Glucose Levels and Hemodynamic Changes in Patients submitted to Routine Dental Extraction under Local Anesthesia with and without Adrenaline

Abstract

Introduction:In maxillofacial surgery, the simplest procedure that we perform is dental extraction. However, this simple procedure is challenged by the patient's poor medical condition. We generally use local anesthesia in combination with adrenaline; however, as we come across patients with diabetes mellitus and cardiovascular diseases who seek dental extraction, we need to be doubly cautious while using adrenaline. In this study, we intend to compare the effects of local anesthesia with adrenaline and local anesthesia without adrenaline on hemodynamic changes (blood pressure and pulse rate) and random blood sugar levels. The comparison is both within the group and between the two groups. Materials and methods:Healthy patients between the ages 20 and 60 years were included and randomized into two groups of 50 each. In one group, plain local anesthesia was used, whereas in the other group, local anesthetic solution containing adrenaline was used. Medically compromised patients were excluded from the study. Random blood sugar levels, blood pressures, and pulse rates were recorded in both groups before and 10 minutes after injecting the solutions. The findings were compared. Results:When results are compared within the group, a modest increase in the blood sugar level was noted with the group receiving local anesthetic with adrenaline. However, blood pressure and pulse rate showed no significant difference. Similarly, when between-the-groups comparison was done, not a single variable showed any significant difference. Conclusion:The patients injected with local anesthesia containing adrenaline showed similar results to that observed in the patients injected with local anesthesia without adrenaline. However, there is a statistically significant rise in blood sugar levels when a local anesthetic is injected with adrenaline.

Full Arch Implant-Prosthetic Rehabilitation in Patients with Type I Diabetes Mellitus: Retrospective Clinical Study with 10 Year Follow-Up

“…In diabetic patients, as reported by de Bedout et al 2018 [ 21 ], the threshold value of fasting blood glucose level to safely perform oral surgery procedures is 180 mg/dL or 200 mg/dL; in cases of higher values but less than 234 mg/dL, emergency surgical procedures could be performed, while any dental treatment should be avoided if fasting blood glucose level is equal to or greater than 240 mg/dL [ 22 , 23 ].…”

The changes in levels of blood cortisol, glucose, and oxygen saturation in type 2 diabetic patients during tooth extraction

“…Dental practitioners need to establish if the patient has control over his blood glucose levels. An early morning appointment minimizes the risk of stress-induced hypoglycemia (Byakodi et al, 2017;Jia et al, 2019) at around 180 mg/dl (10 mmol/L) for a tooth extraction avoiding hyperglycemia and hypoglycemia. Patients need to take food and their medications or insulin injections as normal, and despite they are immunocompromised and requiring treatment for infections, they do not need prophylactic antibiotics.…”

Management of an emergency tooth extraction in diabetic patients on the dental chair

“…(1) An early morning appointment will minimize the risk of stress-induced hypoglycemia (Jia et al, 2019, Byakodi et al, 2017). (2) Check blood glucose prior to surgery by using blood glucose strips.…”

“…Emergency extraction can be carried out for a patient with blood glucose ≤234 mg/dl, has a painful mobile tooth on condition that LA without adrenaline must be administrated and a course of amoxicillin 500 mg for 5 days must be given after extraction (Gazal, 2019, Gazal et al, 2018, Byakodi et al, 2017).…”