My patient...the ticking timebomb
The other day my patient, I’ll call him Tom, came in for his routine dental visit. He is a perio maintenance patient who should be in every four months, but only makes it in every six. What’s extra frustrating is he is related to the doctor at the practice. But this story doesn’t revolve around his need for more frequent dental care. It’s about his general health. This man is an active guy. He’s a farmer and adventure skiing enthusiast. He looks relatively healthy too, even with the little pudge around his 60-year-old midsection. Of course, when he and I discussed his health history he was so proud to say he didn’t have any medications or health conditions at his age. I awarded him a hearty congratulations and then proceeded to check his blood pressure. This is where the joyous smile on my face fades. His reading was 190/111.
Did your eyes just bug out too? Yeah, mine did. I gulped and told him his reading. He didn’t even bat an eye. He asked, “Is that bad?”, I said “Yes, that’s dangerously high, I’m going to wait a few minutes and check it again.” During our wait, I proceeded to ask some follow-up questions. Like, when was the last time he checked is BP, when was the last time he talked with his primary care provider about his health, how he was feeling now and if he had experienced some major stressors in the last few weeks? His response was, he felt just fine and hadn’t been to regular primary care for “a while”. After about 5 minutes I rechecked his BP again. It was barely any better, 184/109. Needless to say, a long conversation began regarding the importance of being evaluated for his overall health. His blood pressure status was more urgent than addressing his dental cleaning for the day.
Here is one thing to remember. This was just a routine dental visit. We weren’t going to administer any anesthetics or dispense any medications. He was there to have his periodontal maintenance procedure completed. Fast forward a few days and his gratitude abounded. He talked with his primary healthcare provider and found out he was a ticking timebomb and didn’t even know it. His health care team was able to address the situation before any real damage was done. All because his blood pressure was checked at a routine appointment.
I think this is an important reminder for all of us. While as oral health care providers we aren’t in the business of diagnosing and treating hypertension, we are in the business of health care. We’ve heard the statistics of patients visiting their dental office more often than their general health practitioners. That was definitely true in Tom’s case. When we incorporate blood pressure and pulse into all dental visits, we can guide our patients towards the resources they need.
We already know BP and pulse are part the most basic vital signs we evaluate (don’t forget temperature and respiration are part of the vitals too!). I’m sure you, just like me, have lost count of how many times our patients ask “Is my blood pressure too low or too high? What’s normal?” (Check out the chart below to see how a BP reading relates to severity).
Not only can we help our patients skirt past a cardiovascular emergency, like a stroke, by assessing their blood pressure, we may be able to help them with other aspects of health, which can directly correlate with their oral health. For example, did you know that an elevated BP is also a sign of sleep apnea? Plus, blood pressure impacts our patients ASA status (this is used to determine a patient’s capability to handle anesthesia). Someone with type II hypertension is considered to have an ASA III status. This means anesthetics with vasoconstrictors need to be used with caution and at reduced amounts.
Now if Tom had been seeing his doctor regularly, changed his lifestyle habits and was taking medications as directed still had a blood pressure reading like the 190/111 the questions would have been a little different. Questions surrounding, when his medications were last taken, what his typical normal “controlled” reading is and, what other ways is he controlling his pressure. Those are just a few examples of questions we need to be thinking about. No matter what a conversation with his primary cardiac provider needs to happen. In a situation like this, I encourage you to reach out to that office and have a medical clearance signed.
Some final thoughts on the topic
We need to remember that as oral health care professionals we are an integral part of the health care team. When we document our patients’ vital signs, we give them the gift of information regarding their own health. It provides all who care for that patient a history of their health journey. And you may just help someone diffuse their own ticking timebomb.