Local Anesthesia with or without Vasoconstrictor in Hypertensive and Diabetic Patients João Vitor da Silva Rodrigues; Luciane Dias de Oliveira, Ph.D.; Simone Lapena; Letícia de Miguel Nazario; Taís Maria Cardoso de Oliveira; Alessandra Buhler Borges, Ph.D.; Regina El Dib, Ph.D.
ABSTRACT Hypertensive and diabetic patients present a public health issue. Vasoconstrictors have been added to local anesthetics to increase the length of the anesthetic effect during dental procedures. However, there is no consensus showing whether local anesthetic is safer with or without vasoconstrictors in this population. This paper is a systematic review of the literature, undertaken to investigate the systemic effects resulting from the use of any local anesthetic with either adrenergic or non-adrenergic vasoconstrictor versus local anesthetic without vasoconstrictor in hypertensive patients with controlled blood pressure and/ or controlled diabetes during dental extraction, and periodontal or routine dental treatments. The number of people with diabetes and hypertension is increasing globally. Despite being preventable, diabetes mellitus (DM) and hypertension fall among the top 10 leading causes of death globally.[1] In 2017, around 425 million people had DM; and this number is expected to rise to 629 million by 2045.[2] This estimate includes people diagnosed with the disease and patients sus-
pected of having DM.[2] The arterial hypertension affects about one billion people worldwide.[3] It is estimated that by 2025, up to 1.56 billion adults worldwide will be hypertensive.[4] Usually, elevated blood pressure is the leading risk factor for mortality and morbidity, accounting for 7% of disability, adjusted life years, and 9.4 million deaths in 2010.[5] About 75% of DM patients will develop hypertension over time. The rate at which hypertension co-exists with diabetes is such that diabetics are 1.5to 2-times more likely to be hypertensive than their non-diabetic counterparts.[6] Some soft-tissue abnormalities associated with oral DM problems were reported. They included xerostomia, cavities and periodontal diseases that require dental care.[7] The oral manifestations reported by hypertensive patients were related to the adverse effects of the antihypertensive drugs, including xerostomia, gingival hyperplasia manifested by pain, gingival bleeding and difficulty chewing.[8] Special care should be given to both DM and hypertensive patients undergoing dental procedures regardless of the reason that led them to treatment. Local anesthetics are the most commonly used drugs in dentistry, and the usual method for controlling pain in dental practice.[9] Local anesthesia is induced when the propagation of action potentials is avoided, so that the impulse cannot be transmitted from the source of stimulation, such as the tooth or the periodontium, to the brain. Local anesthetics act by blocking the entry of
The New York State Dental Journal APRIL 2021 21 ●
