|ORIGINAL RESEARCH REPORT
|Year : 2022 | Volume
| Issue : 3 | Page : 92-97
Clinico-odontological management of medically compromised patients during intra-alveolar exodontia in Saudi Arabia: A retrospective study
Ramat Oyebunmi Braimah1, Dawood Ali-Alsuliman1, Bandar Alyami2, Abdurrazaq Olanrewaju Taiwo3, Adebayo Aremu Ibikunle4, Abdullah S Al-Walah1
1 Department of Oral and Maxillofacial Surgery, Najran Specialty Regional Dental Center, Medical Village Complex, Najran, Kingdom of Saudi Arabia
2 Department of Preventive Dentistry, Faculty of Dentistry, Najran University, Najran, Kingdom of Saudi Arabia
3 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
4 Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
|Date of Submission||29-Mar-2022|
|Date of Acceptance||05-Jul-2022|
|Date of Web Publication||25-Aug-2022|
Dr. Ramat Oyebunmi Braimah
Department of Oral and Maxillofacial Surgery, Najran Specialty Regional Dental Center, Najran
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Objective: Worldwide, the increase in chronic comorbid medical conditions in the young and elderly is of a major concern, especially in Saudi Arabia. Therefore, the objective of the present study was to investigate the prevalence and clinico-odontological management of medically compromised during intra-alveolar exodontia in Saudi Arabia. Methods: This 5-year retrospective study was conducted on patients who had intra-alveolar extraction of teeth at the department of oral and maxillofacial surgery of a government referral hospital, between January 2016 and December 2020. Data on the age, gender, comorbid medical conditions, and management protocols which include general, specific, and special consultations with relevant specialties were also recorded and analyzed. Results: The prevalence of comorbidities in 8065 patients seen during the study period was 19.6%. There were 1578 (748 [47.4%] males and 830 [52.6%] females) patients with age range of 10–102 years. The mean (±standard deviation) of 36 (16.6) was observed. The most frequent spectrum of medical conditions discovered included endocrine (458 [29.0%]), cardiac (259 [16.4%]), respiratory (79 [5.0%]), central nervous system (83 [5.2%]), and autoimmune (54 [3.4%]). Five hundred and sixteen (32.7%) patients had combined medical conditions. Out of the 1578 patients with medical conditions, 1554 (98.5%) were on routine prescription medications. Conclusions: The current study observed that 19.6% of patients presenting for intra-alveolar tooth extractions were medically compromised. Majority were in middle age and were female. Endocrine and cardiac abnormalities were most prevalent medical conditions. Prescription medications were observed in 98.2%.
Keywords: Comorbidity, elderly, intra-alveolar extraction, Najran
|How to cite this article:|
Braimah RO, Ali-Alsuliman D, Alyami B, Taiwo AO, Ibikunle AA, Al-Walah AS. Clinico-odontological management of medically compromised patients during intra-alveolar exodontia in Saudi Arabia: A retrospective study. J Clin Sci 2022;19:92-7
|How to cite this URL:|
Braimah RO, Ali-Alsuliman D, Alyami B, Taiwo AO, Ibikunle AA, Al-Walah AS. Clinico-odontological management of medically compromised patients during intra-alveolar exodontia in Saudi Arabia: A retrospective study. J Clin Sci [serial online] 2022 [cited 2022 Sep 26];19:92-7. Available from: https://www.jcsjournal.org/text.asp?2022/19/3/92/354671
| Introduction|| |
Due to a significant economic growth in the Kingdom of Saudi Arabia in the last 3 decades, the majority of the population have adopted unhealthy lifestyle habits resulting in chronic noncommunicable diseases. These conditions include cardiovascular disease, diabetes mellitus, and obesity, all of which lead to cellular and tissue dysfunction because of metabolic derangement. Globally, the increase of these chronic conditions in the young and elderly is of a major public health concern, especially in Saudi Arabia. The World Health Organization (WHO) has ranked Saudi Arabia as the third in the world for high prevalence of diabetes mellitus and obesity. Furthermore, as improved access to medical facilities and better socioeconomic conditions continue to advance, the percentage of elderly patients will continue to soar. Consequently, the number of elderly patients with an array of medical conditions will also continue to surge. Many of these patients (young and elderly) will continue to visit the dental clinics and they may/may not be on routine prescriptions. Those on routine prescriptions often times are under polypharmacy with the possibility of drug interactions. Therefore, dentists should be aware of these group of patients with comorbid systemic conditions and polypharmacy that may warrant dental management to be altered.
