Managing the Hypertensive Patient in Dentistry

The hypertension is the condition that the dental practice meets in the every day, and the patient who carries the elevated pressure without the symptoms is the patient who presents the risk that the chair-side measurement reveals. The dental team occupies the position that no other profession ho...

The hypertension is the condition that the dental practice meets in the every day, and the patient who carries the elevated pressure without the symptoms is the patient who presents the risk that the chair-side measurement reveals. The dental team occupies the position that no other profession holds, because the recall visits provide the repeated contact that the screening and the monitoring require. The clinician who measures the pressure, stratifies the risk, and adapts the treatment protects the patient from the crisis and the practice from the emergency. This article reviews the measurement, the risk stratification, the anaesthesia, and the management of the hypertensive patient in the dental setting.

The Prevalence and the Risk

The hypertension affects the large share of the adult population, and the many of those patients are unaware of the diagnosis that the raised pressure represents. The untreated hypertension is the risk factor for the stroke, the myocardial infarction, and the renal disease, and the dental appointment is often the first occasion that the patients receive the measurement in the years. The practice that records the pressure at the new patient examination and the recall performs the service that the profession should treat as the standard.

The Measurement in the Chair

The measurement requires the correct technique, because the cuff that is too small or the arm that is unsupported produces the false reading that misleads the plan. The patient should be seated for the five minutes, the back should be supported, and the arm should rest at the level of the heart. The first reading that is elevated should be repeated after the interval, and the average of the values rather than the single number guides the decision.

The Risk Stratification and the Appointment

The pressure that the measurement returns places the patient in the category that guides the treatment, and the plan ranges from the routine to the urgent referral as the values rise. The patient with the mild elevation proceeds with the routine care and the note to the physician, while the patient with the severe elevation receives the referral before the elective treatment and the management of the pain in the meantime.

The patient who reports the headache, the visual change, the chest pain, or the breathlessness with the elevated pressure requires the urgent medical attention, because the symptoms point to the hypertensive crisis rather than to the asymptomatic elevation.

The Local Anaesthesia and the Vasoconstrictor

The vasoconstrictor in the local anaesthetic is the question that the dental team raises with the hypertensive patient, and the evidence supports the use of the limited dose in the controlled patient while the careful technique protects the circulation. The adrenaline that the patient with the controlled hypertension receives in the small amount produces less cardiovascular change than the pain and the anxiety of the untreated procedure, which is the reason the anaesthesia is the safer choice than the denial of it. The clinician uses the aspirating technique, injects the slowly, and limits the dose, and the patient with the unstable or the severe pressure receives the treatment only after the medical control.

The Hypertensive Crisis in the Chair

The crisis is the emergency that the practice must prepare for, and the presentation includes the severe pressure with the headache, the visual disturbance, the chest pain, or the neurological sign. The management is the cessation of the treatment, the sit-up position, the oxygen, and the monitoring, and the patient with the symptoms of the end-organ damage requires the emergency transfer. The practice that keeps the emergency plan and the drugs that the protocol lists and the team that rehearses the sequence act with the speed that the crisis requires.

The Drug Interactions and the Bleeding

The medication that the hypertensive patient takes changes the dental plan, because the calcium channel blocker that produces the gingival overgrowth, the diuretic that dries the mouth, and the anticoagulant that the patient may take with the hypertension all affect the care. The gingival overgrowth that the nifedipine produces requires the meticulous hygiene and the sometimes the substitution of the drug in the cooperation with the physician. The patient on the antihypertensive and the antiplatelet requires the review of the bleeding risk before the extraction, and the decision to modify the medication belongs to the physician rather than to the dentist.

The Home Care and the Prevention

The hypertensive patient benefits from the oral hygiene that the health and the comfort of the gingiva depend on, and the inflammation that the plaque produces adds to the systemic load that the patient carries. The patient who brushes with the soft electric brush such as the BrushO keeps the gingival margin clean at the gentle pressure, and the routine that the clinician reviews at the recall supports the prevention that the medical and the dental care share.

Clinical Key Points

- Measure the blood pressure with the correct technique at the examination and the recall.

- Repeat the elevated reading and record the average rather than the single value.

- Refer the patient with the stage two or the severe pressure before the elective treatment.

- Manage the crisis with the cessation, the oxygen, the monitoring, and the transfer.

- Review the medication for the gingival overgrowth, the dry mouth, and the bleeding risk.

Conclusion

The hypertensive patient is the routine patient who carries the risk that the measurement reveals, and the dental practice that measures, stratifies, and adapts the care delivers the treatment that is safe in the chair. The clinician who treats the pressure as the vital sign of the appointment gives the patient the screening, the referral, and the dental care that the condition allows.