PATIENT MANAGEMENT- HIGH BLOOD PRESSURE

Question 1

OS - Given PAN with no lower teeth, a few upper teeth and 14-12 is a bridge, 13 pontic. Complain of pain.
I/O: 14 and 12 carious, TTP; 12 has gingival swelling with pus exudation.
MH: On antihypertensive medication, allergy to “acetaminophen”, gastric pain

FSH: Heavy smoker (10 a day), social drinker

a. Would you perform any dental procedures? Why? What precautions to take? (3)

Answer 1

• Yes. Patient with well controlled hypertension or with stage 1 hypertension (SP: 140 - 159 mmHg, DP: 90 - 99 mmHg) are good candidates for ALL dental procedures
• Stage 2 (SP: 160 - 179 mmHg, DP: 100 - 109 mmHg), all treatment is OK if no other risk factors, only urgent treatment if any other risk factors
• Stage 3 (SP > 180 mmHg, DP > 110 mmHg) is not suitable for all dental treatment and require physician referral
• Other risk factors include history of MI, uncontrolled angina pectoris, DM, recurrent stroke are needed to be considered
• Limit use of adrenaline → although research conclude the use of adrenaline in LA resulted in infrequent adverse outcomes, it is widely recommended that:
  
  • 2 to 3 cartridges of lidocaine with 1:100000 adr is safe
  • Use of retraction cord containing adrenaline should be avoided
• Reduce anxiety of patient
  
  • Clear explanation and use of nitrous oxide for sedation or anxiolytics
• Monitoring BP before treatment or intraoperatively if prolonged
• Consult physician
• Avoid possible drug interaction with antihypertensive
  
  • NSAID decrease the antihypertensive effect since inhibition of renal prostaglandin synthesis –> decrease renal perfusion, thus increase water and sodium retention
• All from JADA 2004. New national guidelines on hypertension