Dental Management of Hypertension

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Questions and Answers

What is the first step in managing a patient with hypertension in a dental setting?

Identify patients with both diagnosed and undiagnosed hypertension (correct)

Initiate treatment without considering their medical history

Consult with the physician before any appointment

Perform blood pressure measurements before any treatment

What blood pressure reading indicates a need for immediate referral to a physician?

≥ 180/110 (correct)

≤ 120/80

≥ 160/100 but < 180/110

≥ 140/90 but < 160/100

Which of the following is NOT a concern when treating patients with hypertension?

Acute elevation in blood pressure during treatment

Hypertension being a minor predictor of cardiovascular risk

Potential drug interactions with antihypertensive medications

Marketing dental treatments to high-risk patients (correct)

What dental management action should be taken for patients with blood pressure readings between ≥160/100 but <180/110?

Consider intraoperative monitoring of blood pressure Signup and view all the answers

How should dental professionals manage patients with blood pressure readings of ≥180/110?

Defer elective treatment and only provide emergency care Signup and view all the answers

Which factor can cause an acute elevation in blood pressure during dental treatment?

Injection of exogenous catecholamines in local anesthetics Signup and view all the answers

What is the recommended dental management for a patient with a blood pressure of ≥140/90 but <160/100?

Any treatment could be done, but medical consultation is encouraged Signup and view all the answers

Why is it important to take blood pressure measurements routinely for all new patients?

To detect any hypertension which could complicate dental treatment Signup and view all the answers

What is a primary consideration before treating a hypertensive patient?

Benefit versus potential risks Signup and view all the answers

Which sedative is considered appropriate for premedication before surgery for a hypertensive patient?

Diazepam 2-5 mg Signup and view all the answers

What should be avoided to prevent orthostatic hypotension in hypertensive patients?

Rapid position changes Signup and view all the answers

What is the recommended limit for intraoperative blood pressure before terminating an appointment for patients with upper level stage 2 hypertension?

179/109 Signup and view all the answers

Why should adrenalin-impregnated gingival retraction cord be avoided in hypertensive patients?

It contains high concentrations of adrenalin Signup and view all the answers

Which vasoconstrictor should be avoided in hypertensive patients due to its excessive alpha1 stimulation effects?

Noradrenalin Signup and view all the answers

What complication has been reported occasionally in patients with malignant hypertension?

Facial palsy Signup and view all the answers

Which of these medications is most likely to cause gingival hyperplasia in hypertensive patients?

Calcium channel blockers Signup and view all the answers

What is a potential effect of ACE inhibitors on hypertensive patients?

Neutropenia and delayed healing Signup and view all the answers

What should be monitored closely when using adrenalin in hypertensive patients?

Blood pressure and heart rate Signup and view all the answers

Study Notes

Dental Management of Hypertensive Patients

Patient Identification: Identify patients with diagnosed or undiagnosed hypertension. Obtain comprehensive medical history, including treatment, medications, compliance, symptoms, and stability of the condition.
Blood Pressure Monitoring: Routinely measure blood pressure for all new patients and at recall appointments. Monitor patients not compliant with treatment, those poorly controlled, or with comorbidities like heart failure, prior MI, or stroke.
Treatment Considerations:
- Acute Pressure Elevation: Stress, anxiety, vasoconstrictors (local anesthetics or retraction cord), and medication absorption can elevate blood pressure during treatment. This may cause stroke or MI.
- Drug Interactions: Potential interactions between antihypertensive medications and dental treatments pose a risk.
- Blood Pressure Management: Treatment guidelines based on blood pressure readings.

Blood Pressure Guidelines

≤120/80: Any treatment is permissible.
≥120/80 but <140/90: Any treatment is permissible, but encourage medical consultation.
≥140/90 but <160/100: Any treatment is permissible, but encourage medical consultation.
≥160/100 but <180/110: Any treatment is acceptable. Consider intraoperative blood pressure monitoring for higher levels. Terminate treatment if pressure exceeds 179/109. Refer to physician promptly.
≥180/110: Elective procedures are deferred; only emergency treatment is provided. Consult the physician; use intraoperative blood pressure monitoring, ECG monitoring, IV line, and sedation as needed. Weigh benefits and risks of the proposed treatment.

Managing Hypertensive Patients During Treatment

Stress Reduction: Implement strategies to reduce stress and anxiety in patients.
Patient Rapport: Establish a positive and trusting relationship with the patient.
Appointment Scheduling: Schedule shorter, morning appointments.
Premedication: Consider premedication with sedatives or anxiolytics like Diazepam.
Conscious Sedation: Use nitrous oxide/oxygen for conscious sedation; maintain adequate oxygenation, particularly during cessation. Avoid hypoxia; it can cause blood pressure elevation.
Orthostatic Changes: Make slow position changes to prevent orthostatic hypotension.
Intraoperative Monitoring: Regularly monitor blood pressure in patients with moderate hypertension. Terminate procedure if pressure exceeds 179/109.
Local Anesthesia: Use effective local anesthesia. Use small doses of epinephrine; 1-2 cartridges of 2% lidocaine with 1:100,000 epinephrine are generally safe. Avoid excessive doses. Avoid intravascular injection; use aspirating syringes.
Retraction Cords: Avoid epinephrine-impregnated retraction cords; they can cause rapid absorption and adverse reactions.
Alternative Vasoconstrictors: Avoid use of norepinephrine and levonordefrin due to potential excessive alpha1 stimulation.
Epinephrine Considerations: Limited use of epinephrine may be permissible in situations with uncontrolled or severe hypertension; consider the necessity. Be aware of potential interactions with other medications.
Drug Interactions: Caution is needed when using vasoconstrictors with non-selective beta-blockers or peripheral alpha-blockers.

Oral Manifestations and Hypertension

General: Hypertension itself does not typically cause oral complications.
Malignant Hypertension: Facial palsy might occur.
Severe Hypertension: Patients may experience excessive bleeding after oral surgeries or trauma.
Medications: Some antihypertensive medications can cause side effects:
- Diuretics: Dry mouth is a possible side effect.
- Thiazides, methyldopa, propranolol, labetalol: Risk of lichenoid reactions.
- ACE inhibitors: Neutropenia (delayed healing/gingival bleeding), angioedema, and burning mouth might occur.
- Calcium channel blockers: Potential for gingival hyperplasia.

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Description

This quiz focuses on the dental management of patients with hypertension, covering identification, blood pressure monitoring, and treatment considerations. Understand the precautions necessary to ensure safe dental care for hypertensive patients, including potential drug interactions and stress factors that can elevate blood pressure.