Medical Conditions – Tooth Be Told

Most often than not, when I take the blood pressure monitor out to check my patient, they give me a look of shock and curiosity. "Why are you taking my blood pressure before getting my teeth cleaned?" Taking blood pressure at the dentist is not a new thing, but many don't do it, and they should be. Dental hygienists take blood pressure to ensure the patient is safe to treat. If blood pressure is already high, emotional stress and discomfort of dental treatment can raise blood pressure suddenly and high enough to possibly cause a stroke or heart attack. There is more to why we take blood pressure in the dental office that I go over it in more detail below. In this post, I touch on what blood pressure is considered too high for treatment, what signs and symptoms dental professionals watch out for, how often you should have your blood pressure taken at the dental office, and tips on lowering your blood pressure before going to the dentist. Why dental hygienists and dentists take blood pressure! Patient safety is the number one priority in the dental office, I know it sounds cheesy or cliché, but it is true! When dealing with potentially serious medical conditions, doing our due diligence can save a life and prevent serious health damage, no matter how low the chance. Dental treatment can become unsafe if the patient's blood pressure is too high. Some people can become very stressed and anxious in the dental chair, which causes their blood pressure to rise quickly. If the patient has high blood pressure to begin with, the added stress from the dental office can spike it enough to cause a medical emergency. In my practice, at the patient's first appointment at the dental office, I will take their blood pressure to get a baseline and review it in conjunction with the patients' medical history. The following medical conditions are considered as added risk factors; diabetes renal (kidney) diseasemyocardial infarction (heart attack)stroke angina (chest pain) Any of the above medical conditions, along with warning signs (you can find these under the next subheading), tell me if I should continue to monitor the patient's blood pressure at subsequent appointments. Your dental professional may take a blood pressure reading at both the beginning and end of your appointment. Blood pressure is usually lowest at the end of the appointment when the patient is the most relaxed. This will give the dental professional a good idea of the impact of dental treatment on the patient's blood pressure. Read Now: How Dental Hygienists Clean Teeth! What You Need to Know! Another reason why we take blood pressure is to help choose which anesthetic to use for freezing the mouth. If the blood pressure is in the high range but still under the threshold of when not to treat, an anesthetic with epinephrine may be avoided. More info can be found in this study. Below you can find the thresholds of blood pressure that will indicate postponement of dental treatment and referral to a medical doctor. What blood pressure is too high for dental treatment? The different thresholds. With systolic pressure over 180 mmHg and/or diastolic pressure over 110 mmHg, medical care should be accessed immediately and dental treatment postponed. If blood pressure does not exceed the above reading, sometimes treatment will be limited or full treatment can still be done. As a reminder, added risk factors include history of; diabetesrenal(kidney) diseasemyocardial infarction (heart attack)strokeangina (chest pain) Blood pressure thresholds WITHOUT history of risk factors Blood pressure readingDental treatment allowed?Systolic above 180 and/or diastolic over 110 NoReferred for emergency medical treatment Systolic 130-179 and/or diastolic 85-109Yes Second reading is taken 5 minutes later and refer for medical consultation Systolic below 130 and/or diastolic below 85Yes Blood pressure thresholds WITH history of risk factors Blood pressure readingDental treatment allowed?Systolic above 180 and/or diastolic over 110NoSystolic 160-179 and/or diastolic 100-109Limited to non-invasive treatmentSecond reading is taken 5 minutes later and refer for medical consultationSystolic 130-159 and/or diastolic 80-99YesSecond reading is taken 5 minutes later and refer for medical consultationSystolic below 130 and/or diastolic below 80Yes Even if the patient's blood pressure is within the threshold of allowing to go ahead with treatment, if they are exhibiting any warning signs, delay of treatment will still be considered, and recommendation to seek medical attention ASAP. Warning signs and symptoms that could postpone dental treatment severe headachenauseousthrowing upblurry visionnosebleedshortness of breathchest painseizures How often should you have your blood pressure taken at the dental office? How often blood pressure is taken at the dental office is patient specific depending on the baseline reading and medical history. Blood pressure should always be taken at the first appointment. Every two years for readings below 120/80. Every year for 120–139/80–89, every visit for readings above 140/90 or if the patient has heart disease, diabetes, or kidney disease with readings above 135/85 or established hypertension. You can read more in this review article. In the Dental ChairI had a man in his mid 50's who had come into my dental office as a new patient. I took his blood pressure at the beginning of the appointment, and it was abnormally high, within the range of do not treat and refer for emergency medical treatment. I retook his blood pressure 5 minutes later, and it was around the same reading.I discussed with him that it was unsafe to treat him as his blood pressure was too high. I wrote down his blood pressure readings, I consulted with the dentist, and we both told the patient that we don't feel comfortable treating him that day, and his health and safety were more important at that time than the planned dental treatment.The patient was quite annoyed that we were not continuing with the appointment that day and that we would not see him until his blood pressure was lowered to a safe threshold and monitored and controlled. However, the next time I saw him, he was thankful to us for doing our jobs correctly, and he was appreciative that he was receiving the medical care he needed. Read Now: Why You Shouldn’t Have Your Teeth Polished at the Dentist How can I lower my blood pressure before the dentist? Non-obvious answers only! I have had a few patients who have the textbook white coat syndrome, and even though their blood pressure may be normal in regular circumstances when they come to the dental office, their blood pressure will immediately rise. For my patients who have higher blood pressure and are looking to reduce it before the appointment, here are 7 tips to lower it before the appointment. Book later appointments, preferably late afternoon. Blood pressure usually decreases throughout the day.Book on a less busy day. For example, book an appointment on a Friday, and take the rest of the day off work. Therefore you won't be rushed to get back to work.Ask to book in a room that is quieter and away from other sounds/noises, such as the dental drill. Bring headphones/earbuds to listen to music. Ask for a longer appointment so it won't feel as rushed, which can increase anxiety. Talk with your medical doctor to make sure any underlying medical conditions are being adequately treated and controlled. And the obvious ones; breathing slowly and deeply, and engaging in calming meditative practices. Read Now: Scaling and Polishing: How Long a Typical Dental Cleaning Is Just knowing that you can make the above adjustments to your dental appointment can reduce anxiety and blood pressure before the appointment and reduce the fight and flight response. I hope this information has been useful to you, and you have a wonderful day, Holly :)