How to safely extract a decayed tooth if there is a bleeding risk due to high blood pressure?

Thank you for your question. I respect the care and concern about your father and you must be very worried for him. I will do my best to give you sound advice.

In my practice, we see patients just like your father with complex medical and systemic health issues , and a good number of these patients require urgent dental treatment.

It is likely that your father's blood pressure rises whenever he sees the dentist because of dental anxiety, worry or fear.

Blood pressure can rise sharply as your father is anticipating a painful procedure.

If he were my patient, i would consider doing the extractions under IV sedation and/or in conjunction with medication to help him relax. While he is comfortably asleep and sedated, we can monitor his heart rate and blood pressure in a very precise manner, and carry out the extractions safely. While he is sedated, his blood pressure should normalize.

I would also need him to be taking his blood pressure medication religiously as prescribed by his medical doctor. And i would also check to see if he is on any blood thinning medication as these may need to be stopped a few days prior to the procedure.

Many patients also want to have dental implants placed immediately after their teeth are extracted , in the same procedure. This might also be a possibility in your fathers case, if he is suitable for implants. This would allow him to have a tooth replacement to restore his bite, without a second surgery.

We have all the tools and technology available now to help to stop unexpected bleeding safely and effectively under such controlled conditions.

I hope my advice helps you and i wish you all the best to find a good, reliable and trustworthy dentist!

Kind regards,

Dr Gerald Tan

We will need to first determine the cause of your father's high blood pressure - whether it is anxiety or hypertension. In order to do that, you may want to bring your father to a medical general practitioner (GP) or cardiologist for a check up.

After your father's medical doctor has established the cause of the increase in blood pressure, do let your father's dentist/dental specialist know the following:

1) your father's existing medical conditions, if any

2) medications and the dosage taken currently, if any

3) name and contact number of your father's medical doctor.

As an oral surgeon practicing in a hospital-based dental group, we see alot of patients who have high blood pressure and/or heart conditions. When treating them, we work closely with their medical doctors/cardiologist before we proceed with any dental treatment to ensure that patient's well-being and safety is taken care of.

In the right hands and with appropriate measures in place, it is safe for patients with high blood pressure to undergo a dental extraction without the risk of excessive bleeding.

Best regards

Dr Ho Kok Sen

I understand that both you and your family are concerned about your father's blood pressure. It sounds like there is a possibility of 'white coat' syndrome where the blood pressure is increased only due to the 'nervousness' a patient might have when he sees a dentist or doctor.

As you probably know, it is not advisable for an extraction to be done where the blood pressure is very high and the cause is not established and treated. Such patients are also at a higher risk of bleeding after extraction and hence why it is crucial that he is treated by an experienced practitioner.

I handle many patients with complex medical conditions. I am very happy to speak to Cardiologists or a GP who is managing his blood pressure and might know about the intimate details of his blood pressure.

I would typically check his blood pressure with the monitoring equipment in my clinics and advise further. It would be very useful to know the details of the medications that he is on, his cardiologist or General Practitioner. Most importantly it would be great to have a record of the trend of his early morning blood pressure readings that he is taking at home for my analysis.

In addition, I hope we can sort out his dental decay and save the remaining teeth as he will need them to enjoy what we love doing best in Singapore.

yours,

Dr Samintharaj Kumar