CASE 7 — Patient has a broken buccal cusp of tooth #4. Baseline BP is 105/65. After LA injection, BP increases. What should you do?

Correct answer: C. Continue treatment while monitoring

• A. Cancellation is not necessary for an asymptomatic, moderate BP rise post-LA — this is a common and expected response to epinephrine-containing LA.
• B. EMS is activated only for severe hypertensive crisis with symptoms (chest pain, severe headache, neuro symptoms) or BP ≥180/120 with end-organ signs.
• C. A transient BP increase after LA with epinephrine is expected and normal. If the patient is asymptomatic and the rise is moderate, treatment can continue with monitoring. The baseline of 105/65 was relatively low, so the rise represents normalization or mild sympathomimetic response.
• D. Administering antihypertensives in the dental office is not within the dentist's emergency scope.