High Blood Pressure – Oral Health Implications

What Is Hypertension?

Hypertension is the term used to describe high blood pressure (Medline Plus 2011).

In today’s society, high blood pressure is the most common problem managed by general practitioners. The prevalence of hypertension indicates that 3.7 million Australians over the age of 25 have high blood pressure, or are on medication for the condition, which is 32% of men and 27% of women (AIHW 2011). One third of individuals affected by the disease are unaware of its presence, hence why hypertension is referred to as the ‘silent killer’ due to its asymptomatic manner (Little 1997).

What is Blood Pressure?

Blood pressure is a measurement of the force against the walls of the arteries as the heart contracts and pumps blood around the body (Tortora & Derrickson 2009). Blood pressure readings are given as two measurements; systolic and diastolic pressure. Systolic pressure corresponds to the pressure in the arteries when the heart contracts and pumps blood forward into the arteries. Diastolic pressure represents the pressure in the arteries as the heart relaxes after contracting and as it fills up with blood again (MedicineNet.com 2011).

Symptoms of Hypertension

For most individuals there are no symptoms of hypertension and most cases are found out when visiting a health care provider. Due to there being no symptoms, most patients will not know they have high blood pressure and can develop heart disease and kidney problems without knowing so straight away (Medline Plus 2011).

Patients with severe hypertension, known as ‘Malignant Hypertension’ can often experience:

– Severe headaches

– Nausea/Vomiting

– Confusion

– Changes in vision

– Nosebleeds

– Chest Pains (PubMed Health 2011 & AIHW 2011).

Effects on Oral Health

Often medications that are used to treat hypertension (anti-hypertensive medications) can have effects on the oral environment. Some may cause patients to experience dry mouth, also known as Xerostomia (Colgate 2011). Xerostomia may result in gingivitis, periodontal disease or due to erosion, loss of tooth structure (Bartels C, 2000). Overtime if left untreated, Xerostomia will lower the pH within the oral cavity, which will increase the development of plaque and therefor dental caries (Bartels C, 2000).

An altered sense of taste (Dysgeusia) is another effect hypertension medications may have on the oral cavity as well as some others may make patients more likely to faint when raised in a dental chair too quickly, which is a reaction known as Orthostatic Hypotension (Colgate 2011).

Gingival overgrowth (Gingival Hyperplasia) is another possible side-effect of medications used to treat high blood pressure, for example, Calcium channel blockers can often have this effect (Colgate 2011). Some patients will have to undergo gingival surgery to remove some of the gingiva, but quite often it will just grow back. The gingiva are very difficult to look after when experiencing this overgrowth, as plaque can easily get trapped underneath and as they are often quite sore, it is difficult to brush and therefore maintain good oral health (Colgate 2011).

Example of drymouth (Xerostomia):

(Exodontia.Info 2011)

Examples of gingival hyperplasia:

(Clocheret, Dekeyser, Carels & Willems 2003)(YGo Dentist 2009)

At the Dentist

Patients with high blood pressure should have their dentist check their blood pressure at each visit. Depending on how high the blood pressure is, how well it is controlled and whether the patient has any other medical conditions, the dentist can decide whether or not it is safe for non-emergency treatment to be completed (Colgate 2011).

Most people suffering from hypertension can safely take anti-anxiety medications, such as Nitrous Oxide or Valium, and can also safely receive local anaesthetics for dental procedures. It is extremely important that dental professionals know which medications a patient with hypertension is on at every dental visit (Colgate 2011).

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