A tooth extraction, while common, becomes complex when a patient has high blood pressure (hypertension). Since many adults manage this chronic condition, coordination between dental and medical care is often necessary. Dentists and oral surgeons must assess the stability of the patient’s cardiovascular health before proceeding. This caution ensures safety, as the stress of surgery can affect blood pressure and potentially lead to serious complications.
When Extraction Must Be Postponed
A dental professional measures the patient’s blood pressure immediately before any surgical procedure to establish a baseline. Mild to moderate hypertension generally does not prevent an extraction, especially if the condition is managed with medication. However, severe or uncontrolled hypertension presents a significant risk and requires medical stabilization first. The accepted threshold for postponing a procedure is a systolic reading of 180 mmHg or higher, or a diastolic reading of 110 mmHg or higher. Readings at or above this level signal a hypertensive urgency or crisis, necessitating immediate referral to a physician or emergency room.
Why Blood Pressure Matters During Surgery
The physiological stress of extraction can cause a temporary, significant surge in blood pressure, even in patients with controlled hypertension. This elevation places an increased load on the heart, and the combination of pre-existing high pressure and the acute spike increases the risk of a cardiac event. Elevated blood pressure also affects the surgical site by increasing pressure within blood vessels, which leads to excessive bleeding during and after the extraction. Furthermore, the fragile nature of blood vessels in patients with chronic hypertension makes them more susceptible to damage from sudden pressure changes, raising the risk of complications like stroke.
Preparation Steps Before the Procedure
Patients must provide the dentist with a complete medical history, including the specifics of their hypertension diagnosis and a list of all current medications and dosages. If blood pressure has been unstable recently, obtaining medical clearance from a primary care physician may be necessary to confirm fitness for the procedure. Patients must strictly adhere to their prescribed medication schedule on the day of the extraction, as skipping doses can cause a dangerous spike in blood pressure. Monitoring blood pressure at home in the days leading up to the appointment also provides valuable information to share with the dental team.
Anesthesia Choices and High Blood Pressure
The choice of local anesthetic is a specific consideration for patients with hypertension. Many common dental anesthetics include a vasoconstrictor, usually epinephrine, to prolong the numbing effect and reduce bleeding. Epinephrine works by constricting blood vessels, which can cause a temporary, small increase in heart rate and blood pressure. For patients with controlled hypertension, the small amount of epinephrine in a standard dental cartridge is generally safe, provided proper injection techniques are used. However, for those with uncontrolled hypertension, the dentist may choose an anesthetic formulation with a lower concentration of epinephrine or a non-epinephrine alternative.