Therefore, the aim of this present study was to present the prevalence, spectrum, prescription consumptions, and clinico-odontological management of medically compromised patients presenting for intra-alveolar dental extractions.
| Methods|| |
This 5-year retrospective study was conducted on patients who had intra-alveolar extraction of teeth at the department of oral and maxillofacial surgery of a government referral hospital, between January 2016 and December 2020.
Patients below 11 years old at the time of treatment and all trans-alveolar extraction of the third molars were excluded from the study. Data on the age, gender, comorbid medical conditions such as: endocrine, cardiac, renal, respiratory, gastrointestinal, central nervous system, organ donor, hematology, infective, oncology, autoimmune and combined medical conditions were retrieved and stored. Management protocols of this group of patients, which include general, specific, and special consultations with relevant specialties, were also recorded.
Statistical analyses were done using the Statistical Package for the Social Sciences version 20 (IBM SPSS Statistics for IOS, Version 20.0. Armonk, NY, USA: IBM Corp.). Descriptive analyses and cross-tabulations of variables were done. Pearson's Chi-square test was used to measure the level of significance among categorical variables such as age group of patients, sex, and comorbid conditions with P ≤ 0.05 being considered statistically significant.
| Results|| |
The prevalence of comorbidities in 8065 patients seen during the study period was 19.6%. There were 1578 (748 [47.4%] males and 830 [52.6%] females) patients with age range of 10–102 years. The mean (±standard deviation) of 36 (16.6) was observed. When comorbid medical conditions were analyzed against gender of patients, there were more female gender with endocrine conditions, which was statistically significant (χ2 = 95.818, df = 11, P = 0.000) as shown in [Table 1].
|Table 1: Distributions of comorbid medical conditions according gender of patients|
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Spectrum of other medical conditions observed included cardiac, renal, respiratory, gastrointestinal, central nervous system, organ donor, hematology, infective, oncology, autoimmune, and combined medical conditions. The majority of the patients had endocrine and cardiac conditions as seen in 458 (29.0%) and 259 (16.4%) patients, respectively, while 516 (32.7) patients had combined medical conditions [Table 1]. Breakdown of distribution of each medical condition is shown in [Table 2]a and [Table 2]b. The majority of the patients with endocrine, cardiac, and combined comorbid conditions were in the age groups of 41–50 years, 51–60 years, and 61–70 years, respectively. Distributions of these medical conditions according to the age group of patients are shown in [Table 3]a and [Table 3]b.
Out of the 1578 patients with medical conditions, 1554 (98.5%) were on routine prescription medications, while only 24 (1.5%) were not. The most commonly used medications among the study population were hypoglycemics, antihypertensives, and anticoagulants as shown in [Figure 1]a and [Figure 1]b.
|Figure 1: (a and b) Bar chart showing distribution of prescription medications among medically compromised patients|
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[Table 4] shows the clinico-odontological management of patients with comorbid conditions presenting for routine dental extractions in the dental clinic.
|Table 4: Clinico-odontological management protocol of medically compromised patients presenting for tooth extraction|
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| Discussions|| |
Worldwide, epidemiological studies have shown different variations in the prevalence of medically compromised patients among dental patients.,, This is as a result of diverse patients structure and different methodologies adopted in these studies. Literature has reported the prevalence of medically compromised patients to be between 10% and 69%., In the current study, a prevalence rate of 19.6% medically compromised patients presenting for intra-alveolar tooth extraction was observed. This falls within the range reported in the literature. While some studies have reported a higher prevalence rate,,, others have reported a lower rate., In the Kingdom of Saudi Arabia, a lower prevalence rate of 10.3% was reported among males only in Asir region. This region is in the same southern province with Najran where the current study was conducted. Similarly, a lower rate of 10.3% was also reported in Riyadh due to the study conducted on patients presenting for periodontal treatment.
Similarly, studies showed female preponderance in the medically compromised presenting for dental treatment., The current study also corroborated this report as more females patients were observed. Females generally pay more attention to both general and oral health than the males. On the contrary, male preponderance was reported by Bhateja.
