ASA Guidelines

ASA I: A normal, healthy patient without systemic disease (Green)

Review of their medical history, physical evaluation, and all other evaluation parameters indicate no abnormalities.
Physiologically and psychologically these patients should be able to tolerate whatever stress is associated with their
planned dental treatment without added risk of serious complications. Healthy patients with little or no dental anxiety.
Treatment modification is usually not required for these patients.
ASA II: A patient with mild systemic disease or extreme anxiety and fear in the dental environment (Yellow)
Patients are able to walk up one flight of stairs or two level city blocks before distress causes them to stop.
Generally less stress tolerant than ASA I however, they still represent a minimal risk during their dental treatment.
Routine (elective) dental care is permitted as long as some thought is given to possible treatment modification or
considerations warranted by the patients medical condition. Examples of such considerations or modifications include
the use of prophylactic antibiotics or sedative techniques, limits on the duration of treatment, and possible medical
consultation. Elective dental care is warranted because of the minimal increase in risk to the patient during therapy.
Treatment modifications should also be considered.
Examples:
Type 2 diabetes (well controlled)
Epilepsy (well controlled)
Asthma (well controlled)
Hyperthyroid or hypothyroid (well controlled) in which patients are under a physicians care and currently have
normal thyroid function (considered euthyroid)
ASA I patients presenting with upper respiratory tract infections
Healthy ASA I pregnant patients
Otherwise healthy patients with allergies, especially drugs
Otherwise healthy patients with extreme dental fears
Healthy patients over the age of 60
Adults with blood pressures between 140 and 159 mm Hg systolic and/or 90-94 mm Hg diastolic
ASA III: A patient with severe systemic disease that limits activity but is not incapacitating (Yellow)
Patients are able to negotiate one flight of stairs or two level city blocks, but will have to stop and rest at least once
while en route. At rest patients do not exhibit signs and symptoms of distress; however, distress is exhibited when
patients encounter either physiologic or psychologic stress. Example, an angina patient may be normal (no chest pain)
in the reception area but develops chest pain when placed in the dental chair. Elective dental care is not
contraindicated, but this patients risk during treatment is increased. Serious consideration should be given to the
possible use of treatment modification.
Examples:
Angina pectoris (stable)
Status post-myocardial infarction: more than 6 months prior to dental appointment and with no significant
residual signs or symptoms.
Status post-CVA: more than 6 months prior to dental appointment and with no significant residual signs or
symptoms
Type I diabetes (well controlled)
Heart failure with orthopnea and ankle edema
COPD: emphysema and chronic bronchitis
Exercise induced asthma
Epilepsy (less well controlled)
Hyperthyroid or hypothyroid disorders (patient is asymptomatic)
Adults with blood pressures 160-199 mm Hg systolic and/or 95-114 mm Hg diastolic
ASA IV: A patient with an incapacitating systemic disease that is a constant threat to life. (Red)
Patients are unable to walk up one flight of stairs or two level city blocks. Distress is present even at rest. These
patients have severe systemic disease that is a constant threat to their lives. They have severe medical problems that
are of greater significance to their health than the planned dental treatment. Whenever possible, elective dental care
should be postponed until the patients medical condition has improved at least to an ASA III classification. The
management of dental emergencies, such as infection and pain, should be treated as conservatively as possible in the
dental office until the patients physical condition improves.
Examples:
Unstable angina pectoris (preinfarction angina)
Myocardial infarction: within the past 6 months
CVA: within the past 6 months
Adult blood pressure greater than 200 mm Hg systolic or 115 mm Hg diastolic
Severe heart failure or COPD (requiring oxygen supplementation or confinement in a wheelchair)
Uncontrolled epilepsy (with a history of hospitalization)
Uncontrolled type I diabetes (with a history of hospitalization)

Malamed, Stanley F. (2007). Medical Emergencies in the Dental Office 6th Edition. St. Louis: Elsevier Inc.