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Management of Patients with Chronic Diseases

Course Number: 567


Elevated arterial blood pressure (high blood pressure) that over time can damage organs such as the heart and kidneys.49 The disease is referred to as the “silent killer” because often there are no warning signs and people are unaware they have the condition.57 The only way to identify hypertension is by measuring blood pressure. The American Heart and Stroke Association blood pressure guidelines are in Figure 14.58

Chart showing blood pressure categories with accompanying systolic and diastolic values.

Figure 14. Blood Pressure Guidelines.58

Epidemiology and Etiology

Hypertension affects 1 out of 3 adults living in the United States.57 It is a primary or contributing cause in many deaths.59 Health conditions such as diabetes and kidney disease, an unhealthy diet, lack of physical activity, obesity, too much alcohol, tobacco use, and family history increase a person’s risk for developing this condition. Figure 15 lists additional hypertension statistics.

Figure 15. Hypertension Statistics.57,59

  • Hypertension is a primary or contributing cause of more than a half a million deaths yearly
  • Hypertension is present in 7 out of 10 people who have their first heart attack
  • Hypertension is present in 8 out of 10 people who have their first stroke
  • In adults with hypertension, 35% are unaware they have the disease
  • Hypertension is a major risk factor for cardiovascular disease and stroke

Patient Management and Oral Health Considerations for Hypertension

When providing care to patients diagnosed with hypertension, dental providers should assess the patient’s risk for complications before providing any dental care. The risk for most patients who are having routine treatment is very low. Items to consider include severity of the disease, type and magnitude of dental procedure, and patient stability.49 Patients who have uncontrolled high blood pressure (≥ 180/110 mm Hg) are at high risk for complications. Elective care should be postponed.49 A consultation with the patient’s physician is recommended. Short stress-free appointments scheduled in the morning reduce the risk for complications. Dental providers may administer nitrous oxide with oxygen and oral premedication with a short-acting benzodiazepine to reduce stress. Orthostatic hypertension may be caused by antihypertensive agents. Dental providers need to avoid sudden changes with the patient chair and when treatment is finished return the chair slowly to an upright position.49 They should also avoid placing a retraction cord impregnated with epinephrine.

Effective pain control during the procedure and post-operative will reduce stress and the risk for complications. Topical vasoconstrictors are not recommended. Local anesthesia should have a limited amount of vasoconstrictor (epinephrine). If a vasoconstrictor is necessary, patients can be safely given 2 cartridges of anesthesia with epinephrine 1:100,000 (0.036 mg). Intravascular injections should be avoided. It is very important to effectively aspirate before depositing any anesthesia.49

There are no oral manifestations that are the direct result of hypertension. Medications used to treat hypertension may produce xerostomia, lichenoid mucosal lesions, burning mouth, delayed healing, and gingival bleeding. Gingival hyperplasia may be present in patients who are taking a calcium channel blocker. Oral lesions may be present in patients who have an allergic reaction to mercurial diuretics.49