Should blood pressures above 180/110 preclude elective dental treatment?

Goal: To validate the current recommendation that blood pressures (BP) recorded above 180/110 should preclude elective dental treatment. Objectives: 1. To retrospectively review charts of patients receiving emergent minor oral surgical treatment, to compare adverse cardiovascular events (ACE) in patients with normal and elevated BP. 2. To search the literature for additional risk factors to facilitate comprehensive patient risk assessment for ACE. Rationale: Comparing the occurrence of ACE in patients presenting with elevated and normal BPs for the management of dental emergencies would allow extrapolation of results to estimate the risk of rendering elective dental treatment to patients with elevated BP. Methods: 1. Retrospective chart review of patients treated for dental emergencies at the Hospital Dental Clinic, UMDNJ-The University Hospital. Data collected included patient age/sex, vitals, medical history, current medications, type and quantity of local anesthetic (LA) administered and complications, if any. 2. Review of PubMed literature to identify additional criteria for comprehensive risk assessment in patients requiring dental treatment. Results: Of the 3970 records evaluated, 635 patients reported history of hypertension. Over 300 patients had elevated baseline BP readings (>140/90 or SBP of >160), with 9 readings higher than 180/110. ACE occurred in two normotensive patients as well as in two hypertensive patients whose BP measurements corresponded to JNC7 Stages I and II, one of whom experienced angina and received sublingual nitrates. Conclusions: The occurrence of ACE did not correlate with increasing BP or LA usage. However, when observed, ACE occurred at BPs well below the recommended cutoff, indicating existence of additional risk factors. ACE appeared to be unrelated to BP in asymptomatic patients. Careful patient selection, taking individual metabolic reserve and medical history into consideration, rather than using a numerical cutoff as a guideline, would allow for safe elective dental treatment of patients with BP above 180/110.