Date of Award

1979

Document Type

Thesis - Restricted

Degree Name

Master of Science (MS)

Department

Dentistry

First Advisor

Nery, Edmundo

Second Advisor

Foshager, Vernon

Third Advisor

Tristani, Felix

Abstract

During periodontal surgery, patient safety and comfort is of utmost concern and should always be foremost in our therapeutic endeavors. With this in mind, this investigation will gather baseline information concerning the cardiovascular status of patients during periodontal surgery under local anesthesia. The incidence of cardiac arrhythmias during dental treatment has not yet been fully appreciated or documented. Periodontal surgery has not been evaluated with respect to the occurrence of cardiac arrhythmias. Studies to date have been conducted during minor oral surgery procedures such as single or multiple extractions, removal of impactions, alveoloplasty and biopsy. Periodontal surgery procedures have become more complex and sophisticated, and the area treated at one appointment has been extended so that frequently the supporting structures of an entire quadrant, an arch or both arches are treated in one appointment. As these procedures are more time- consuming, they are presumably more stressful for the patient than routine oral surgery. The visual and auditory stimuli associated with a long dental procedure, along with tempromandibular joint fatigue and masticatory muscle fatigue from holding one's mouth open for long periods of time, may cause stress. Metabolism of the local anesthetic during a long procedure, resulting in painful stimuli, and reinjection of local anesthetic, may also cause stress. An increased level of endogenous and exogenous catecholamines during a long periodontal surgical procedure may cause an increase in cardiac arrhythmias. In addition, a longer procedure allows more time for an arrhythmia to develop. Moreover, the periodontal patient is usually in an older age group and would therefore be expected to have a higher incidence of arrhythmias during surgery. The primary purpose of this study, therefore, is to document the incidence and types of cardiac arrhythmias present during periodontal surgery on patients free of cardiovascular disease. The presence or absence of cardiac arrhythmias during periodontal surgery can be used as an indicator of patient stress. Knowledge of the incidence and types of cardiac arrhythmias produced during periodontal surgery under local anesthesia is a valuable indicator of the cardiovascular status. It is important to be aware of the patient's cardiovascular status, even during minor surgical procedures, in order to avoid dental office emergencies. If periodontal surgery is associated with serious arrhythmias, routine, direct monitoring of the patient's electrocardiogram on a cardioscope may be indicated. If this surgery is associated with frequent arrhythmias, perhaps shorter treatment periods are indicated. Moreover, if arrhythmia is a frequent occurrence during periodontal treatment, reduction of stress with sedation is indicated. By learning more about the physiology of patients during periodontal surgery, we may render dental care in a more appropriate fashion.

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