Systemic complications and their management during dental treatment.

According to data obtained from the Japanese Dental Society and from Osaka University Dental Hospital, systemic complications during dental treatment fall into one of two categories; one set of complications has no relationship to underlying disease, and the other is related to disease status. In the former category there are the hyperventilation syndrome and neurogenic shock and in the latter, cerebrovascular accidents and heart disease are prominent, particularly in the geriatric patient. The pathophysiology of neurogenic shock and hyperventilation syndrome is explained. The influences of epinephrine and norepinephrine on the young healthy adult, the older healthy adult and on the patient with cardiac disease have been investigated by means of the Systolic Time Interval (STI) method and echocardiography. In the evaluation of likely haemodynamic changes during dental treatment, examination of the fundus oculi is recommended. Glyceryl trinitrate infusion, sublingual glyceryl trinitrate and isosorbide dinitrate tape have been introduced as agents for blood pressure control during dental treatment. From the dentists' standpoint, the evaluation of the patient with various cardiovascular disorders is described.