Dental procedures in patients with cardiovascular disease (CVD) and diabetes mellitus (DM) present unique challenges due to their systemic complications and increased susceptibility to infections, delayed healing, and adverse drug interactions. CVD is one of the leading causes of morbidity and mortality worldwide, with conditions such as hypertension, coronary artery disease, and heart failure requiring careful perioperative management to prevent complications such as myocardial infarction and arrhythmias (1,2). Similarly, DM affects millions globally and is associated with poor wound healing, increased risk of periodontal disease, and a higher likelihood of postoperative infections due to impaired immune response and microvascular complications (3,4).

Dental management in these patients must consider systemic factors, including medication use, stress response, and hemostatic stability. Anticoagulant and antiplatelet therapy in CVD patients poses a risk of excessive bleeding during invasive procedures, necessitating individualized coagulation assessments before treatment (5). In diabetic patients, poor glycemic control can lead to prolonged wound healing and a greater predisposition to oral infections, requiring close monitoring of blood glucose levels before and after dental interventions (6,7).

Several studies have emphasized the importance of tailored dental protocols for medically compromised patients. Preoperative risk assessment, antibiotic prophylaxis, local anesthesia considerations, and stress management strategies are critical in preventing adverse events (8,9). However, despite existing guidelines, there remains a lack of standardized approaches for optimizing dental care in these populations, necessitating further research into best practices for managing CVD and DM patients during dental procedures. This study aims to evaluate the impact of modified dental protocols on clinical outcomes in patients with CVD and DM, emphasizing safety, hemodynamic stability, and postoperative healing.

Study Design and Participants

This prospective clinical study included 100 patients undergoing dental procedures, divided into two equal groups: 50 patients with cardiovascular disease (CVD) and 50 patients with diabetes mellitus (DM). Participants were recruited from the outpatient department of a dental hospital, with ethical approval obtained before the study commenced. Written informed consent was acquired from all patients.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Patients aged 18–70 years diagnosed with either CVD or DM.
• Patients requiring routine dental procedures such as tooth extractions, scaling, and restorative treatments.
• Patients on stable medical therapy for at least three months before the procedure.

Exclusion Criteria:

• Patients with uncontrolled hypertension (BP > 180/110 mmHg) or severe uncontrolled diabetes (HbA1c > 9%).
• Those with a history of recent myocardial infarction (within the past six months) or unstable angina.
• Patients with bleeding disorders or those on high-dose anticoagulant therapy.
• Pregnant or lactating women.

Preoperative Evaluation

A detailed medical and dental history was recorded for all patients. Blood pressure (BP), heart rate (HR), and blood glucose levels were measured before treatment. International Normalized Ratio (INR) was assessed for CVD patients on anticoagulant therapy. Diabetic patients were instructed to undergo fasting blood sugar (FBS) and postprandial blood sugar (PPBS) testing before the procedure.

Intervention and Dental Procedure Modifications

Patients were divided into two groups based on the management protocol:

1. Standard Care Group (n=50) – Underwent routine dental procedures without any modifications.
2. Modified Protocol Group (n=50) – Received tailored interventions, including:
• Pre-procedural antibiotic prophylaxis for high-risk CVD patients.
• Stress reduction strategies, including short morning appointments and supplemental oxygen if needed.
• Blood glucose optimization before invasive dental procedures for diabetic patients.
• Local anesthesia adjustments (use of epinephrine-free anesthetics in high-risk CVD patients).
• Post-procedural monitoring for potential complications such as delayed healing or excessive bleeding.

Outcome Measures and Follow-up

• Primary Outcome: Healing time and postoperative complications (infection, bleeding, pain, delayed healing) over a four-week follow-up period.
• Secondary Outcome: Hemodynamic stability (BP and HR changes), glycemic control variations, and patient-reported pain levels using a Visual Analog Scale (VAS) score.
• Patients were reviewed on Day 3, Day 7, and Day 30 post-procedure to assess healing and monitor complications.

Statistical Analysis

Data were analyzed using SPSS software version 25. Continuous variables (BP, HR, blood glucose levels) were expressed as mean ± standard deviation (SD) and compared using paired t-tests. Categorical variables (infection rate, bleeding episodes) were analyzed using chi-square tests, with a significance level of p < 0.05.

