Blood pressure measuring equipment in the dental surgery: use or ornament?

Mandibular anterior nutrient canals in periapical radiography in relation to hypertension

Background:

Hypertension (HTN) is the most commonly encountered systemic disease in general population. Nutrient canals contain blood vessels and nerves that mostly appear in the anterior mandibular region. Nutrient canals are not detected in radiographs of all patients, and their normalcy is controversial by many investigators.

Objectives:

The present study investigated the correlation between the appearance of nutrient canals and hypertension as a potential clue to diagnose patients with hypertension.

Patients and Methods:

Thirty two patients with HTN and 32 normotensive subjects were selected. Periapical radiographs were taken from mandibular anterior cuspid-central incisor region since nutrient canals are commonly observed in this area. Data was analyzed by SPSS software with Chi-square and Fisher tests.

Results:

The incidence of nutrient canals was 37.5% in patients with hypertension and 53.1% in the normotensive subjects, but this difference was not statistically significant (P = 0.209). We did not find any association between duration of hypertension (P = 0.292) or controlled hypertension (P = 0.144), and the presence of nutrient canals. The mean of subject age with nutrient canal was more than those without nutrient canals, and this difference was statistically significant in normotensive patients.

Conclusions:

This study revealed that there was no significant association between mandibular anterior nutrient canals and hypertension.

Cardiovascular monitoring and its consequences in oral surgery

Objective:

Higher life expectancy has lead to an increase of elderly patients in dental practices, thus also causing an increase in high-risk cardiovascular patients.

Study Design:

In all, 3012 patients had oral surgery with local anesthesia at the Department of Oral Surgery, Oral Radiology and Oral Medicine at the University of Basel. The Colin BP 306 compact monitor was used during these surgeries. The patient's heart rate, blood pressure, and oxygen saturation were routinely checked, both before and during the procedure.

Results:

The oral surgical procedure had to be discontinued 17 times, because the patient developed significantly elevated blood pressure. Twice, the procedure had to be discontinued due to cardiac arrhythmia. The average age of these 19 patients was 63.5 years.

Conclusions:

Pre-and intraoperative monitoring allows the dentist to identify patients with high-risk diagnostic findings and to reduce problematic cardiovascular situations.

The medical and dental attendance pattern of patients attending general dental practices in Warwickshire and their general health risk assessment

BACKGROUND

The dental team could have an important role to play in general health risk assessment within primary and community healthcare.Aims To describe medical and dental attendance patterns, demographics and health profiles of patients routinely attending general dental practices in Warwickshire. To identify whether a subgroup attend dental practices regularly but attend medical practices infrequently and discuss whether preventive healthcare interventions delivered in general dental practice would be appropriate.

METHODS

A self-completion questionnaire was administered to patients attending 16 dental practices in Warwickshire.

RESULTS

Eight hundred and eleven completed questionnaires were returned (74% response). Seven hundred and eighty-nine (98%) respondents visited their dentist every one to two years or more frequently and of these a subgroup of 121 (15.3%) visited their general medical practice surgery or health centre less often than every two years. In the subgroup 9.5% reported high blood pressure, 17.6% currently smoked, 22% drank above recommended guidelines, 32.1% were overweight and 7.3% obese.

DISCUSSION

The data suggest there may be a role for dental practitioners in identifying patients at risk of having undiagnosed or future general health problems and providing appropriate general health advice, screening or signposting the patient to relevant general healthcare facilities either within or external to the dental practice.

Should we screen for hypertension in general dental practice?

Hypertension is reported by the World Health Organisation as one of the most important causes of premature morbidity and mortality, although it is often asymptomatic. Approximately 40% of the UK population are thought to be affected, however, only one third of these are currently detected. Dental practice offers an ideal opportunity to screen for hypertension, due to the large cohort of the general population who regularly attend. A pilot study was carried out to screen for hypertension and associated risk factors in 114 consecutive patients who attended a city general dental practice. Results revealed that 39% (44) of the population screened had a high blood pressure reading but only 18% (8) of these were previously diagnosed as hypertensive, and 16% (7) had systolic readings greater than 160 mmHg. Of those currently receiving treatment for hypertension, the blood pressure was still elevated in 63% (5). This suggests that screening for hypertension in general dental practice may be of benefit to the population at large.

The potential use of gingival crevicular blood for measuring glucose to screen for diabetes: an examination based on characteristics of the blood collection site

BACKGROUND

This study examined conditions under which gingival crevicular blood (GCB) could be used to obtain a useful glucose reading to screen for undiagnosed diabetes during routine dental visits.

METHODS

GCB and capillary finger-stick blood (CFB) glucose readings obtained with a glucometer were compared for 46 patients recruited from an urban university dental clinic. Study participants were divided into two groups based on probing depth or bleeding on probing (BOP) at the site of collection of the GCB sample. Group 1 participants had blood collected from sites with adequate BOP to obtain a sample without touching the tooth or gingival margin, whereas group 2 participants had blood collected from sites with little or no bleeding. For each group, Pearson correlations were calculated for glucose readings obtained using GCB and CFB samples, and the limits of agreement between the two samples were examined.

RESULTS

For group 1 participants, correlations between CFB and GCB glucose readings were high (0.89), and the limits of agreement were acceptable (-27.1 to 29.7). By contrast, for participants in group 2, correlations between the glucose readings were lower (0.78), and limits of agreement were much broader (-25.1 to 80.5).

