TAMPA — A few years ago, Mearlin Griffin was at her dentist's office, all set to have a tooth extracted.
"I was sitting in the chair and before they numbed me up they took my blood pressure," she recalled. "I was shocked that it was high. Too high."
She felt fine, but accepted her periodontist's recommendation that she get her blood pressure resolved before having the tooth pulled.
Many people think dentists are only interested in teeth and gums. The idea of a dentist asking about blood pressure and medical history may surprise some.
But the state of your mouth can say a lot about your general health. Oral problems like plaque can affect the rest of your body. Medications like diuretics and antihistamines that dry out your mouth can lead to dental problems. Diseases like diabetes that lower resistance to infection can affect dental health.
What's the big deal with blood pressure?
For starters, it's known as the "silent killer" because lots of people don't even know they have it. The U.S. Centers for Disease Control estimates about 30 percent of us have high blood pressure, yet fewer than half have it under control with diet, exercise and medications.
Let's say, like Griffin, you're having a tooth pulled. The local anesthetic used to block pain and control bleeding often contains epinephrine, a drug that may also cause a rapid rise in heart rate. If your blood pressure is already high, epinephrine might put you at risk for a heart attack.
Dr. Terry Bruckenheimer, president of the Florida Dental Association, says questions about medications should be routine at all dental visits. "The bigger and the longer the procedure, the more likely you are to have your blood pressure taken, too," said Bruckenheimer, who practices general dentistry in Tampa.
And your dentist wants to know about over-the-counter medications as much as the prescription drugs you take.
If you're having multiple teeth pulled or implants placed, your dentist needs to know if you are on blood thinners, such as Coumadin, or even an over-the-counter pain reliever, since they, too, can lead to excessive bleeding during and after the procedure.
"I can't imagine not taking blood pressure," said Dr. Patrick Johnson, president of the Hillsborough County Dental Association and a periodontist in Tampa who takes care of Griffin. Sometimes he uncovers undiagnosed hypertension, and sometimes his findings provide the nudge a patient needs to begin taking their blood pressure seriously.
When he told Griffin her pressure was up, she was surprised, in no small part because she already was taking blood pressure medication.
She called her physician, who adjusted her medication. The following week, she had the extraction in Johnson's office.
How high is too high when it comes to dental procedures? Bruckenheimer says there is no formal policy, but most dentists follow American Heart Association guidelines, which call for a blood pressure below 120/80. But he points out that slightly elevated blood pressure or prehypertension — in the range of 120-139 over 80-90 — wouldn't "cause problems with dental procedures and anesthesia."
Also, he noted, sometimes blood pressure is elevated because of an oral infection. "Removal of an infected tooth and/or abscess will most likely allow blood pressure to get back to normal, especially if it's causing pain," he said. "So judgment is required to weigh the pros and cons."
For patients with unpredictable heart conditions like unstable angina or chest pain, a dental procedure may have to be done in a hospital or office that has cardiac monitoring equipment. All dentists in Florida are required to have a working automated external defibrillator, or AED, to revive patients who go into cardiac arrest.
If the dental procedure can't wait for blood pressure to be brought under control, sometimes another anesthesia can be substituted. "If I have somebody we know has heart issues, we can choose an anesthetic that doesn't have epinephrine," Johnson said. "It may not begin working as quickly or last as long, but we can adjust for that and still have a successful procedure."
Postponements due to a patient's blood pressure are rare. In almost 20 years, Johnson has had to postpone perhaps five procedures. Bruckenheimer has seen it happen about 10 times in 34 years.
"The purpose is not to turn people away," Bruckenheimer said, "it's to make the procedure as safe as possible."