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.