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Monitoring Blood Pressure

What You Don't Know Can Hurt You

A Consultation with Dr. Wayne W. Herman

Dear Doctor,
I went to see a new dentist and was surprised that my blood pressure was taken. Is this normal practice?

Monitoring blood pressure in dental office.

Dear Denise,
I'm glad to hear that your blood pressure was taken at your dentist's office. Dental professionals can play an important role in screening for diseases that can affect not only your general health, but also your dental health — and treatment.

Here's why. Hypertension, the medical term for high blood pressure, is the most common primary diagnosis in the United States. It is a major cause of cardiovascular (“cardio” – heart; “vascular” – blood vessel) disease (CVD), an increasingly prevalent public health concern. A staggering 80 million people are recognized as having some type of CVD. Even more noteworthy, a significant proportion of people are unaware of their disease.

What's more, studies have confirmed that people don't always see their doctors as regularly as they see their dentists. And when they do go to the dentist, they usually believe they are medically healthy. One study published in the Journal of the American Dental Association looked at dental patients who had no reported cardiovascular risk factors and who had not seen a doctor in the previous 12 months. When their blood pressure was taken along with other screening tests while visiting a dental office, it turned out that 17% were at an increased risk of experiencing a cardiovascular event in the next 10 years and didn't know it.

Additionally the U.S. Preventive Services Task Force (USPSTF) has reaffirmed that asymptomatic adult patients with sustained high blood pressure, greater than 135/80 mm Hg (millimeters of mercury) should be tested for diabetes, even in the absence of symptoms. The recommendations emphasize the importance of early recognition of high blood pressure, which, like type II diabetes, is often referred to as the “silent killer” because it commonly occurs without symptoms and remains undiagnosed during its earliest stages.

Blood Pressure Screening — You And Your Dentist

Screening for diseases is meant to identify those who have an increased likelihood of developing a disease or experiencing an increase in disease severity, as a first step in disease prevention and control. That's where your dentist and other health professionals come in.

Blood pressure refers to the amount of force your circulating blood exerts on your blood vessels. Its measurement is expressed as “systolic” pressure over “diastolic” pressure in millimeters of mercury (mmHg). Systolic pressure is the peak pressure in the arteries when the heart is contracting. Diastolic pressure is the lowest pressure when the heart muscle is at rest between beats. Optimal blood pressure is less than 120/80 mmHg. It takes just a few minutes to measure and record this potentially life-saving information.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure presented the following recommendations for the prevention and management of high blood pressure:

  • Cardiovascular disease risks begin at 115/75 mm Hg, and doubles for each incremental increase of 20/10 mm Hg.
  • For adults over 50 years of age, systolic pressure above 140 mm Hg is a more important risk factor for cardiovascular disease than diastolic pressure.
  • Pre-hypertensive individuals, with systolic pressure of 120 to 139 mm Hg (or diastolic pressure of 80-89 mm Hg), should make health-promoting lifestyle modifications. These include weight control, smoking cessation, dietary sodium reduction, appropriate physical activity, moderation in consumption of alcohol, and a healthy diet rich in fruits, vegetables and low-fat dairy products. Without these measures, blood pressure may not be controlled adequately despite the use of antihypertensive drugs.

Your blood pressure measurement provides important information to your dentist, your physician and you. In addition, any situation that causes stress can increase blood pressure — even undergoing dental work. If your blood pressure is already high, it could result in a dangerous situation, and in a worst-case scenario, prompt a heart attack or stroke. Even if you are taking medication for hypertension, your blood pressure should be monitored. If your blood pressure reading is higher than normal, your dentist will likely refer you to a physician for further testing. A diabetes screening may also be recommended if your blood pressure is high.

Managing Hypertension: Critical for Oral And General Health

If you are diagnosed with hypertension, your dentist should measure your blood pressure and review all of the medications you are taking at each visit. A significant number of anti-hypertensive (blood pressure) medications have undesired oral side effects (notably dry mouth, which can lead to severe tooth decay) that can require intervention by your dentist. Also, be aware that epinephrine — adrenalin, the naturally produced hormone that makes your heart rate and blood pressure go up in the fight-or-flight response — is a vasoconstrictor (“vaso” – blood vessel; “constrictor” – to tighten) commonly used in local anesthetics to prolong the numbing effect. However, it is widely recommended that vasoconstrictor usage be limited in people with cardiovascular disease. Dentists' experience in dealing with countless patients over many years supports this practice.

All In The Service Of Your Health

In summary, dentists can provide a valuable public health service by regularly checking their patients' blood pressure and informing them when measurements are suggestive of hypertension. As healthcare providers, dentists should be active in monitoring hypertension, assessing patients' cardiovascular status and their ability to withstand potentially stressful procedures, and should promote changes in their behavior that can improve overall health.

A blood pressure screening at your dentist's office is just too good an opportunity to pass up, as your new dentist fortunately knows.