Changes In Cardiorespiratory Rate and Blood Pressure Under Local Anesthesia in Hypertensive and Normotensive Patients Undergoing Oral Surgery and Restorative Treatments: A Scoping Review

Abstract : Introduction: Dental procedures such as tooth extractions can increase blood pressure and heart rate, representing potential risks, particularly in patients with systemic diseases. These variations may be influenced by surgical technique, local anesthetic type, vasoconstrictor use, and comorbidities. Understanding these hemodynamic responses is essential for safe clinical management. Objective: To evaluate the impact of oral surgery/tooth extraction under local anesthesia on blood pressure and heart rate in hypertensive and normotensive patients. Methodology: A Scoping Review was performed following PRISMA-ScR guidelines. Databases consulted: PubMed, ScienceDirect, Wiley Library, Oral Surgery–Oral Medicine–Oral Pathology–Oral Radiology, JOMS, and AJH Oxford. The Boolean strategy used was: (“Hypertensive patients” AND “Normotensive patients” AND “local anesthesia” AND “dental treatment” AND (“blood pressure” OR “arterial pressure”) AND “heart rate”), limited to publications from 1980–2024. Rayyan software assisted screening and study selection. Twenty-two studies were identified, and 173 additional references were reviewed; 13 met the inclusion criteria. Results: Tooth extraction and oral surgery under local anesthesia produce measurable cardiovascular responses. On average, systolic pressure increases by 5.6 mmHg and diastolic pressure by 4.7 mmHg, with greater rises in hypertensive or diabetic patients (6.2 mmHg vs. 4.8 mmHg). The use of epinephrine in local anesthesia amplifies these changes, reinforcing the need for cautious dosing and monitoring. Conclusion: Oral surgery and tooth extraction may elevate blood pressure and heart rate, especially in patients with comorbidities. Continuous monitoring and individualized anesthetic management are essential to reduce cardiovascular risk. Future studies should include larger samples and meta-analyses focusing on hemodynamic changes under local anesthesia in hypertensive patients.