Abstract
A statistical study of systemic management of compromised patients during dental treatment was conducted.
The subjects were 116 patients who received dental treatment at Tsurumi University Dental Hospital during 1998. They were 66.6±18.2 years (mean±SD) in age and those aged over 70 accounted for 81% (Fig .1). The most common preoperative systemic diseases were hypertention, which 49% of them suffered from, and ischemic heart diseases, major arrhythmias, and diabetes mellitus (Fig. 2). Habitual drugs such as Ca blockers, vasodilators, and diuretics were taken by 87% of the patients (Table 1). Local anesthesia was performed on 85% (99 cases) of patients; propitocaine containing felypressin was used in 78 cases, lidocaine containing epinephrine was used in 19 cases, and, in two cases, the both anesthetics were used (Table 2). As procedures, extractions of the tooth were performed in 67% of the patients, and pulpectomy and prosthetic procedures were the next most commen (Table 3). The duration of procedures was 27.6±22.0 min, and the duration of systemic management was 50.8±24.0 min (Table 4). Prophylaxic nitroglycerin buccal tablets were administered to 32 cases of hypertensive patients, of which 24 cases did not require further cardiovascular drugs during their procedures. Twenty-eight cases required drugs for systemic complications (Table 5); in 19 cases, drugs to decrease blood pressure were administered; nicardipine in 16 cases and midazolam 1-2mg in 3 cases. In 5 cases, a decrese in Spo2 was tereated with oxygen through a nasal cannule.
As the number of elderly patients increases, compromised dental patients also increase. The needs for systemic management and treatment for cardiovascular changes during dental treatment thus become more important. Decisions about the discontinuation of anticoagulant therapy, administration of prophylaxic antibiotics, and selection of the kind of local anestehtics, should be based upon the dental interventions as well as the systemic condition of the patients.
