A patient with hypertension and a condition that forces him to breathe more easily when sitting up (orthopnea — consistent with COPD) had a myocardial infarction one year ago. He now wants to begin dental care, and after radiographs and an intraoral exam, treatment is indicated. What should you do?

Correct answer: B. Begin treatment with appropriate stress-reduction modifications

• A. Permanently refusing care is not justified for a stable patient one year out from an MI.
• B. Correct. Elective dental care is generally deferred for the first ~6 months after an MI; at ONE YEAR post-MI a stable patient can be treated with stress-reduction measures (short appointments, good anesthesia, monitoring, profound pain control). A medical consult is reasonable for a complex patient but is not mandatory for routine care at this point.
• C. Routine dental care does not require hospital general anesthesia for this patient.
• D. A one-year-old MI is NOT an absolute contraindication; the 6-month window has long passed.

Note: The 6-month post-MI rule is the key board point. Obtaining a medical consultation is also a defensible, cautious choice for a patient with this many comorbidities — but at 1 year post-MI it is not required for routine care.