USE OF LOCAL ANESTHETICS WITH A VASOCONSTRICTOR AGENT DURING DENTAL TREATMENT IN HYPERTENSIVE AND CORONARY DISEASE PATIENTS. A SYSTEMATIC REVIEW

Maria Seminario-Amez; Beatriz González-Navarro; Raul Ayuso-Montero; Enric Jané-Salas; José López-López

doi:10.1016/j.jebdp.2021.101569

USE OF LOCAL ANESTHETICS WITH A VASOCONSTRICTOR AGENT DURING DENTAL TREATMENT IN HYPERTENSIVE AND CORONARY DISEASE PATIENTS. A SYSTEMATIC REVIEW

J Evid Based Dent Pract. 2021 Jun;21(2):101569. doi: 10.1016/j.jebdp.2021.101569. Epub 2021 Apr 10.

Authors

Maria Seminario-Amez¹, Beatriz González-Navarro², Raul Ayuso-Montero³, Enric Jané-Salas⁴, José López-López⁵

Affiliations

¹ DDS, Master Degree in Oral Medicine, Oral Surgery and Implantology, School of Dentistry, University of Barcelona, Barcelona, Spain.
² PhD, DDS, Master Degree in Oral Medicine, Oral Surgery and Implantology, Assistant Professor of Oral Pathology, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain.
³ PhD, DDS, Master Degree in Oral Rehabilitation, Associate Professor of Prosthodontics, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain. Electronic address: raulayuso@ub.edu.
⁴ PhD, MD, DDS. Aggregate Professor of Oral Pathology, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain.
⁵ PhD, DDS, MD, Professor of Oral Pathology, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Medical-Surgical Area and Medical Director of Dentistry Hospital, University of Barcelona, Barcelona, Spain.

PMID: 34391560
DOI: 10.1016/j.jebdp.2021.101569

Abstract

Background: Coronary disease and Hypertension are highly prevalent health problems worldwide, with the latter being one of the most common diseases in patients visiting dental clinics. Local anesthetics (LAs) with vasoconstrictor agents (VC) are known to be commonly used in dental practice. For the above-mentioned reasons, dentists should know how to adapt and treat patients with these hazardous conditions.

Objective: The aim of this study was to find out if the use of local anesthetics (LAs) in combination with vasoconstrictor (VC) agents in dental treatment presents a risk in patient with a known history of Hypertension and/or Coronary disease.

Materials and methods: This systematic review was conducted in accordance with The PRISMA guidelines and registered on the PROSPERO database (CRD42020187369). The search strategy was based on Mesh terms, Boolean operator AND, and the PICO model. It was designed to identify all the randomized clinical trials (RCTs) published in the last 30 years, which assessed whether the use of LA with VC agents in dental treatment produces a significant increase/decrease in hemodynamics in patients with known history of Hypertension and/or Coronary disease. The Cochrane Collaboration's tool was used to assess risk of bias of the included RCTs.

Results: An initial electronic search resulted in 87 papers; however only 9 RCTs met the inclusion criteria. There was a total of 482 subjects (N = 482), of which 412 had a known history of Hypertension or Coronary disease.

Conclusions: According to the literature reviewed, the use of 1 to 2 cartridges of local anesthetics with 1:80,000, 1:100,000 or 1:200,000 epinephrine in patients with controlled Hypertension and/ or Coronary disease is safe. Randomized clinical trials are essential in determining the safety or risks associated with the use of LAs with VC agents in patients with poorly controlled Hypertension and Coronary disease.

Keywords: Coronary disease; Dentistry; Hemodynamics; Hypertension; Vasoconstrictor-agents.

Publication types

Review
Systematic Review

MeSH terms

Anesthetics, Local
Coronary Artery Disease*
Dental Care
Humans
Hypertension* / drug therapy
Vasoconstrictor Agents

Substances

Anesthetics, Local
Vasoconstrictor Agents