CONCLUSION

GCB samples were suitable to screen for diabetes in persons with sufficient BOP to obtain a sample without touching the tooth or gingival margin (i.e., in patients having the basic clinical signs of gingivitis or periodontal disease).

Association between high blood pressure and deep periodontal pockets: a nested case-referent study

A hypertension screening project was performed jointly at a dental clinic and a primary health care centre. In this report the hypothesis that there is an association between high diastolic blood pressure and deep periodontal pockets was tested. A total of 1,239 consecutive patients aged 35-65 years had their blood pressure measured before the dental examination or had a known hypertension. Information on medical history and tobacco use was obtained by interview and dental status was recorded. Fifty-four subjects had known hypertension and 141 had previously unknown diastolic blood pressure >90 mmHg (cases). For each case an age, sex and tobacco-use matched referent was chosen from those with diastolic blood pressure < or =90 mmHg. Significantly more cases than referents had periodontal pockets > or = 5 millimeters deep. In multivariate analyses the prevalence of deep periodontal pockets was associated with blood pressure status also after adjustment for the small differences between the groups in age, sex, tobacco use and number of teeth. In conclusion there was an association between diastolic blood pressure and prevalent deep periodontal pockets. Whether the relationship is a causal one remains to be explored. Screening for high blood pressure at regularly visits at the dental clinic may give the dental care a new important role in the public health field.

General health promotion in general dental practice — The involvement of the dental team Part 2: A qualitative and quantitative investigation of the views of practice principals in South Yorkshire

AIM

To investigate the factors that might influence the provision of general health promotion through seven different health interventions by dental teams in general dental practice.

METHOD

A mixed-method was used comprising cross-sectional qualitative research using semi-structured interviews of a purposive sample of 10 practice principals, and a cross sectional survey of a practice principal from every dental practice in South Yorkshire, using a self-complete questionnaire.

RESULTS

Two core categories emerged from the qualitative data: seeing health or disease and practitioners' views of the structure of dental practice. The former refers to the participants' general outlook and cut across many dimensions constituting the structure of dental practice. Health-orientated dentists were more likely to be involved in prevention and were more open-minded to expanding the dental team's role into general health promotion. However participants perceived that barriers existed to involvement such as time and financial factors, current workload and lack of personal skills. The response rate of useable questionnaires in the cross sectional survey was 84%. Reported levels of involvement in general health promotion were low. Most frequently reported barriers were 'insufficient funding' and 'poor use of time'. 'Poor use of time' and 'lack of training/knowledge' were reported less frequently for professionals complementary to dentistry (PCDs) than dentists (p<0.05). Most dentists agreed that PCDs could be trained to deliver health interventions and would be happy for PCDs to do so in their practice if reported barriers were removed.

CONCLUSIONS

Although dental teams' involvement in general health promotion is low, there is willingness to increase involvement, particularly among health-orientated dentists. Some reported barriers to involvement might be removed by impending changes to the GDS in England. Other important factors include a lack of education and workforce shortages of dentists and PCDs. Respondents indicated a high regard for PCDs and there was broad agreement that they were suitable to be involved in this work.

General health promotion in general dental practice — The involvement of the dental team Part 1: A review of the evidence of effectiveness of brief public health interventions

OBJECTIVES

To review the evidence of the effectiveness of dentists, dental teams and other healthcare workers in seven different brief public health interventions that might contribute to Government targets in cancer and circulatory disease. The interventions were: smoking prevention, smoking cessation, advice on alcohol consumption, diet counselling, advice on physical exercise, advice on skin cancer prevention and blood pressure monitoring.

METHOD

A series of literature reviews, using a generic systematic approach, were undertaken to investigate the effectiveness of dentists, dental teams and other healthcare workers in each intervention.

RESULTS

Apart from smoking cessation and dietary advice, no studies were identified on the effectiveness of dentists or dental teams in the interventions investigated. There is some evidence that dentists and dental teams can be effective in smoking cessation. There is minimal evidence for effectiveness in dietary counselling, and that which exists shows only a transient effect. There is evidence that other healthcare workers can have some effect in all interventions, though the effect in preventing skin cancer is questionable.

CONCLUSIONS

Due to the paucity of studies undertaken, there is minimal evidence of effectiveness of dentists and dental teams in any of the seven interventions. However other healthcare workers are effective in most of them. Dentists and dental teams' involvement in such brief general health promotion interventions might contribute to Government targets on cancer and circulatory disease.

Should GDPs be checking blood pressure?

OBJECTIVE:To survey the attitudes, knowledge and practice of general dental practitioners (GDPs) with regard to hypertension in dental patients and to assess opinion with regard to the concept of screening. SETTING:General dental practice. SUBJECTS AND METHODS:GDPs via a postal survey. To achieve an acceptable level of accuracy, at least 196 responses were required. RESULTS:Out of 300 questionnaires, 207 were returned (69% response rate). Most practitioners (98%) had received training in the measurement of blood pressure. Only 4.8% measured blood pressure routinely and this figure rose to 9.2% in patients with a known history of hypertension. Only 27.1% felt that the involvement of dentists in screening for hypertension was a good idea but 85.3% thought that education of practitioners about hypertension would be valuable. CONCLUSION:Most GDPs thought that education of practitioners about hypertension was a good idea. They did not, however, want to be involved with screening of patients for hypertension.