J Korean Assoc Oral Maxillofac Surg 2019; 45(4): 207~214
Acute cardiovascular complications in patients with diabetes and hypertension: management consideration for minor oral surgery
Ajinath Nanasaheb Jadhav, Pooja Raosaheb Tarte
Department of Dentistry, Jamia Islamia Ishaatul Uloom (JIIU)’s Indian Institute of Medical Science & Research Medical College, Jalna, India
Ajinath Nanasaheb Jadhav
Department of Dentistry, Jamia Islamia Ishaatul Uloom (JIIU)’s Indian Institute of Medical Science & Research Medical College, Warudi, Tq.Badnapur, Jalna 431202, India
TEL: +91-9823460440 FAX: +91-02482-222515
E-mail: dr.ajinathjadhav@gmail.com
ORCID: https://orcid.org/0000-0002-2415-2418
Received October 21, 2018; Revised December 9, 2018; Accepted December 16, 2018.; Published online August 31, 2019.
© The Korean Association of Oral and Maxillofacial Surgeons.. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Objectives: Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies.
Materials and Methods: A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients.
Results: Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL.
Conclusion: The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality
Keywords: Diabetes, Hypertension, Cardiovascular complications, Oral surgery


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25 October 2019
Vol. 45
No. 5 pp. 231~299

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