Patient Demographics

The study included 100 patients, with 50 individuals diagnosed with cardiovascular disease (CVD) and 50 with diabetes mellitus (DM). The mean age of the participants was 55.6 ± 10.2 years in the CVD group and 53.2 ± 9.8 years in the DM group. Male participants comprised 60% of the CVD group and 55% of the DM group. The mean blood pressure (BP) in the CVD group was 138/85 mmHg, while the mean HbA1c level in diabetic patients was 7.2 ± 1.5% (Table 1).

Comparison of Clinical Outcomes

Patients in the modified protocol group showed significant improvements in post-procedure recovery compared to the standard care group. The infection rate was lower in the modified protocol group (8% vs. 18%), and delayed healing was observed in only 12% of cases compared to 22% in the standard care group. The incidence of excessive bleeding was also lower (4% vs. 10%). Additionally, the mean healing time was significantly shorter in the modified protocol group (7.8 ± 1.8 days) compared to the standard care group (10.5 ± 2.3 days) (Table 2).

Hemodynamic and Glycemic Stability

Patients in the modified protocol group exhibited better hemodynamic stability and glycemic control. The mean BP variation was significantly lower (+3.2 mmHg in the modified protocol group vs. +8.5 mmHg in the standard care group). Similarly, the mean heart rate (HR) change was lower in the modified group (+2.8 bpm vs. +6.2 bpm). In diabetic patients, postoperative fasting blood sugar (FBS) increase was only +5 mg/dL in the modified protocol group compared to +15 mg/dL in the standard care group. HbA1c changes were also minimal in the modified protocol group (+0.1%) compared to the standard care group (+0.3%) (Table 3).

These findings suggest that tailored dental care protocols significantly improve patient safety and recovery in individuals with CVD and DM. ​​

Table 1: Patient Demographics

Table 2: Comparison of Clinical Outcomes

Table 3: Hemodynamic and Glycemic Stability

Patients with cardiovascular disease (CVD) and diabetes mellitus (DM) require special considerations during dental procedures due to their increased risk of complications, including impaired wound healing, excessive bleeding, and hemodynamic instability. The findings of this study highlight the effectiveness of modified dental protocols in improving patient outcomes by reducing post-procedure infections, minimizing hemodynamic fluctuations, and enhancing healing rates.

The higher prevalence of postoperative infections and delayed healing in the standard care group aligns with previous research, emphasizing that diabetic patients have compromised immune responses and microvascular complications that delay tissue repair (1,2). Studies have shown that hyperglycemia is a major contributor to increased susceptibility to infections, with prolonged wound healing attributed to defective neutrophil function and impaired collagen synthesis (3,4). The significantly lower infection rates (8% vs. 18%) in the modified protocol group suggest that pre-procedural glycemic optimization and antibiotic prophylaxis play a crucial role in improving postoperative outcomes, similar to findings in earlier studies (5,6).

In CVD patients, perioperative hemodynamic fluctuations pose a major risk, particularly in individuals on antihypertensive or anticoagulant therapy. Previous studies indicate that the use of epinephrine-containing local anesthetics can contribute to acute hypertensive episodes and arrhythmias, necessitating caution in high-risk patients (7,8). In this study, the modified protocol group exhibited better hemodynamic stability, with lower BP and HR variations, likely due to the use of epinephrine-free anesthetics, shorter appointments, and stress reduction strategies. These findings are consistent with literature advocating for the careful selection of local anesthetics and stress management techniques in medically compromised patients (9,10).

The lower incidence of excessive bleeding (4% vs. 10%) in the modified protocol group further supports the importance of individualized anticoagulant management. Literature suggests that abrupt discontinuation of anticoagulants increases the risk of thromboembolic events, whereas adjusted dosages or bridging therapy can minimize bleeding risks without predisposing patients to cardiovascular complications (11,12). In this study, patients undergoing invasive procedures were managed using preoperative coagulation assessments (INR monitoring), localized hemostatic measures, and controlled post-operative monitoring, which contributed to improved safety outcomes (13).

Furthermore, the modified protocol group exhibited a significantly faster healing time (7.8 ± 1.8 days vs. 10.5 ± 2.3 days), which underscores the role of optimized preoperative patient preparation. Research suggests that tight glycemic control (HbA1c <7%) and stress reduction techniques are associated with improved periodontal and surgical healing in diabetic patients (14,15). The integration of systemic disease management into dental care protocols not only enhances patient safety but also ensures optimal procedural success.

Overall, this study highlights the necessity of patient-specific modifications in dental procedures for individuals with CVD and DM, reinforcing existing literature that supports preoperative assessment, medication adjustments, stress control, and postoperative monitoring. Future research should focus on long-term outcomes and larger sample sizes to further validate these findings.

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