticoagulant medication without explicit guidance from your GP. The management of anticoagulants before dental surgery (whether to hold, bridge, or continue) is a clinical decision based on your individual risk profile. Your GP and Picasso's surgeon will coordinate the appropriate protocol.
How do I send the GP letter to Picasso?
Email your GP letter to [email protected], or send it. Include your booking reference and the name of your coordinating clinician. Your coordinator will confirm receipt and advise whether additional information is needed before surgical booking proceeds.