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WHAT IS IT?

The pressure caused by the bloodflowing in our arteries is calledblood pressure. Blood pressure ismeasured both when the heartbeats (systolic blood pressure) andwhen the heart is at rest (diastolicblood pressure), and hence referredto as two numbers. Blood pressureis measured in millimeters of mer-cury, or mmHg, indicating theamount of pressure required topush mercury up a gradated col-umn in a blood pressure measuringdevice. For a healthy adult, theblood pressure should not be higherthan 120/80mmHg. According tothe American Heart Association(http://www.americanheart.org),blood pressure that stays between120–139/80–89 is considered pre-hypertension, while a blood pres-sure of 140/90mmHg or higher isconsidered high blood pressure, orhypertension.

It is estimated that approximately60 million people in the UnitedStates have or are being treated forhypertension,1 and yet one-third ofthose with hypertension are notaware of it. That is why hyperten-sion is often referred to as the“silent killer,” as it can be fatalwhen not diagnosed and properlymanaged.

Risk factors for high blood pressureinclude obesity, excessive alcoholuse, excessive use of table salt, lackof exercise, and stress. Althougheveryone can be affected by thecondition, high blood pressure runsin families, and is more prevalent inAfrican-Americans than any otherethnic group. Also, the riskincreases with age and is greater inmen than in women.

HOW DOES IT AFFECT YOUR

ORAL HEALTH?

The single most important contri-bution of dental professionals tothe prevention of high blood pres-sure and its consequences is theconstant monitoring of patients’blood pressure to identify individu-als who might be hypertensive orprehypertensive. An accurate hyper-tension diagnosis can only be madeby a physician, but it is helpful tocheck the blood pressure in the den-tal office in every patient visit forall patients.

No elective dental treatment shouldbe rendered to patients with severe,persistent, or uncontrolled highblood pressure. Untreated pre-hypertensive and hypertensivepatients should be encouraged to dis-cuss the elevated high blood pressurereadings with their physician. Hyper-

High Blood Pressure and Oral HealthAndré V. Ritter, DDS, MS

Talking with Patients

tensive patients who are undergoingmedical treatment can receive dentaltreatment. Hypertensive patientswho are prescribed antihypertensivedrugs by their physician should taketheir blood pressure pills every day,including the day of the dentalappointment, not just when they feelsick or have a headache.

Dental appointments may be asso-ciated with stress and anxiety, andthis can further elevate the bloodpressure of hypertensive patients.Care should be exercised duringdental appointments to avoid twoserious consequences of uncon-trolled high blood pressure: cere-brovascular accidents (stroke) ormyocardial infarction (heartattack). The very anxious dentalpatient may benefit from the use ofantianxiety medications prior tostressful dental appointments.These can be prescribed by the den-tist or physician. Some dentists mayalso use nitrous oxide/oxygen(“laughing gas”) to relieve stressfrom dental appointments.

Hypertensive patients should avoidhigh doses of local anesthetic withvasoconstrictors, such as epineph-rine. Certain antihypertensive drugscan have side effects that affect oralhealth, such as dry mouth (which

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increases the risk for cavities),altered taste, gum overgrowth, andoral lesions. If you have been diag-nosed with and/or are being treatedfor hypertension, you should notifyyour dental care professionalsabout this medical condition, sothat they can properly manage yourdental care.

CONCLUSIONS

High blood pressure, or hyperten-sion, is the abnormal elevation of the

pressure inside of the body’s arteries.Hypertension can cause seriousorgan damage or be fatal when notproperly diagnosed and treated.Because the condition has no obvi-ous symptoms, many affected peoplemight not be aware of it. The onlyway of knowing whether or not youhave hypertension is to have yourblood pressure monitored regularly,and to consult with your physician ifyour blood pressure is often higherthan normal.

DISCLOSURE

The author does not have anyfinancial interest in the manufactur-ers whose materials are discussed inthis article.

R E F E R E N C E

1. Little JW, Fallace DA, Miller CS, Rhodus NL. Dental management of themedically compromised patient. 6th ed.St. Louis (MO): Mosby; 2002, pp. 64–78.

©2007 Blackwell Publishing, Inc.

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