A Case of Vasovagal Syncope Induced by Tooth Extraction

Abstract

Background : Vasovagal syncope (VVS) is a neurogenic reflex-mediated fainting episode characterized by sudden, transient, and self-limiting symptoms. While VVS accounts for a significant portion (around 60%) of emergent medical events in dental practice, it remains an underrecognized condition among dental professionals, often misdiagnosed as hypoglycemia, conversion disorder, or epilepsy. This case report describes a VVS episode induced by tooth extraction, aiming to improve dental clinicians’ awareness and diagnostic approach to VVS. Case Presentation : A 35-year-old female visited the dental department in April 2022 with a two-year history of food impaction in the upper right molar. Examination revealed an elongated, discolored, and tender tooth 18, lacking proper occlusion with the opposing tooth. After confirming no contraindications, the tooth was extracted using a minimally invasive technique. Following the procedure, the patient experienced dizziness upon standing; her blood pressure was 69/47 mmHg, and her heart rate was 65 bpm. The nursing staff assisted her to sit as she showed limb weakness, closed eyes, and briefly lost consciousness. Oxygen was administered, and her blood glucose was 6.5. Blood pressure later improved to 124/78 mmHg, with a pulse of 62 bpm. Oral glucose was given, which she vomited, and emergency services were called. Upon arrival, the patient was alert and cooperative. Neurology consultation and imaging (MRI, MRA, and DWI) ruled out cerebral infarction, initially diagnosing a conversion disorder. A subsequent tilt-table test, including sublingual nitroglycerin, induced a marked blood pressure drop and symptoms confirming a diagnosis of vasovagal syncope (VVS). Conclusions : This case shows that preoperative anxiety, fear, and prolonged waiting can trigger vasovagal reflex during tooth extraction, especially in patients with anxiety or cardiac arrhythmias. For such patients, preoperative precautions and intraoperative cardiac monitoring are advised. In cases of VVS, quick actions like monitoring blood pressure, placing the patient in a supine position, providing oxygen, and administering IV fluids or medications like atropine, if necessary, can help stabilize the patient.