With the progress of society and the improvement of people’s medical health level, China has already entered the aging society. The third national oral health epidemiological survey in 2008 showed that the average number of teeth left in the elderly aged 65-74 (32 teeth examined) was 20.97, and 6.82% of the elderly had no teeth in their mouth. The organs of the elderly are aging gradually, and up to 30% of the elderly suffer from one or more systemic diseases, which makes the elderly encounter many problems when they come to the dentistry department. This is because systemic diseases have a significant impact on the timing of tooth extraction surgery, post-operative recovery and wound healing.
Before tooth extraction for the elderly, a comprehensive assessment of the local condition of the oral cavity, the systemic systemic condition, the patient’s mental and psychological condition, and the condition of medical equipment should be made.
In the case of complex local conditions and serious systemic complications, the dentist should also consult with other specialists to carefully decide whether the tooth can be extracted, detect the adverse reversal of the disease in advance, and take timely and effective regulatory measures to minimize the occurrence of tooth extraction complications.
The following is a brief description of some common complications in the elderly, issues and measures that need attention before tooth extraction surgery.
Cardiovascular diseases: If there has been a heart attack within six months; or frequent episodes of angina pectoris recently; cardiac function class III-IV (such as intolerance of minor physical activities not tolerated, even shortness of breath still felt when lying in bed, etc.); severe arrhythmias (atrial flutter, recurrent supraventricular tachyarrhythmias, frequent or multi-source trial premature beats, history of unexplained syncope, etc.), all need to suspend tooth extraction.
1. Coronary artery disease: The tension and painful stimuli generated during the dental treatment may induce a series of stress reactions in the body. In severe cases, angina may be induced, so when visiting the stomatology department, you should carry emergency drugs such as nitroglycerin. If symptoms such as panic, palpitations and chest pain occur during treatment, you should immediately stop treatment, take the drug under the tongue, lie down on the consultation chair or sit down in the waiting room, and go to the emergency room immediately after 5 to 10 minutes of observation if the symptoms are still not relieved or aggravated. Generally in the daily dental treatment process, the incidence of this situation is very low.
2. Hypertension: blood pressure over 180/100mmHg needs to be controlled before tooth extraction. Nifedipine tablets can be taken sublingually before scaling and complex oral endodontic treatment to control higher blood pressure.
3. Diabetes: fasting blood glucose should be controlled below 8.88mmol/L (160mg/dl) and 2 hours postprandial blood glucose below 10mmol/L (180mg/dl), and tooth extraction can be considered. Patients with hyperglycemia increase the risk of post-extraction infection, which directly affects the wound healing. Therefore, oral antibiotics should be taken from 3 days before tooth extraction, and if the extraction is too traumatic, oral antibiotics still need to be continued for 2 to 3 days after the operation.
4. Hepatitis: tooth extraction should be suspended during the acute stage of hepatitis. Severe liver insufficiency, such as cirrhosis combined with ascites, hepatic encephalopathy, hypoproteinemia, and coagulation dysfunction should contraindicate tooth extraction.
5. Hematopoietic system diseases: tooth extraction is allowed only when hemoglobin is above 80g/L and erythrocyte pressure product is above 30%. Neutrophils above 1*109/L (1000/mm3) can be extracted. Acute leukemia cannot be extracted.
6. Hyperthyroidism: Patients need to have their hyperthyroidism under control and the indicators of thyroid function normalized before tooth extraction or surgery.
7. Kidney disease: Acute kidney disease (or called acute kidney injury) needs to suspend tooth extraction. Kidney transplant patients take immunosuppressants for a long time and have a poor ability to resist infection. Generally, antibiotics that are not metabolized by the kidneys need to be routinely taken after tooth extraction.
8. Asthma: You can bring your own fast-acting β2 agonist, such as salbutamol aerosol (Vantorin), when you visit the clinic. Apply it promptly once the symptoms of acute attack appear during tooth extraction and promptly ask the specialist for further treatment. Explain your condition and allergy history to your physician before treatment and avoid using drugs that may trigger or aggravate asthma, such as beta-blockers (betalactam, Bosu, Conoco, etc.). Avoid mental stress during treatment. Extraction is not recommended during the period of frequent seizures.
9. Epilepsy: Patients with poorly controlled epilepsy and during adjustment of antiepileptic drugs should withhold tooth extraction. Some anti-epileptic drugs have side effects of platelet reduction, such as sodium valproate, and it is best to improve blood routine and coagulation function tests before tooth extraction.
10. thrombocytopenia: at least greater than 30,000/ul in adults. if the vascular condition is poor, often accompanied by skin and mucous membrane bleeding, tooth extraction needs to be withheld and a visit to the hematology department is required to clarify the etiology.
11. Long-term use of anticoagulants and antiplatelet agents: Many elderly patients who have undergone vascular stenting, or after cerebral infarction, will routinely take oral anticoagulants or antiplatelet aggregation drugs to prevent thrombosis. If a loose tooth needs to be extracted, the medication can usually be stopped before extraction. If the extraction of complex teeth takes a long time surgically, the discontinuation of medication should start 5 days before the operation. After the operation, a hemostatic drug such as iodoform sponge should be placed in the extraction wound and observed for 30 minutes, and the extraction wound should be left without active bleeding. If there is no active bleeding on the day after surgery, the administration of anti-platelet aggregation drugs can be resumed. In patients who have been using Warfarin for a long time, if it is necessary to discontinue the drug, it should be done 2-3 days before the extraction procedure. If it is not possible to discontinue Warfarin for fear of embolism, an international standardized ratio of prothrombin time between 1.5 and 2 is preferred. Patients are generally advised to visit the relevant department to decide whether the drug can be discontinued depending on their condition, and should not discontinue the drug on their own with adverse consequences.
There is a general fear of stomatological treatment in the elderly, and changes in the mental state of the patient may cause changes in the physiological function of the body, especially for those elderly patients with systemic diseases. Patients should inform the dentist in as much detail as possible about the diseases they have suffered from, their recent physical condition and commonly used drugs, calm their emotions, relax and distract themselves, and fully trust the physician. Patients will get good treatment results if they cooperate closely with the physician.
For patients who are elderly, have mobility problems and poor vision, they should be accompanied by their family members to reduce the patient’s travel and medical risks.
Elderly people should pay attention to the following issues after tooth extraction: the cotton gauze rolls used for pressure hemostasis after tooth extraction should be spit out in about 40 minutes and should not be too short and too long; do not brush and rinse the mouth for 24 hours after tooth extraction; do not eat too hot and too hot food; do not do strenuous sports such as swimming and playing ball; do not smoke and drink alcohol; do not scrub the wound with hard objects such as cotton swabs to avoid destroying and dislodging the clot and causing postoperative bleeding or wound infection.
Elderly patients who can well understand their general condition, adjust their physical and mental state, and actively cooperate with the dentist will get a more satisfactory treatment effect.