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Hypertension and the Dental Patient

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    Hypertension is one of the most common diseases encountered in a dental practice. Nowadays hypertension affects almost one third of the population in the United States.  The biggest issue with this disease is the fact that many people are not aware of having it since it doesn’t always show symptoms. In a dental practice management includes recognizing the disease, correctly measuring the blood pressure, knowing about the treatment options and the adverse effects for the mouth. Hypertension is divided into primary and secondary hypertension.  Primary hypertension, also known as essential hypertension is recognized as a chronic medium to high blood pressure. Secondary hypertension is due to an organic cause.

Several studies have determined that hypertension is due to a complex interaction between genetic and environmental factors. Several of the predisposing factors are age, family history of cardiovascular disease, smoking, excessive alcohol consumption, sedentariness, cholesterol rich diets and co-occurrence with other diseases.  The treatment of hypertension includes more than just antihypertensive medication. One of the critical aspects of controlling blood pressure is to adopt a healthy lifestyle. A healthy lifestyle includes smoking cessation, moderate alcohol consumption, exercise, low sodium diet and losing weight for the overweight patients. Some of the antihypertensive medications to treat hypertension are thiazide diuretics, beta blockers, ACE inhibitors, calcium channel blockers, etc.  All these medications influence the oral environment.  The most common side effects are xerostomia, gingival hyperplasia, and lichenoid reactions.

            Xerostomia results in decay, difficulty chewing, swallowing and speaking, candidiasis and burning mouth syndrome. This side effect sometimes forces the physician to switch the medication and it is imperative of the dentist to find ways to alleviate this symptom. The dentist can advise the patient in different ways to stimulate salivary flow and to sip water frequently, to reduce the caffeine intake, to avoid alcohol and alcohol containing mouthwashes. In addition, the dentist can apply fluoride topically to protect the teeth surfaces from caries. Gingival hyperplasia is caused by calcium channel blockers and it is manifested by pain, gingival bleeding, and difficulty while chewing.  This can be reversed by switching to a different antihypertensive medication. Other side effects of antihypertensive medications are ageusia and dysgeusia.

            When a patient presents in the dental office with hypertension it is essential to obtain a detailed medical history that includes a family history of cardiovascular disease, hypertension, medications, duration of treatment and severity of the disease. It is important to always remember that patients with hypertension are at an increased risk of developing adverse effects in the dental office.  Blood pressure measurements should be done for every new patient for each visit.  Measuring the blood pressure routinely may reduce the event of complications during dental treatment.  It also important to take into consideration the “white coat hypertension”.  This results in a higher blood pressure reading in the office than if it were taken outside the office. This can either give the impression that the patient has high blood pressure when they don’t or can mask the underlying disease.