A Case-Finding Protocol for High Cardiovascular Risk in a Primary Care Dental School-Model with Integrated Care

Uncontrolled hypertension at the dentist: a case report of integrated healthcare

Hypertension is a risk factor for major cardiovascular events and it is usually detected and managed by general medical practitioners (GPs) in primary care. However, it is estimated that 4.8 million adults are living with untreated high blood pressure (BP) in the UK. Health authorities are encouraging more collaborative work across health professions to find and refer individuals with undiagnosed hypertension. In this case, in 2022, a 65-year-old man with a previous history of hypertension, taking antihypertensive medication, attended a BP clinic at the University of Plymouth, Peninsula Dental School as part of a hypertension case finding pilot. His systolic and diastolic BP were 150 and 85 mmHg, respectively, and as per the trial protocol, a referral letter was sent to his GP for suspected further assessment and investigation. Then, an onward referral was made to secondary care and the participant was subsequently hospitalised for 13 days for treatment of heart failure and suspected acute coronary syndrome. This case report highlights that BP readings taken in a primary care dental setting can be very useful and recommends better integration of dental services into primary care to reduce the risk of major cardiovascular events.

Opportunistic health screening for cardiovascular and diabetes risk factors in primary care dental practices: experiences from a service evaluation and a call to action

Introduction Substantial evidence has established associations between oral health and chronic diseases, mediated by common risk factors and inflammatory processes. Dental professionals are aptly positioned to screen for cardiovascular disease and diabetes high-risk indicators. This article presents a service evaluation of two dental practices delivering health screening in dental practice, and a call to action for the wider profession.Methods Following training, two general dental practices implemented a suite of health screens, including blood pressure, blood glucose, cholesterol, body mass index (BMI) and waist-to-height ratio. A service evaluation was undertaken to review and improve service provision.Results Most patients (78.4%) had blood pressure values above normal range. More than half (55.8%) were outside of the healthy range for BMI. Out-of-range results for cholesterol were observed in less than one-fifth (16.7%). High blood glucose values were observed for few patients (3.3%).Conclusion Dental professionals can be successfully trained to deliver health screening interventions. Out-of-range health screening results offer an opportunity to provide targeted health advice for both the oral and general health. Clear protocols and careful interpretation of screening tests are required to minimise patients' confusion. More robust alliances between dental and general medical care are recommended.