Safety analysis of tooth extraction in elderly patients with cardiovascular diseases

BACKGROUND This study aimed to evaluate the safety of tooth extraction in elderly patients with cardiovascular diseases. MATERIAL AND METHODS A total of 13 527 patients underwent tooth extraction at the Affiliated Ninth People's Hospital of Shanghai Jiaotong University. Age, sex, and diseases were analyzed. Cardiac monitoring during tooth extraction was performed in 7077 elderly patients with hypertension and other chronic diseases, and the influence of various factors on safety of tooth extraction was evaluated. Additionally, 89 patients with primary hypertension were recruited, and electrocardiogram was monitored with a general monitor or a Holter monitor, and the detection rate of cardiovascular events was compared between the 2 groups. RESULTS The elderly accounted from 75.3%, and patients aged 70-79 years had highest proportion. The most frequent comorbidities were hypertension, coronary heart disease, arrhythmia, cerebrovascular accident, and diabetes. In analysis of factors influencing the safety of tooth extraction in the elderly, a significant difference was noted in systolic blood pressure at different time points. In addition, change in heart rate was different between males and females. Detection rate of cardiovascular events by use of a Holter monitor was significantly higher than with a general monitor. CONCLUSIONS Hypertension was the most common comorbidity in elderly patients undergoing tooth extraction, followed by coronary heart disease and arrhythmia. Advanced age and increased comorbidity may increase the risk of complications. Risk score can be used to rapidly determine risk for complications during tooth extraction. The Holter monitor is superior to the general monitor in identifying cardiovascular events in high-risk elderly patients undergoing tooth extraction, and can be used in this population.