AS our life span increases, the exposure of aged individuals to routine dental care will no doubt increase. This is of considerable importance as people over the age of fifty not only have a large portion of serious incapacitating diseases but also appear less able to tolerate stresses and trauma inflicted on them.
If anyone were to ask me what it is that I fear most about dentistry, my answer would be to have a patient die in my chair. For many years, dentists have been taught to dread that occurrence or even to have a serious medical emergency during dental treatment. Notwithstanding, ten percent of all non-accidental deaths in the general population are sudden, unexpected, and frequently occur in a rather young age group.
Although not always appreciated as such, dentistry involves physiologic (physical) stress for many patients. For instance, it has been demonstrated that as many as forty percent of patients subjected to local anaesthesia and multiple dental extractions will have cardiac arrhythmias (irregular heartbeats).
Obviously, most individuals tolerate such insults very well. However, this is not always so, and it poses a particularly serious problem in patients with certain recognis ed diseases, the aged, and in people 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 older patients. 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, apart from AIDS.
But how is all this related to an ordinary visit to the dentist? This is how. Dental patients are frequently required to receive local anaesthetic before most regular dental procedures. Every unit of local anaesthetic contains a substance whose purpose is to ensure that the principal drug remains as long as possible in the site where the anaesthetic was injected. If this does not happen, the numb effect lasts only a few minutes.
This substance called a vasoconstrictor, can also elevate 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. Ischemic heart disease, which includes myocardial infarction and angina pectoris, is simply a condition in which the heart does not get sufficient blood to circulate between the cells and its muscular walls, and so immense pain results.
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 susceptible 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 ischemic 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 cardiovascular disease, which includes high blood pressure, or are on medication for any illness, should inform their dentist before beginning treatment. Their life may literally depend on it.
