Table 3.80.

Key considerations for dental management in hypertension (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2/3	Influenced by hypertension severity
Pain and anxiety control
– Local anaesthesia	2	Caution with epinephrine and lidocaine
– Conscious sedation	1	Avoid opioids
– General anaesthesia	3–5	Hypotension; rebound hypertension; arrhythmias; avoid barbiturates, opioids, muscle relaxants, halothane and isofluorane
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	Late morning
– Patient positioning	1	Postural hypotension
Treatment modification
– Oral surgery	2
– Implantology	2
– Conservative/Endodontics	2
– Fixed prosthetics	2	Avoid gingival retraction cords containing epinephrine
– Removable prosthetics	1
– Non-surgical periodontology	2
– Surgical periodontology	2
Hazardous and contraindicated drugs	2	Avoid indometacin, steroids, ibuprofen and naproxen; some patients are on aspirin

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.