The practice of taking a patient’s blood pressure (BP) during a routine dental visit is a standard safety procedure. This simple, non-invasive measurement provides the dental team with immediate insight into a patient’s current cardiovascular stability before any treatment begins. The BP check establishes a baseline for monitoring potential complications and confirms that the dental environment and necessary medications will not pose an undue threat to the patient’s health.
Identifying Undiagnosed or Uncontrolled Hypertension
Many individuals who have high blood pressure, known as hypertension, are completely unaware of their condition because it often presents without obvious symptoms. Hypertension has earned the nickname “the silent killer” because it can progress without detection, increasing the risk of cardiovascular events like stroke or heart attack. Since many people visit their dentist more frequently than their primary care physician, the dental office serves as a valuable screening point for this common health concern.
Checking blood pressure allows the dental team to identify patients with undiagnosed or poorly controlled hypertension. Studies show that a significant percentage of patients presenting for dental care who have elevated readings were unaware of their status. By detecting these elevated readings, the dental professional can refer the patient to their physician for appropriate medical management, potentially leading to life-saving treatment.
The Interaction Between Dental Procedures and Blood Pressure
Beyond screening for pre-existing conditions, the dental setting itself can dynamically affect a patient’s blood pressure. Anxiety and stress, sometimes referred to as “white coat syndrome,” can cause an acute, temporary spike in readings, even in patients who are normally well-controlled. This acute elevation is a physiological response to fear or pain, which naturally increases the risk of complications during treatment.
The use of local anesthetics containing a vasoconstrictor, most commonly epinephrine, is a specific concern. Epinephrine is added to prolong the anesthetic effect and reduce bleeding, but it is a potent stimulator of the cardiovascular system. For patients with high or uncontrolled blood pressure, the introduction of this substance can cause a further increase in blood pressure and heart rate. A precautionary reading is necessary to prevent a dangerous rise, even though the amount of epinephrine in dental cartridges is small.
Treatment Protocols Based on Readings
The blood pressure reading directly influences the decision to proceed with dental treatment. Dental professionals utilize classification systems, often guided by American Heart Association (AHA) and American College of Cardiology (ACC) guidelines, to categorize the patient’s risk. A reading below 120/80 mm Hg is considered normal, allowing for routine care without modification. Readings categorized as Elevated (120–129/<80 mm Hg) or Stage 1 Hypertension (130–139 or 80–89 mm Hg) generally allow the procedure to continue, but warrant a discussion about medical follow-up. When a patient presents with Stage 2 Hypertension (systolic pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher), the dentist typically proceeds with caution. They often recommend a medical consultation before elective procedures. The absolute threshold for deferring all elective dental treatment is generally a systolic pressure greater than 180 mm Hg or a diastolic pressure greater than 110 mm Hg. At this level, the risk of a serious cardiovascular event, such as a hypertensive crisis, is significantly increased. If a patient presents with a severe elevation and symptoms like chest pain or shortness of breath, they are immediately referred for urgent medical evaluation. Significant readings are communicated back to the patient's physician to ensure continuity of care.