International governing bodies of dentistry have actively recommended measuring patient blood pressure, since at least 1998. This practice has allowed uncovering undetected hypertension and possibly safeguarding against cardiac events during outpatient surgeries. This recommendation is logical, given that it’s estimated that 45% of the US adult population has hypertension. Based on the body of current scientific evidence, how can we manage patients with varying levels of hypertension in the dental setting?
Current Protocol
Its recommended that a blood pressure reading of 130/80 mm Hg or less is optimal, and any reading above 180/110 mm Hg should be cancelled (with referral to a primary care physician for evaluation).
Current scientific findings
Patient with stage 1 or 2 hypertension:
- Limited to 3 carpules, Lidocaine 2% with 1:100k epinephrine administered, as local injection does not show any significant effect on systolic or diastolic blood pressure. This was observed in a randomized study.
- Articaine 4% with 1:200K epinephrine administered as local injection does not show any significant effect on systolic or diastolic blood pressure. This was observed in a randomized study.
- There is no current literature evidence showing that a patient with hypertension indicates an increased patient risk when performing minor surgery (oral or dental surgery) in an outpatient environment.
2014 American College of Cardiology/ American Heart Association Guideline on Preoperative Cardiovascular Evaluation and Management of Patient Undergoing Noncardiac Surgery:
- When a patient with cardiac disease is medically optimized and has no cardiac symptoms (headache, chest pain, or vision changes), no further evaluation is required before initiating low risk surgery such as a tooth extraction.
Conclusions:
Preoperative blood pressure reading less than 180/110 mm Hg without any cardiac symptoms does not indicate cancelling a dental appointment.
Any patient with a blood pressure reading above 180/110 mm Hg needs referral to primary care provider for evaluation of their hypertension. The practitioner should consider potential benefits versus risk of delaying urgent dental care.