The relation between high blood pressure and dental treatments is something which every person should know before visiting his or her dentist. It becomes even more important when the person is suffering from high blood pressure from a very long time.
Below, we have given certain important points that establish the relationship between high blood pressure and dental treatments and how to manage them.
Why Does The Dentist Measure Your Blood Pressure?
High blood pressure is one of the most common diseases which is encountered in the day to day practice by the dentist.
A person is known to be suffering from high blood pressure when his/her systolic blood pressure is above 140mm Hg and his/her diastolic blood pressure is 90mm Hg.
A very high blood pressure usually has significant oral adverse effects and associated risks in dental treatments.
If a person suffering from high blood pressure undergoes tooth extraction, stopping the bleeding post extraction may become very difficult.
Even if the bleeding is stopped with suturing and other techniques, there are chances of reactionary or secondary bleeding. Also, wound healing (the wound caused by tooth removal) may take a longer time.
Excessive bleeding may also put unnecessary load on the person’s cardiovascular system or the heart, which may render the patient unconscious.
This is just an example.
It doesn’t mean that every high blood pressure patient who undergoes dental treatments will have the same consequences as this one. But it’s definitely a possibility.
Similarly, there are many other complications related to hypertension. And that’s why your dentist measures the blood pressure prior to the dental treatment.
What Is The Maximum Blood Pressure A Patient Can Have To Undergo Dental Treatments?
180/110 mmHg has been set as the highest upper limit for dental treatments. But this is only the case if the person is already undergoing treatment for high blood pressure and doesn’t have any history of previous emergencies or organ damage.
If the patient is a known high-risk patient who has the history of earlier end-organ damage or similar occurrences, the treatment will most probably be postponed.
If the patient is having such high blood pressure levels the dentist will most probably keep the treatments limited to minor or nonsurgical procedures. The dentist will most probably avoid extractions and other surgical procedures at this BP level.
Most Common Problems Associated With High Blood Pressure and Dental Treatments
Bleeding In Dental Treatments
As mentioned earlier, bleeding is the most common complication of uncontrolled high blood pressure. This may be also a result of antihypertensive medication that the patient is taking.
Many hypertensive patients are prescribed anticoagulants and blood thinning agents by their doctor’s as a part of the antihypertensive treatment plan. Such medications especially Aspirin can cause profuse bleeding during oral operative procedures especially tooth extraction.
If in case such an emergency occurs, the dentist usually controls the bleeding by applying local pressure to the bleeding area, suturing or by applying vasoconstrictors. The local anesthesia used for dental procedures can act as a potent vasoconstrictor because of the presence of Adrenaline in it.
The vasoconstrictor is an agent that causes the constriction or narrowing of blood vessels thereby causing the stoppage of bleeding.
Other methods of controlling the bleeding caused by high blood pressure during dental treatments are
- Using the chitosan-based products,
- Using bone wax,
- Applying fibrin sealants,
- Using epsilon-aminocaproic acid,
- Using tranexamic acid,
- Using oxidized cellulose,
- Applying aluminum chloride,
- Utilizing ferric sulfate,
- Applying Aluminum potassium sulfate,
- Using Zinc chloride, Trichloroacetic acid, and Tannic acid,
- Utilizing cordless retraction techniques
Hypertensive crisis is the name given to the condition where there is a severe increase in blood pressure which can lead to health complications, especially stroke.
This is not a very common complication encountered in dental clinics, but it does happen.
When the systolic blood pressure or the top number is above 180 mmHg and the diastolic or the bottom number is above 120 mmHg, it can cause damage to the blood vessels and end organs.
Here are the signs and symptoms of hypertensive crisis. You should inform the dentist immediately if you are suffering from one or more of the following symptoms.
- Severe chest pain
- A severe headache
- Confusion and vomiting sensation
- Breathlessness or shortness of breath
- Blurred vision
If you are suffering from one or more of the following symptoms contact your physician immediately.
This condition may require hospitalization.
Vasoconstrictors and High Blood Pressure
Adrenaline a potent vasoconstrictor is an important component of the local anesthesia agents used in dental treatments.
If a person is suffering from hypertension, the usage of adrenaline may cause a further increase in the blood pressure due to its vasoconstrictor action. It may also increase the heart rate temporarily.
This, in turn, may increase the load on the heart.
That’s why informing your dentist about the existing hypertension is important.
Antihypertensive Drugs and The Complications in Dental Procedures
Now, there are many drugs used in the treatment of high blood pressure that doesn’t go very well with some dental procedures. And here are the complications they may cause.
Dryness of Mouth
Dryness of mouth medically termed as Xerostomia is a condition characterized by a partial or a complete absence of saliva in the mouth.
Many drugs used in the treatment of high blood pressure are known to cause Xerostomia.
Xerostomia may, in turn, cause tooth decay, oral infections, gum diseases etc.
The antihypertensive drugs that are known to cause dryness of the mouth are
- ACE Inhibitors
- Thiazide diuretics
- Loop diuretics
Many antihypertensive drugs have the tendency to react with the local anesthetic agents and some analgesics. Especially the non-selective beta blockers are known to cause drug interactions.
Here are some of the most common drug interactions that take place when a patient taking antihypertensive medication undergoes dental treatments.
Drug interactions with NSAIDs
The prolonged use of some NSAIDs may interfere with the antihypertensive action of drugs like diuretics, alpha and beta blockers, ACE inhibitors, vasodilators etc.
Non-selective beta blockers used as antihypertensive medication can exaggerate the effect and response of adrenaline used in the local anesthetic agent. This may cause complications related to the cardiovascular system.
In some rare cases, the same non-selective beta blockers have caused LA toxicity because of the drug interaction with the components of the local anesthetic agents.
Lichenoid reaction is a term given to the lesion which is similar to Lichen planus. These lesions histopathologically and clinically resemble lichen planus when seen with the naked eye as well as under a microscope.
Certain medications and some dental materials are known to cause such Lichenoid Reactions.
There are many antihypertensive medications that are linked with oral lichenoid reactions.
These drugs are as follows.
- Thiazide diuretics
If the dentist notices such a lesion in the mouth of a known hypertensive patient he may consult the physician and request him to change the antihypertensive medication. If that doesn’t solve the problem corticosteroids can be used topically.
Gingival Enlargement or Gum Enlargement
Gingival enlargement, also known as Gingival overgrowth or Gingival hyperplasia, simply means the increase in the size of the gums or Gingiva. This overgrowth is mostly pathological and is the most common symptom of gingival disease.
But what we are interested here is the drug-induced gingival hyperplasia.
Antihypertensive drugs especially the calcium channel blockers are known to cause gum enlargement. Nifedipine is a known culprit.
Gingival enlargement is mainly associated with bleeding gums, pain in the gums and difficulty while eating, especially while chewing or masticating.
An improved oral hygiene can bring back the gingiva to its normal state, fast.
The drug-induced gum enlargement is mainly associated with the dosage of these antihypertensive drugs. The dentist may consult with the physician and alter the dose or replace the medication completely if possible. Doing this will cure the problem of drug-induced Gingival enlargement.