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Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
Hypertension in exodontia  (2) /certified fixed orthodontic courses by Indian dental academy
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Hypertension in exodontia (2) /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

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  • 1. HYPERTENSION IN EXODONTIA www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3. CONTENTS           Definition Types Causes Signs Target organ diseases Investigation General Management Dental aspect of hypertension Conclusion References www.indiandentalacademy.com
  • 4.  Increase in blood pressure  It is a traitor opposed to a specific disease and represent a quantitative rather than a qualitative deviation from the norm, hence any definition is arbitrary www.indiandentalacademy.com
  • 5. Types Hypertension Essential Secondary www.indiandentalacademy.com White collar
  • 6. Causes Idiopathic Secondary www.indiandentalacademy.com
  • 7. Idiopathic  40-60% is genetic factor  High salt intake  Heavy consumption of alcohol  Obesity  Lack of exercise  Impaired intrauterine growth  Stress www.indiandentalacademy.com
  • 8. Secondary  Alcohol  Pregnancy  Renal disease – – – – – Renal artery disease Pyelonephritis Glomerulonephritis Polycystic disease Post trasnplant  Coarctation of aorta www.indiandentalacademy.com
  • 9. Secondary causes contd.  Endocrine disease – – – – –  Pheochromocytoma Cushings syndrome Acromegaly Thyrotoxicosis Hyperaldosteronism Cerebral disease – Cerebral oedema (stroke, head injuries & tumours)  Drugs – – – Oral contraceptives Streroids NSAIDS www.indiandentalacademy.com
  • 10. Signs  Paroxysmal headache  Palpitation  Sweating  Breathlessness  Angina www.indiandentalacademy.com
  • 11. Target organ disease Blood vessels Central nervous system Retina Heart Kidneys Malignant or accelerated phase hypertension www.indiandentalacademy.com
  • 12. Blood vessels Larger arteries Smaller arteries www.indiandentalacademy.com
  • 13. Larger arteries (Over 1mm in dia) ↓ Internal elastic lamina is thickened ↓ Smooth muscle hypertrophy ↓ Fibrous tissue is deposited ↓ Vessels dilate become tortous, walls become less compliant ↓ Aggravates hypertension by increasing peripheral vascular resistance ↓ Aortic aneurysm & dissection, coronary & cardiovascular disease, renal failure www.indiandentalacademy.com
  • 14. Smaller arteries ↓ Hyaline arteriosclerosis in the wall ↓ Lumen narrows ↓ aneurysm develops ↓ Aggravates hypertension by increasing peripheral vascular resistance ↓ Aortic aneurysm & dissection, coronary & cardiovascular disease, renal failure www.indiandentalacademy.com
  • 15. Central nervous system  Stroke due to cerebral hemorrhage or infarction  Carotid atheroma & transient cerebral ischemia attacks are common  Subarachnoid haemorrhage  Symptoms are – – – –  Disturbance of speech or vision Paraesthesia Disorientation Fits & loss of consiousness Neurologial deficit is usually reversible if the www.indiandentalacademy.com hypertension is controlled
  • 16. Retina  Central retinal vein thrombosis occurs  Micro aneurysm also occurs www.indiandentalacademy.com
  • 17. Heart High blood pressure Left ventricular hypertrophy (atrial fibrillation) www.indiandentalacademy.com Left ventricular failure
  • 18. Kidney  Proteinuria  Progressive renal failure by damaging the renal vasculature www.indiandentalacademy.com
  • 19. Malignant or accelerated phase hypertension  This rare condition may complicate hypertension of etiology and is characterized by damage with necrosis in the walls of small arteries & arterioles www.indiandentalacademy.com
  • 20. Investigations For all patients Selected patients www.indiandentalacademy.com
  • 21. Investigations for all patients  Urine analysis for blood, protein and glucose  Blood urea, electrolyte, and creatinine  Blood glucose  Serum total and high density lipoprotien  12 lead ECG www.indiandentalacademy.com
  • 22. Investigations for selected patients         Chest radiograph Ambulatory BP recording Echocardiogram Renal ultrasound Renal angiography Urinary catecholamines Urinary corstiol and dexamethasone supressing test Plasma renin activity and aldosterone www.indiandentalacademy.com
  • 23. Management Non-drug therapy www.indiandentalacademy.com Drug therapy
  • 24. Non drug therapy  Correct obesity  Reducing alcohol intake  Restricting salt intake  Regular physical exercise  Increasing consumption of fruits and vegetables  Quitting smoking  Eating oily fish www.indiandentalacademy.com
  • 25. Drug therapy  ß adrenoreceptor blockers – – – – – – –   Metaprolol (100-200mg/day) Bisoprolol (50-100mg/day) Atenolol(50-100mg/day) Labetalol (200-2.4g/day) Dry mouth Lichenoid reactions Paresthesia with labetalol – – – – – Contraindicated in asthma Avoid in heart failure/block Muscle weakness Lassitude Disturbed sleep www.indiandentalacademy.com Possible oral effects Other adverse effects
  • 26. Vasodilators  Prazosin (0.5-20mg/day)  Indoranmin (20-100mg/day)  Hydralazine (25-100mg/day)  Minxidil (10-50mg/day)  Adverse effects – Headache – Hypertrichosis – oedema www.indiandentalacademy.com
  • 27. ACE inhibitors – – – – – – – –   Captopril (25-75 mg/BD) Enalapril (20mg/day) Ramipril (5-10 mgdaily) Lisinopril (10-20 mg /day) Sinusitis Lichenoid reaction Loss of taste Burning sensation – – – – Sudden fall in bp Impair renal function Cough Angioedema Possible oral effects Adverse effects www.indiandentalacademy.com
  • 28. Calcium channel blockers – Nifidipine (30-90mg/day) – Verapamil (240mg/day)  Oral effects – Gingival hyperplasia – Salivation  Adverse effects – Headache and flushing – Swollen legs www.indiandentalacademy.com
  • 29. Dental aspects  Pre operative evaluation  Management guidelines www.indiandentalacademy.com
  • 30. Pre operative evaluation  Determine – – – –  Electrolyte Creatinine BUN Hypokalemia – – – – – Status of therapy Papilledema Retinal hemorrages Heart failure Cardiac enlarge maent Asses the complications www.indiandentalacademy.com
  • 31. Management guidelines  Untreated mild or moderate hypertension – – – Diastolic- 90-110 mg hg Bp should be monitored Medication should be used pre and post operatively  Controlled hypertnsion – Therapy should be maintained untill the night before surgery – Medication to be known to anaesthesiologist – Potassium preoperative to be given www.indiandentalacademy.com
  • 32.  Moderate to severe hypertension – – – – – Diastolic greater than 110mm hg Rapidly acting agents can be given Emergency- nitriprusside or nitroglycerine I.v methydopa or diazoxide Oral prazosin or clonidine www.indiandentalacademy.com
  • 33. General anesthesia  Contraindications – – – – Severe hypertension Cardiac failure Coronary / cerebral artery insufficiency Renal insufficieny  Best treated under LA  Diuretics should be stopped before surgery www.indiandentalacademy.com
  • 34. Conclusion www.indiandentalacademy.com
  • 35. References www.indiandentalacademy.com
  • 36. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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