Sir, a 46-year-old male was referred from the stroke ward of the neighbouring hospital to an urgent dental care (UDC) unit. The patient had very recently suffered a stroke and was, coincidentally, due to have a tooth taken out by a GDP the following Monday under local anaesthetic (LA). He was accepted by the UDC unit with a treatment plan to extract the tooth under LA.

However, he refused to have the tooth extracted under LA, advising that he was too dentally anxious and required the tooth to be extracted under general anaesthetic (GA). It was explained that a GA was not appropriate given his recent stroke and also the simplicity of the extraction. Following further discussions and given that the patient was not in acute pain with no signs of spreading infection, the decision was made to delay treatment.

Initially clinicians were surprised at the patient's adamant decision, having previously agreed to treatment under LA just days previously. However, some research into recovery post strokes revealed that an increase in anxiety is one of the most common psychological problems.1

Given the significant impact that strokes have on an individual's life and the physical injury that is suffered to the brain, it should be unsurprising that an increase or new onset of dental anxiety is a consequence. It is worthwhile for clinicians to have a heightened awareness and sensitivity of this. In addition to appropriate use of LA and management of anti-coagulants or antiplatelet medications, this will help in achieving a holistic approach to treating patients with a history of stroke.