Tooth extraction in Uncontrolled Diabetes leading to cerebral infarction and Death: A Case Report
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/104Keywords:
Tooth extraction, cerebral infarction, hyperglycemia, Ischemia, Fatal outcome.Abstract
Tooth extraction is one of the most common dental procedures, generally safe and does not bear any complications, although several incidents have led to unpleasant consequences and fatality. The current case report is a fatal incident that happened to a 46-year-old male patient with a history of diabetes, who underwent the procedure of dental extraction for the first molar in a nearby clinic. The following day, the patient experienced swelling on the left side of the face, lid ptosis and dropping of the left corner of the mouth. Upon examination, temperature was 38°c, BP 100/65 mmHg, and heart rate 98 bpm, and labs showed glucose levels of 337mg/dl and HbA1C of 14.2%. The patient was referred to the neurosurgery department and was admitted immediately. The patient was managed for neurological symptoms, although the patient did not survive and eventually experienced demise after two days of admission, and on the third day of the dental extraction process.
References
1. Bernabe E, Marcenes W, Abdulkader RS, Abreu LG, Afzal S, Alhalaiqa FN, et al. Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. 2025 Mar 15;405(10482):897–910.
2. Yang S, Li Y, Liu C, Wu Y, Wan Z, Shen D. Pathogenesis and treatment of wound healing in patients with diabetes after tooth extraction. Front Endocrinol. 2022;13:949535.
3. Rakhshan V. Common risk factors of dry socket (alveolitis osteitis) following dental extraction: A brief narrative review. J Stomatol Oral Maxillofac Surg. 2018 Nov;119(5):407–11.
4. Hujoel PP, Lingström P. Nutrition, dental caries and periodontal disease: a narrative review. J Clin Periodontol. 2017 Mar;44 Suppl 18:S79–84.
5. Tonetti MS, Cortellini P, Graziani F, Cairo F, Lang NP, Abundo R, et al. Immediate versus delayed implant placement after anterior single tooth extraction: the timing randomized controlled clinical trial. J Clin Periodontol. 2017 Feb;44(2):215–24.
6. Dioguardi M, Di Cosola M, Copelli C, Cantore S, Quarta C, Nitsch G, et al. Oral bisphosphonate-induced osteonecrosis complications in patients undergoing tooth extraction: a systematic review and literature updates. Eur Rev Med Pharmacol Sci. 2023 Jul;27(13):6359–73.
7. Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang HL, Avila-Ortiz G. Alveolar ridge preservation: Complications and cost-effectiveness. Periodontol 2000. 2023 Jun;92(1):235–62.
8. Stöhr J, Barbaresko J, Neuenschwander M, Schlesinger S. Bidirectional association between periodontal disease and diabetes mellitus: a systematic review and meta-analysis of cohort studies. Sci Rep. 2021 Jul 1;11(1):13686.
9. Håheim LL, Nafstad P, Schwarze PE, Olsen I, Rønningen KS, Thelle DS. Oral health and cardiovascular disease risk factors and mortality of cerebral haemorrhage, cerebral infarction and unspecified stroke in elderly men: A prospective cohort study. Scand J Public Health. 2020 Nov;48(7):762–9.
10. Smith MM, Barbara DW, Mauermann WJ, Viozzi CF, Dearani JA, Grim KJ. Morbidity and Mortality Associated With Dental Extraction Before Cardiac Operation. Ann Thorac Surg. 2014 Mar 1;97(3):838–44.
11. Mortazavi H. Death Rate of Dental Anaesthesia. J Clin Diagn Res [Internet]. 2017 [cited 2025 May 26]; Available from: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&volume=11&issue=6&page=ZE07&issn=0973-709x&id=10009
12. Shahana Y. Man dies days after having 23 teeth extracted in one day | The Independent [Internet]. Independent. 2024 [cited 2025 May 27]. Available from: https://www.independent.co.uk/asia/china/china-teeth-extraction-death-b2610863.html
13. Ashe I. Ilkeston man died from complications after teeth extraction. 2024 May 3 [cited 2025 May 27]; Available from: https://www.bbc.com/news/uk-england-derbyshire-68950580
14. Gazal G. Management of an emergency tooth extraction in diabetic patients on the dental chair. Saudi Dent J. 2020 Jan;32(1):1–6.
15. M J, Ahamed AS, Lakshmi G V. The Influence of Glycemic Control Over Post-extraction Healing in Diabetic Patients. Cureus. 2024 Oct;16(10):e70998.
16. Gholinejad Ghadi N, Seifi Z, Shokohi T, Aghili SR, Nikkhah M, Vahedi Larijani L, et al. Fulminant mucormycosis of maxillary sinuses after dental extraction inpatients with uncontrolled diabetic: Two case reports. J Mycol Medicale. 2018 Jun;28(2):399–402.
17. Prabhu S, Alqahtani M, Al Shehabi M. A fatal case of rhinocerebral mucormycosis of the jaw after dental extractions and review of literature. J Infect Public Health. 2018 May 1;11(3):301–3.
18. R R, M R M, Kumar SP. Mucormycosis Following Tooth Extraction in a Diabetic Patient: A Case Report. Cureus. 2020 Aug 15;12(8):e9757.
19. Kelley RE, Kelley BP. Heart-Brain Relationship in Stroke. Biomedicines. 2021 Dec 4;9(12):1835.
20. Nasrollahi F, Eilbert W. Thrombotic microangiopathy presenting with stroke-like symptoms. Am J Emerg Med. 2022 May;55:229.e5-229.e6.
21. Yao J, Li S, Cui Q, Ren Y, Li M, Wang J, et al. Intraoperative Hypotension and Postoperative Stroke in Older Patients Who Had Brain Tumor Resections: A Retrospective Cohort Analysis. World Neurosurg. 2023 Jun;174:e72–81.
22. Mazzeffi M, Chow JH, Anders M, Gibbons M, Okojie U, Feng A, et al. Intraoperative hypotension and perioperative acute ischemic stroke in patients having major elective non-cardiovascular non-neurological surgery. J Anesth. 2021 Apr;35(2):246–53.
23. Minassian C, D’Aiuto F, Hingorani AD, Smeeth L. Invasive Dental Treatment and Risk for Vascular Events. Ann Intern Med. 2010 Oct 19;153(8):499–506.
24. Sagris M, Vardas EP, Theofilis P, Antonopoulos AS, Oikonomou E, Tousoulis D. Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics. Int J Mol Sci. 2021 Dec 21;23(1):6.
25. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, et al. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging. 2021;25(7):824–53.
26. Bruno A. Pre-diabetes, Diabetes, Hyperglycemia, and Stroke: Bittersweet Therapeutic Opportunities. Curr Neurol Neurosci Rep. 2022 Nov;22(11):781–7.
27. Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation. 2023 Feb 21;147(8):e93–621.
28. Sinha RK, Singh A, Kishor A, Richa S, Kumar R, Kumar A. Evaluation of Oral Hygiene Status in Patients with Hemorrhagic and Ischemic Stroke. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S233–6.
29. Shahi S, Farhoudi M, Dizaj SM, Sharifi S, Sadigh-Eteghad S, Goh KW, et al. The Link between Stroke Risk and Orodental Status—A Comprehensive Review. J Clin Med. 2022 Oct 2;11(19):5854.
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