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Masuda, Seika
Ronen Shika Igaku, 2002, Volume: 16, Issue: 3Journal Article
A case of a patient who lost consciousness during home-visit dental treatment is reported. The patient was a 78-year-old female with a chief complaint of occlusal dysfunction. The patient's medical history was diabetes, hypertension, hyperlipidemia, or right hemiplegia, dementia, and depression due to cerebral hemorrhage and infarction. At the first home-visit intraoral examination, production of upper and lower partial dentures was planned. In consultation with the physician in charge of the patient, it was suggested that in cases when local anesthetics containing epinephrine are used, it is necessary to monitor preoperative and postoperative blood pressure. The home-visit dental treatment from the first through fifth visits were performed without incident. During trial denture fitting using wax dentures at the sixth home-visit dental treatment, the patient suddenly fell from the chair and lost consciousness. Approximately 10 seconds later, the patient showed a slight reaction when her name was called, and after several minutes, the patient regained her normal state and was able to speak. The operator observed the conditions of the patient for approxi- mately 40 minutes, and after confirming that there were no abnormalities in her general condition, he left the patient's house. Neurogenic shock by the stress during trial denture fitting was thought to cause the loss of consciousness reported here, since the patient's decreased cognitive ability by dementia prevented her from sufficiently understanding the treatment, although repetitive transient ischemic attack (TIA) and symptomatic epilepsy were also suggested as a cause. Furthermore, it was possible that propranolol, which the patient orally took on the morning before the treatment, induced the neurogenic shock. These results suggest that, in home-visit dental treatment, sufficient attention must be paid to the dependent elderly whose physical reserve force has diminished even during procedures, such as trial denture fitting, which are not usually considered stressful.
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