In general, the most common medical disorder observed in the current study (from high to low) was endocrine (458 [29.0%]), cardiac (259 [16.4%]), central nervous system (83 [5.2%]), and respiratory (79 [5.0%]) conditions. Diabetes and hypertension were reported as the most common medical conditions in various studies,,, which have been corroborated in the current research. In contrast, other studies reported gastrointestinal conditions as the most prevalent.,, Diabetes in Saudi Arabia is the second highest in the Middle East and 7th globally according to the WHO. It has also been related to high mortality, morbidity, and cardiac and vascular complications including hypertension.,, Reasons for this upsurge have been linked to unhealthy diet, sedentary lifestyle, lack of exercise, and poor weight control.,, Researchers in Saudi Arabia have been advocating a wide-ranging control programs to reduce this upsurge. Such programs include; promoting a healthy diet, regular exercise, active lifestyles and weight control., Patients with combined medical conditions have diabetes and hypertension as their main components. This was observed to be more prevalent among the female gender, which shows that females are more prone to developing complex medical conditions.
Another important factor in the Kingdom is tobacco smoking, which has been ranked the second leading risk factors for death worldwide. In addition, it is a major risk factor for the development of chronic diseases including lung diseases and heart and renal conditions. The prevalence of smoking in the Kingdom was reported to be 12.2% in 2013 and has continued to increase. Surprisingly, chronic obstructive pulmonary disease was not a common medical condition in dental patients despite high rate of smoking. This aspect needs more research to unravel the reasons. The incidence of renal diseases is low in the current study as only 27 (1.7%) cases were recorded. This prevalence falls within the range of dental patients with renal conditions reported in Asir region, Kingdom of Saudi Arabia.
Another notable medical condition was the central nervous system with psychiatry and seizure disorders ranking highest. The psychiatric disorder has been associated with substance abuse with its associated consequences including medical diseases, educational, occupational, legal, and social problems. Addiction medications in the Kingdom have been reported to include amphetamine (4%–70.7%), heroin (6.6%–83.6%), alcohol (9%–70.3%), and cannabis (1%–60%). Patients on substance abuse usually have poor oral hygiene with high risk of caries and its sequelae.
Thyroid gland diseases are also a public health problem worldwide. In the Arab world including Saudi Arabia, changes in lifestyle led to increase in the burden of thyroid gland related diseases. The current study reported 81 (5.1%) cases of hypothyroidism and 19 (1.2%) cases of hyperthyroidism, with both conditions being highest in the female gender. Similar findings have been reported where cases of hypothyroidism were more frequent than hyperthyroidism. In agreement with the current study, female gender predilection had been reported.
There is generally a growing demand for medications use, especially polypharmacy due to the increase in the incidence of systemic conditions. This study reported routine medication intake in 98.2% of the medically compromised. This is comparable with the study by Valderrama Gama et al., wherein 83.1% of their study population were on routine medications. Other studies have documented lower rates., As a single medication use, antihypertensives have been observed as the most frequently prescribed medications (215 [13.6%]), followed by oral hypoglycemics (188 [11.9%]) and then insulin (167 [10.6%]). A similar report was observed by Esteves and Quintanilla, where antihypertensive medication was the most commonly reported medication. Regarding polypharmacy, oral hypoglycemics + antihypertensives + aspirin was observed to be a more frequently used drug combination (353 [22.4%]), followed by oral hypoglycemics + antihypertensives + warfarin + aspirin (161 [10.2%]). This study showed that many patients were on different medication prescriptions which were mostly in combination as reported previously in the literature. This requires oral health-care providers to be familiar with drugs and their possible interactions.
In general, stress reduction protocol must be followed when managing this group of patients. Such protocols maintained in this study include counseling, early morning appointments, short duration care, air-cooled environment, proper preoperative rest, and mindful display of instruments. Consultation with cardiologists on anticoagulant regulations was carried out for all patients on anticoagulation therapy. Antibiotic prophylaxis is given 1 h preoperatively for all cases of possible subacute bacteria endocarditis patients with possible extension postoperatively. Renal patients were managed with consultation to the nephrologists and dental extractions were carried out a day after dialysis with optimal coagulation factors values. Patients who have undergone kidney transplantation are always on immune suppressants; therefore, they were always placed on antibiotics to prevent extraction site infection. In the management of patients' with infective conditions such as hepatitis, exodontia was scheduled as the last clinic procedure. The instruments used for such patients' were separated and clearly labelled as “Hepatitis infected” while sending them to the sterilization unit.
| Conclusion|| |
The current study concluded that 19.6% of patients presenting for intra-alveolar tooth extractions were medically compromised. Combined medical conditions, endocrine, and cardiac were most prevalent medical conditions. Majority were in middle age and were female. Out of the patients with medical conditions, 98.2% were on prescription medications with antihypertensives as the mostly consumed, followed by oral hypoglycemics and insulin. Stress reduction protocols have been generally adopted for all patients together with consultations to the physicians. Furthermore, the study demonstrates the importance of general medicine knowledge and clinical experience during dental education.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]