Prophylaxis: Prophylaxis only for a qualifying indication (such as a prosthetic valve), not for MVP or aortic dilation alone
Cardiovascular safety: Reduce pain and stress and monitor cardiovascular status.
Local anesthesia: Individualize local-anesthetic/vasoconstrictor use to the actual aortic and cardiac disease and medications; Marfan syndrome alone does not define a universal epinephrine limit.
Jaw support: Support the jaw and use short visits to avoid TMJ dislocation; plan orthodontics for crowding
Antithrombotic changes: do not stop or reduce prescribed anticoagulants or antiplatelets independently. Most routine dental procedures can use local hemostasis; higher bleeding risk or extensive surgery needs a prescriber-directed plan. ADA: medication management.