dental venue - Hypertension and Oral Health

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Hypertension

Approximately 25% of the adult population has high blood pressure (high blood pressure is defined as having a mean systolic bp of 140 mm Hg or greater, a diastolic bp of 90 mm Hg or greater, or use of a prescription anti-hypertensive medication).

Epinephrine use. Epinephrine is widely used as an additive in local anesthetics (usually in extremely small concentrations of 1:100,000) to improve the localization and duration of the anesthesia, as well as to reduce bleeding in the operative field.

Controversy. Despite these benefits, the clinical impact of cardiovascular changes caused by the introduction of external epinephrine makes its use among patients with high blood pressure a controversial subject.

Hypertension Risks

The added risks attributed to the use of epinephrine in hypertensive patients include:

Higher probability of acute hypertensive crisis (dangerously high BP)
Angina pectoris (chest pain)
Myocardial infarction (heart attack)
Cardiac arrthymias (your heart skips a beat)

Classifications of Hypertension

Category

Systolic

Diastolic

Normal

<130 mm Hg

<85 mm Hg

High Normal

130-139 mm Hg

85-89 mm Hg

Hypertension

>140 mm Hg

>90 mm Hg

Stage 1 - mild

140-159 mm Hg

90-99 mm Hg

Stage 2 - moderate

160-179 mm Hg

100-109 mm Hg

Stage 3 - severe

180-209 mm Hg

110-119 mm Hg

Stage 4 - severe +

>210 mm Hg

>120 mm Hg

*adults (> 18 years of age)

Recommendation

Most recommendations advise caution in using local anesthetics with epinephrine in patients with hypertension.

Some authors indicate that epinephrine should not be used in patients whose hypertension is controlled, but who are taking medications with known epinephrine interactions; other authors indicate that epinephrine use is acceptable with appropriate precautions and monitoring. Opinion is also divided about the use of epinephrine in patients whose hypertension is uncontrolled, with some authors cautioning against it, while others indicate that this practice is appropriate in most instances.

Note: It is important to note that before beginning any course of treatment you should see your dentist. Please note that without the benefit of a full dental examination, including a review of medical history, dental x-rays, and diagnostic aids, no attempt can be made to provide specific diagnosis or recommended courses of treatment. However, we will be happy to update our site to include topics you feel deserve mention. contact us