2. Hypertension
⚫ also known as high blood pressure
⚫ is a long term medical condition in which
the blood pressure in the arteries is
persistently elevated
⚫major risk factor for coronary artery
disease, stroke, heart failure, peripheral
vascular disease, vision loss, and chronic
kidney disease
4. Hypertension
⚫Signs and Symptoms of Hypertension
⚫ headaches (particularly at the back of the
head and in the morning)
⚫Lightheadedness
⚫Vertigo
⚫tinnitus (buzzing or hissing in the ears)
⚫altered vision or fainting episodes
⚫Pre-eclampsia (pregnant women during
delivery)
⚫Failure to thrive, seizures, irritability, lack of
energy, and difficulty in breathing (children)
8. ⚫ During appointment
⚫Non-pharmacological means of anxiety control
⚫Frequent verbal reassurances
⚫Distracting conversation
⚫No surprises (Dentist warns patients before
doing anything that could cause anxiety)
⚫No unnecessary noise
⚫Surgical instruments out of patient’s sight
⚫Relaxing background music
⚫Pharmacological means of anxiety control
⚫Local anesthetics of sufficient intensity and
duration
⚫Nitrous oxide
⚫Intravenous anxiolytics
9. ⚫After Surgery
⚫Succinct instructions for postoperative care
⚫Patient information on expected postsurgical
sequelae (e.g, swelling or minor oozing of
blood)
⚫Further reassurance
⚫Effective analgesics
⚫Patient information on who can be
contacted if any problem arise
⚫Telephone call to patient at home during
evening after surgery to check whether any
problems exist
10. ⚫Monitor vital signs closely.
⚫Take patient’s BP
⚫ pre-op
⚫ q15 during the procedure
⚫ post-op
⚫Perform procedure in hospital
environment
⚫Limitation of amount of epinephrine up
to 0.04mg
⚫Communicate with patient post-
operatively.
11. Case report
⚫This is a case of a 52y/o female patient
(assessed with hypertension) who went to
CEU School of Dentistry last Feb. 24, 2017
for removal of soft and hard calcular
deposits.
⚫Chief complaint:
“Nagdudugo ang gilagid ko pag
nagsisipilyo” (gingival bleeding during
toothbrushing).
12. Case report
⚫ Hx of Present Illness
⚫5 years PTC, patient noticed that her gingiva is
bleeding that last for 2-3minutes when she
brushes her teeth. Patient gargled warm water
with salt to control the bleeding. Patient didnt
seek any dental consultation.
⚫4 months PTC, patient noticed again gingival
bleeding. Patient did the same management but
took her longer time to control the bleeding.
Patient seek dental consultation and underwent
oral prophylaxis.
⚫2 weeks PTC, (+)gingival bleeding, (+) dull pain
upon eating (2mins).
⚫Upon consultation, (-)gingival bleeding, (+)
gingival recession, (+) pocket depth, (-) pain
13. Case report
⚫Medical Hx
⚫Hypertension last 2005 at Fabella Hospital
⚫Medications: Losartan 50mg od,
Amilodipine 60mg od
⚫Patient denies further knowledge of having
any other systemic diseases.
⚫Dental Hx
⚫Last dental visit: Feb. 24, 2017 (dental check-
up)
⚫(+) extraction experience, (-) dentures
⚫3x/day frequency of brushing
14. Case report
⚫Family Hx
⚫Mother – none
⚫Father - Hypertension
⚫Social Hx
⚫Roman catholic
⚫married
⚫(-)smoking, (-)alcohol drinking
⚫(-) illicit drug use
⚫Patient is coherent, conscious and
ambulatory
22. Case report
⚫Tooth Number 15
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫Tooth Number 14
⚫same with 15
⚫apical
radiolucency
23. Case report
⚫Tooth number 13
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
24. Case report
⚫Tooth Number 12
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫Tooth number 11
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
25. Case Report
⚫Tooth number 21
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫(+) deposits
⚫Tooth number 22
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
26. Case report
⚫Tooth number 23
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫Tooth number 24
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
27. Case report
⚫Tooth number 25
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫Apical radiolucency
⚫Tooth number 26
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
28. Case report
⚫Tooth number 35
and 34
⚫Vertical bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
29. Case report
⚫Tooth number 33
⚫Vertical bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫(+)deposits
31. Case report
⚫Tooth Number 43
and 44
⚫Horizontal bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫(+)deposits
32. ⚫Tooth Number 47
⚫Vertical bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫Furcation
radiolucency
⚫(+)deposits
33. Case report
⚫Tooth number 48
⚫Vertical bone
resorption
⚫Discontinuity of
lamina dura
⚫Widening of
periodontal
ligament space
⚫(+)deposits
36. Case report
⚫ Assessment
⚫Mild Generalized Chronic Periodontitis
⚫ Plan
⚫Patient education
⚫Supragingival scaling
⚫Subgingival scaling and root planing under LA
using 2% lidocaine HCl with 1:100,000
epinephrine (to be done once clearance from
physician secured)
⚫(Re-evaluation for possible periodontal surgery)
⚫Extraction of 4 teeth
⚫Restoration of all indicated teeth
⚫Fabrication of prosthesis
⚫Recall after 1month for possible re-scaling
38. Case Report
⚫Medical clearance by Dr.Eduardo R.
Figueroa last Feb.28,2017 from Kawit,
Cavite with a diagnosis of
Hypertension(Controlled).
⚫Prepare instruments for SRP Non-surgical
39. Case Report
⚫Non-surgical SRP(right) under LA using 2%
lidocaine HCl with 1:100,000 epinephrine
last March. 1, 2017 at CEU School of
Dentistry Graduate School
