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  • Hypertension is often referred to as the silent killer.  One-third of all patients are undiagnosed.  

  • In a typical dental practice population of 2000 patients, around 500 will have hypertension.  

  • Necessary for the dentist and the medical provider to interact to ensure that the patient's blood pressure does not result in target organ damage as well as to insure the safe delivery of care.

  • Stress related to dental treatment can cause increased endogenous release of catecholamines during the dental treatment, increasing the patient's blood pressure.

  • Recent research indicates that health risks are increased with blood pressures higher than 115/75, and treatment at this stage can prevent adverse events such as stroke and myocardial infarction.

  • Patient may state that he/she has "white coat hypertension".

  • Primary or essential hypertension:  no identifiable cause of hypertension - 90% of patients with hypertension

    • Treatment is lifestyle changes (diet, exercise) first then medications.

    • In general, the more medications a patient is taking for hypertension, the more difficult the hypertension has been to control

  • ​Secondary hypertension: an underlying cause or condition has been identified - 10% of patients with hypertension

    • The underlying cause ( kidney disease, drug induced, thyroid or parathyroid disease, pheochromocytoma, chronic steroid therapy, coarctation of the aorta, sleep apnea) is treated 

  • 25% of patients with hypertension are unaware - hypertension is often called the "silent killer" because organ damage and even sudden death may occur without the patient having any symptoms or being diagnosed.

Hypertension

Introduction

Risks to the dental patient

LLUSD Dental Treatment Recommendations for Patients with Hypertension

  • Myocardial infarction (MI)

  • Cerebrovascular accident (CVA)

  • Side effects from medications

Questions to ask 

Blood Pressure Classification 

Signs and Symptoms

  • There may be NO symptoms, even in patients with very high blood pressure (silent killer)

  • Headaches

  • Numbness/tingling in hands or feet

  • Nosebleeds/coughing up blood

  • Shortness of breath

  • Chest pain

  • Sudden severe headache

  • Sudden numbness of face/arm/leg

  • Sudden vision loss

  • Trouble speaking

  • Inability to stand or walk

Prevention 

References

Dental Management of the Medically Compromised Patient.  Little, Falace, Miller and Rhodus. 8th Edition

  • How high can your blood pressure get?  When was the last time it was that high?  Do you know why it was that high?

  • Have you ever had a hypertensive episode when the high blood pressure could not be controlled?

  • How is your hypertension being treated?

  • Did you take your medications today?  Do you take your medications as directed (everyday)?

  • Has your doctor recently changed any of your blood pressure medications?  Why was that change made?

  • Have you ever had to postpone dental treatment or had any problems with dental care due to your hypertension?

  • How often do you see your physician

  • Do you have a history of coronary artery disease or MI, peripheral vascular disease, transient ischemic attacks or CVA, renal/kidney involvement or eye problems (retinopathy)?

  • Can you climb a flight of stairs without chest pain, shortness of breath or fatigue? 

Medical Consultation Recommended

  • Any patient with high blood pressure who is not under medical care

    • Depending on the level of BP, dental treatment may proceed

  • The patient does not appear to be compliant with his or her treatment

  • The patient reports target organ involvement (ocular, renal, cerebrovascular, cardiovascular)

  • Stage 2 hypertension

  • The patient who cannot climb a flight of stairs without shortness of breath, chest pain or fatigue

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