Patients demonstrate a physiological stress response during dental checkups and treatment. Local anesthesia and tooth extraction activate the adrenal cortex to produce cortisol. Changes in adrenaline or noradrenaline concentrations have been reported in plasma and urine after drilling and filling or extraction, and anticipation of a dental checkup increases blood pressure. Both diastolic and systolic blood pressure rise still further during restorative treatment without local anaesthesia and during extraction. In a study by the same authors, no significant changes in blood pressure were observed during restorative treatment with local anaesthesia, which suggests that the pain experienced by the patient contributes to the rise in blood pressure. Dentists must be aware that this increased blood pressure may induce cardiovascular complications during dental therapy.