Tooth extractions and sick sinus syndrome.

The experience of tooth extraction in four patients with sick sinus syndrome (SSS) is described, and electrocardiographic features and a guideline for dental extractions are discussed. Patients controlled by medical therapy were safely treated under administration of an effective drug prior to treatment, while patients with a cardiac pacemaker were examined and checked on the apparatus before tooth extraction by their own specialist. After freedom from the cardiac problems, dental extractions were done smoothly. Electrocardiographically, in the cases with pharmacological treatments, either normal sinus rhythm revealed after additional administration of isoproterenol, or more severe bradycardia-tachycardia pattern was shown immediately after tooth extraction. In the patients with a cardiac pacemaker, ECG presented patterns controlled by pacemaker but beats rose from their own sinus node in the anesthesia-extraction procedure with various grades.