Advanced Education In General Dentistry

Patient Case: Hypertension

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L.N. is a 58 year old man referred to the Oral Surgery Clinic for emergency extraction of a lower molar. The patient has not seen a dentist for more than 15 years because of severe anxiety and desired sedation for this extraction. Vitals on presentation: BP 158/90 Pulse 88 Resp 14/min

PMHx: Hypertension, Hypercholesterolemia, Reflux
Medications: Lasix, Norvasc, Atenolol, Zocor, Protonix
No Known Drug Allergies

Questions For The Patient

  1. How well controlled is your blood pressure? What is your normal blood pressure?
  2. What medications are you taking?
  3. Did you take your medications today?
  4. Has your physician changed you medications recently? Why?

Implications For Sedation

Severe hypertension SBP > 200 or DBP >110 is a contraindication to continue with a dental procedure. Patients in this category should be referred directly to the nearest emergency room. Elective procedures should also be postponed for patients with high-moderate hypertension and they should be referred to their primary care physician for medication adjustment and stabilization of blood pressure prior to undergoing the procedure. Sedating patients with moderate hypertension will likely lower their blood pressure secondary to the anxiolytic effects of benzodiazapines. Diuretics should not be taken prior to the procedure since this with induce hypovolemia in a patient that is NPO. Remember if a patient has hypertension, consider that the patient may have other cardiac problems.

Summary Of Treatment

  1. Monitor Vitals
  2. Supplemental Oxygen
  3. Sedation
  4. Instruct patient not to take Diuretics prior to procedure
  5. Cancel procedure if BP uncontrolled and refer

<<Back to "Clinical Assessment and Guidelines: Special Cases to Consider"