HYPERTENSION IN
EXODONTIA

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INDIAN DENTAL ACADEMY
Leader in continuing dental
education
www.indiandentalacademy.com

www.indiandentalacademy.com
CONTENTS











Definition
Types
Causes
Signs
Target organ diseases
Investigation
General Management
Dental ...
 Increase in blood pressure

 It is a traitor opposed to a specific disease

and represent a quantitative rather than a
...
Types

Hypertension

Essential

Secondary

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White collar
Causes

Idiopathic

Secondary
www.indiandentalacademy.com
Idiopathic
 40-60% is genetic factor
 High salt intake
 Heavy consumption of alcohol
 Obesity
 Lack of exercise
 Imp...
Secondary
 Alcohol

 Pregnancy

 Renal disease

–
–
–
–
–

Renal artery disease
Pyelonephritis
Glomerulonephritis
Polyc...
Secondary causes contd.


Endocrine disease
–
–
–
–
–



Pheochromocytoma
Cushings syndrome
Acromegaly
Thyrotoxicosis
Hy...
Signs
 Paroxysmal headache
 Palpitation
 Sweating
 Breathlessness
 Angina

www.indiandentalacademy.com
Target organ disease
Blood vessels

Central nervous system
Retina
Heart
Kidneys
Malignant or
accelerated phase hypertensio...
Blood vessels

Larger arteries

Smaller arteries

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Larger arteries
(Over 1mm in dia)
↓
Internal elastic lamina is thickened
↓
Smooth muscle hypertrophy
↓
Fibrous tissue is d...
Smaller arteries
↓
Hyaline arteriosclerosis in the wall
↓
Lumen narrows
↓
aneurysm develops
↓
Aggravates hypertension by i...
Central nervous system



Stroke due to cerebral hemorrhage or infarction



Carotid atheroma & transient cerebral ische...
Retina
 Central retinal vein thrombosis occurs

 Micro aneurysm also occurs

www.indiandentalacademy.com
Heart
High blood pressure

Left ventricular hypertrophy
(atrial fibrillation)

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Left ventricul...
Kidney
 Proteinuria

 Progressive renal failure by damaging the

renal vasculature

www.indiandentalacademy.com
Malignant or accelerated phase
hypertension
 This rare condition may complicate

hypertension of etiology and is
characte...
Investigations

For all patients

Selected patients

www.indiandentalacademy.com
Investigations for all patients
 Urine analysis for blood, protein and

glucose
 Blood urea, electrolyte, and creatinine...
Investigations for selected patients









Chest radiograph
Ambulatory BP recording
Echocardiogram
Renal ultras...
Management

Non-drug therapy

www.indiandentalacademy.com

Drug therapy
Non drug therapy
 Correct obesity

 Reducing alcohol intake
 Restricting salt intake

 Regular physical exercise

 In...
Drug therapy


ß adrenoreceptor blockers
–
–
–
–
–
–
–





Metaprolol (100-200mg/day)
Bisoprolol (50-100mg/day)
Atenol...
Vasodilators
 Prazosin (0.5-20mg/day)
 Indoranmin (20-100mg/day)
 Hydralazine (25-100mg/day)
 Minxidil (10-50mg/day)
...
ACE inhibitors
–
–
–
–
–
–
–
–





Captopril (25-75 mg/BD)
Enalapril (20mg/day)
Ramipril (5-10 mgdaily)
Lisinopril (10-...
Calcium channel blockers
– Nifidipine (30-90mg/day)
– Verapamil (240mg/day)
 Oral effects

– Gingival hyperplasia
– Saliv...
Dental aspects
 Pre operative evaluation

 Management guidelines

www.indiandentalacademy.com
Pre operative evaluation


Determine
–
–
–
–



Electrolyte
Creatinine
BUN
Hypokalemia

–
–
–
–
–

Status of therapy
Pap...
Management guidelines
 Untreated mild or moderate hypertension

–
–
–

Diastolic- 90-110 mg hg
Bp should be monitored
Med...
 Moderate to severe hypertension

–
–
–
–
–

Diastolic greater than 110mm hg
Rapidly acting agents can be given
Emergency...
General anesthesia
 Contraindications

–
–
–
–

Severe hypertension
Cardiac failure
Coronary / cerebral artery insufficie...
Conclusion

www.indiandentalacademy.com
References

www.indiandentalacademy.com
Thank you
www.indiandentalacademy.com
Leader in continuing dental
education

www.indiandentalacademy.com
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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
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Hypertension in exodontia (2) /certified fixed orthodontic courses by Indian dental academy

  1. 1. HYPERTENSION IN EXODONTIA www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS           Definition Types Causes Signs Target organ diseases Investigation General Management Dental aspect of hypertension Conclusion References www.indiandentalacademy.com
  4. 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. 5. Types Hypertension Essential Secondary www.indiandentalacademy.com White collar
  6. 6. Causes Idiopathic Secondary www.indiandentalacademy.com
  7. 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. 8. Secondary  Alcohol  Pregnancy  Renal disease – – – – – Renal artery disease Pyelonephritis Glomerulonephritis Polycystic disease Post trasnplant  Coarctation of aorta www.indiandentalacademy.com
  9. 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. 10. Signs  Paroxysmal headache  Palpitation  Sweating  Breathlessness  Angina www.indiandentalacademy.com
  11. 11. Target organ disease Blood vessels Central nervous system Retina Heart Kidneys Malignant or accelerated phase hypertension www.indiandentalacademy.com
  12. 12. Blood vessels Larger arteries Smaller arteries www.indiandentalacademy.com
  13. 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. 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. 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. 16. Retina  Central retinal vein thrombosis occurs  Micro aneurysm also occurs www.indiandentalacademy.com
  17. 17. Heart High blood pressure Left ventricular hypertrophy (atrial fibrillation) www.indiandentalacademy.com Left ventricular failure
  18. 18. Kidney  Proteinuria  Progressive renal failure by damaging the renal vasculature www.indiandentalacademy.com
  19. 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. 20. Investigations For all patients Selected patients www.indiandentalacademy.com
  21. 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. 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. 23. Management Non-drug therapy www.indiandentalacademy.com Drug therapy
  24. 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. 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. 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. 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. 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. 29. Dental aspects  Pre operative evaluation  Management guidelines www.indiandentalacademy.com
  30. 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. 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. 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. 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. 34. Conclusion www.indiandentalacademy.com
  35. 35. References www.indiandentalacademy.com
  36. 36. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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