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THE NEXTDDS Student Ambassador Blogs

Hypertension and the Dental Patient

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    Hypertension is one of the most common diseases encountered in a dental practice. Nowadays hypertension affects almost one third of the population in the United States.  The biggest issue with this disease is the fact that many people are not aware of having it since it doesn’t always show symptoms. In a dental practice management includes recognizing the disease, correctly measuring the blood pressure, knowing about the treatment options and the adverse effects for the mouth. Hypertension is divided into primary and secondary hypertension.  Primary hypertension, also known as essential hypertension is recognized as a chronic medium to high blood pressure. Secondary hypertension is due to an organic cause.

Several studies have determined that hypertension is due to a complex interaction between genetic and environmental factors. Several of the predisposing factors are age, family history of cardiovascular disease, smoking, excessive alcohol consumption, sedentariness, cholesterol rich diets and co-occurrence with other diseases.  The treatment of hypertension includes more than just antihypertensive medication. One of the critical aspects of controlling blood pressure is to adopt a healthy lifestyle. A healthy lifestyle includes smoking cessation, moderate alcohol consumption, exercise, low sodium diet and losing weight for the overweight patients. Some of the antihypertensive medications to treat hypertension are thiazide diuretics, beta blockers, ACE inhibitors, calcium channel blockers, etc.  All these medications influence the oral environment.  The most common side effects are xerostomia, gingival hyperplasia, and lichenoid reactions.

            Xerostomia results in decay, difficulty chewing, swallowing and speaking, candidiasis and burning mouth syndrome. This side effect sometimes forces the physician to switch the medication and it is imperative of the dentist to find ways to alleviate this symptom. The dentist can advise the patient in different ways to stimulate salivary flow and to sip water frequently, to reduce the caffeine intake, to avoid alcohol and alcohol containing mouthwashes. In addition, the dentist can apply fluoride topically to protect the teeth surfaces from caries. Gingival hyperplasia is caused by calcium channel blockers and it is manifested by pain, gingival bleeding, and difficulty while chewing.  This can be reversed by switching to a different antihypertensive medication. Other side effects of antihypertensive medications are ageusia and dysgeusia.

            When a patient presents in the dental office with hypertension it is essential to obtain a detailed medical history that includes a family history of cardiovascular disease, hypertension, medications, duration of treatment and severity of the disease. It is important to always remember that patients with hypertension are at an increased risk of developing adverse effects in the dental office.  Blood pressure measurements should be done for every new patient for each visit.  Measuring the blood pressure routinely may reduce the event of complications during dental treatment.  It also important to take into consideration the “white coat hypertension”.  This results in a higher blood pressure reading in the office than if it were taken outside the office. This can either give the impression that the patient has high blood pressure when they don’t or can mask the underlying disease.

Licensing in a Nutshell

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There are several ways dentists can become licensed in the United States depending on where they want to practice. The different pathways to achieve licensure can be somewhat overwhelming, and taking a live patient examination can make licensure even more stressful. Did you know that dentistry and cosmetology are the only two career fields that still use live patient examinations? Medical doctors, surprisingly, do not have live patient examinations. Licensing exams include the WREB, CDCA (formerly the NERB), CITA, SRTA and CRDTS. In addition, dentists can also be licensed by portfolio in California and by residency in Minnesota, California, Colorado, and Ohio. So, which pathway should you take?


Ultimately, the decision on how you want to achieve licensure depends on the state in which you intend to practice. As a first step, I would highly recommend visiting the website of each state’s dental board. Figure out what exactly their licensure requirements are and if there are any caveats associated with them.

What do I mean by caveats? Let me give you an example. I am currently a fourth-year dental student and will be completing a one-year, PGY1 AEGD program in California. Since I would like to stay in California to eventually practice, I have decided to achieve licensure through my residency program instead of taking the WREBs. Now, why wouldn’t I go ahead and take the WREBS, knowing that it would open me up to practice in more states? After doing some research on the California State Dental Board website, I discovered that if you have failed the WREBs within the last five years and are trying to fulfill licensure by residency, you would not be able to get your license this way. More so, some GPR and AEGD programs will not let you start their program if you have failed the WREBs. Instead of putting myself through all that stress, I decided not to take the WREBs and get my license through residency. This is what I mean by reading into requirements and seeing if there are any minor details to be aware of before taking an exam.

A quick note on licensure by residency: In applicable states, it can be achieved by completing a one-year, post-graduate (PGY1) CODA-approved GPR or AEGD program. Licensure by residency does not include specialty residencies.

Keep in mind, depending on the state, dentists can also achieve licensure by credential if they have already been a licensed dentist in one state and would like to practice in another. Usually the dentist needs to have practiced in their licensed state for about five years and have accumulated many working hours to be licensed in another state. Again, this really depends on the individual state and what their exact requirements are.

Hopefully, in the near future dentistry will start to pull away from the live patient based examinations and opt for more licensure by portfolio or residency. Until then, it is important to do your research and make sure to understand all the details associated with your state and choice of licensure.