Monday, June 22, 2020

Knowledge: Tooth extraction can not be casual

The incidence of dental caries and periodontitis in the elderly is very high. If they are not treated in time, they will eventually have to remove their teeth.

When doctors tell "tooth extraction", people are only afraid of "pain", but few people know that for elderly people with high blood pressure, coronary heart disease, arrhythmia, cardiomyopathy, etc., there are certain risks in tooth extraction. Among them, cardio-cerebrovascular diseases, such as hypertension, coronary heart disease, arrhythmia, heart valve disease, and cardiomyopathy, have a greater impact on tooth extraction. During tooth extraction, the blood pressure of many elderly patients will increase significantly, the heart rate will increase, and palpitations and palpitation will appear. Some can also induce myocardial ischemia, severe angina during tooth extraction, manifested as chest suffocation, severe pain in the precordial area, pale face, cold sweats, and even confusion, requiring immediate rescue.

Therefore, for patients with cardiovascular and cerebrovascular diseases, especially elderly patients with cardiovascular and cerebrovascular diseases, it is important to monitor the whole body condition during tooth extraction, eliminate tension, guarantee painless operation, gentle and rapid surgery, and perfect postoperative treatment.

In response to these patients, the Stomatological Center of the First Affiliated Hospital of Jinan University and the Department of Cardiology cooperated to carry out a new oral treatment project of "electrocardiographic monitoring tooth extraction". Tooth extraction under ECG monitoring has many advantages: Cardiologists and stomatologists discuss the feasibility of patients' tooth extraction surgery and formulate prevention and control plans; senior stomatologists and full-time nurses can reduce the trauma and shorten the operation time of tooth extraction surgery. Improve patient's sense of trust and reduce tension; Relatively quiet environment and sufficient rest time reduce the provocative factors; Real-time monitoring can detect the precursor information of the disease change in advance and take effective preventive measures in time; preoperative, intraoperative and surgical The targeted medication is more targeted and accurate.

So, what should special people pay attention to before tooth extraction?

Hypertensive patients: For patients with hypertension, it is required to control blood pressure stably for a period of time before tooth extraction and take antihypertensive drugs regularly. Monitor blood pressure before tooth extraction. If the blood pressure is still greater than 180/100mmHg for 3 consecutive times after rest and language comfort, intervention treatment is given. Commonly used rapid antihypertensive drugs are: nifedipine, captopril, nitroglycerin, urapidil.

Coronary heart disease patients: For patients with coronary heart disease, if they want to extract their teeth, the requirements are stricter, and they should pay attention to the changes of electrocardiogram, central rate and ST-T segment before surgery. If the patient's electrocardiogram before tooth extraction shows a significant ST-T segment change compared with the past, or a new severe arrhythmia, the tooth extraction should be delayed. Emotional tension before tooth extraction will make the patient feel discomfort in the precordial area. Nitroglycerin or Danshen dripping pills can be taken under the tongue, but if it is confirmed to be an attack of angina, the tooth extraction should be delayed.

Patients treated with anticoagulant drugs for a long time: patients with coronary heart disease or patients with a history of cerebral thrombosis, anticoagulants are mostly used to reduce blood viscosity and prevent thrombosis. Considering that patients who take small doses of aspirin for a long period of time are more at risk of discontinuing the drug than bleeding after tooth extraction, the drug can usually be stopped before tooth extraction. For patients with large wounds such as impacted tooth extraction or multiple tooth extraction, if the drug needs to be stopped, it should be started 5 days before surgery. After the tooth extraction, a hemostatic agent such as iodoform sponge can be placed in the wound, and after 30 minutes of close observation, there is no Active bleeding can only leave. If there is no active bleeding on the day after surgery, you can resume taking platelet-suppressing drugs.

special reminder

Which elderly people can't extract their teeth?

①Myocardial infarction has occurred recently (within 6 months); ②Recent episodes of angina pectoris are frequent; ③Heart function is only grade Ⅲ-Ⅳ; ④Heart disease complicated with hypertension, blood pressure exceeds 180/110mmHg, blood pressure should be controlled before tooth extraction; ⑤ There are severe, uncontrolled arrhythmias.

In general, with the continuous development of China's aging society, the demand for tooth extraction of elderly cardiovascular and cerebrovascular patients is increasing day by day. With the cooperation of stomatologists and cardiologists, ECG monitoring for tooth extraction will escort more patients with cardiovascular and cerebrovascular problems.

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