I HAVE no doubt in my mind that like myself, all dentists, especially those who do private practice would agree that the thing they fear most in this profession is someone dying while undergoing treatment in their dental chair.

Although dentists have been taught not to dread the occurrence of either a serious medical emergency or patient mortality during dental treatment, 10 per cent of all non-accidental deaths in the general population are sudden, unexpected and frequently occur among a rather young age group.

Moreover, as our lifespan increases the exposure of aged individuals to routine dental care will no doubt increase. This is of considerable importance as individuals over the age of 50 not only have a large proportion of serious incapacitating and chronic non-communicable diseases, but also appear less able to tolerate various stresses and trauma inflicted upon them.

Although not always appreciated as such, the practice of dentistry involves considerable psychologic and physiologic (physical) stress for many patients. For instance, it has been recently demonstrated that as many as 40 per cent of patients subjected to local anaesthesia and multiple dental extractions will have cardiac arrhythmias (irregular heartbeats). Obviously, the bodies of most individuals tolerate such insult very well.

However, this is not always so and it poses a serious problem in patients with certain recognised diseases, the aged, and in persons taking certain types of medication.
Some form of cardiovascular (heart and blood vessels) disease is found in a very large segment of the population with an increasing incidence in the older patient. In fact, various types of cardiovascular disorders represent the leading cause of death, thus making it by far the most important health problem in Guyana.

How is all this directly relevant to a classical visit to the dentist? This is how. Dental patients frequently are required to receive local anaesthesia prior to most regular procedures. Every unit of local anaesthetic contains a substance whose purpose is to ensure that the principal drug remains as long as possible on the site where the anaesthetic was deposited. If this does not happen the numb effect would only last for a few minutes.

This substance called a vasoconstrictor is also capable of elevating the patient’s blood pressure. The sudden elevation of blood pressure can result in a stroke. The second highest cause of death by vascular (vessel) diseases is stroke. Ischaemic heart disease, which includes myocardial infarction and angina pectoris are simply conditions in which the heart does not get sufficient blood to circulate between the cells of its muscular walls.

Although unanticipated myocardial infarction, collapse, and death are always a potential occurrence, the practicalities of day to day practice indicate that certain types of patients are especially sensitive to the stress of dental treatment.

These include individuals with congestive heart failure, angina pectoris and recent myocardial infarction. All these conditions come under the heading of ischaemic heart disease, the main cause of death from vascular disease.

Some major factors which make a patient a prospective candidate for death in the dental chair are physical inactivity (“white collar workers”), obesity (excessive body fat), stress or aggression and inveterate smoking. These facilitate heart disease.

Patients who know they suffer from a cardiovascular disease which includes high blood pressure or are on medication for any other illness should inform their dentist of these conditions before beginning treatment. Their life may literally depend on it.