Canceling dental procedures due to elevated blood pressure

Yarows, Steven A.; Vornovitsky, Olga; Eber, Robert; Bisognano, John D.; Basile, Jan

doi:10.1016/j.adaj.2019.12.010

Cited by 9 publications

(13 citation statements)

References 24 publications

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“…In our study, care was only rarely deferred for elevated blood pressure readings and procedures were successfully completed among patients in our sample who received dental care despite elevated dental pressures exceeding current ADA guidelines for deferral of elective dental care. This finding aligns with newer, less restrictive proposed guidelines 13 . According to the American Heart Association (AHA) Guideline on Preoperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery, patients whose cardiac disease is medically optimized and who remain asymptomatic do not require additional evaluation for low‐risk surgeries such as tooth extraction.…”

Section: Discussionsupporting

confidence: 63%

“…When deciding whether to defer care, the potential risks of delaying dental treatment should be weighed against other harms that may occur. Dental providers are encouraged to obtain a comprehensive history and physical examination and understand a patient's functional status to best ascertain a patient's risk when presenting for dental work 13 …”

Section: Discussionmentioning

confidence: 99%

“…Blood pressure measurement in the dental setting may serve as a valuable screening tool for prompt referral for further diagnosis and treatment 2 . The American Dental Association (ADA) recommends that dentists take blood pressure readings at dental visits, 10 and multiple published resources have recommended that dentists defer dental treatment for blood pressure readings as low as 160/100 mmHg for elective oral health care and 180/110 mmHg for urgent oral health care 1,11–13 …”

Section: Introductionmentioning

confidence: 99%

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Treatment deferral for elevated blood pressure at a dental school clinic

Nath,

Jiang,

Barrow

et al. 2023

Journal of Dental Education

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ObjectivesCurrent guidelines by the American Dental Association (ADA) recommend deferral of elective dental care for elevated blood pressure. However, it is unknown how frequently this impacts dental treatment. The purpose of this study was to evaluate rates of asymptomatic hypertension and treatment deferral at a dental school clinic.MethodsThis was a retrospective study with data extracted from a chart review of all patients presenting for care at a dental school teaching practice. Differences in dental procedures, the time between visits, and the number of antihypertensive medications were calculated between patients with and without a blood pressure reading exceeding current guidelines for elective treatment.ResultsAmong 26,821 individuals, 1265 had a visit with elevated blood pressure. Blood pressure readings at the next visit were significantly lower (systolic blood pressure 137 [95% confidence interval {CI} 135–138] mmHg, diastolic blood pressure 82 [95% CI 81–83 mmHg], p < 0.001), although only 24 patients reported taking a new medication. Only 4.1% of these patients had a procedure deferred; for those that did, the average intervisit time was 88.2 days (95% CI 77.7–98.7 days).ConclusionsThe majority of patients with blood pressure readings exceeding current ADA recommendations for treatment were treated without evidence of harm. Patients were also unlikely to return to the clinic with new medications for blood pressure after a visit with an elevated blood pressure reading. Oral health providers must weigh the risks and benefits of care deferral and can consider an expanded role in hypertension management in dental settings when caring for patients with elevated blood pressure.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment deferral for elevated blood pressure at a dental school clinic

Nath,

Jiang,

Barrow

et al. 2023

Journal of Dental Education

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“…The historical separation between medical and dental records creates unnatural and unnecessary barriers to achieving this aim (Kalenderian et al 2016;Jain 2018). For example, high blood pressure readings in the dental office may trigger the cancellation of dental procedures and unnecessary medical consultation requests that could be avoided if dentists had access to medical records showing the patient's hypertension is being managed (Yarows et al 2020). Physicians also consider dental information to be relevant for their practice (Acharya et al 2017;Simon et al 2019), but they do not have ready access to dental records that document their patient's dental treatment, oral health, and drug prescriptions.…”

Section: Introductionmentioning

confidence: 99%

Agreement in Medications Reported in Medical and Dental Electronic Health Records

Tenuta

Canady

Eber

et al. 2021

JDR Clinical & Translational Research

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Introduction: The historical separation between medicine and dentistry has resulted in the creation of separate health records, which have the potential to negatively impact patient care and safety. Of particular importance, errors or omissions in medication lists in separate electronic health records (EHRs) may lead to medical errors and serious adverse outcomes. Objective: This study aimed to compare medication lists reported in the EHRs of active patients treated by both the University of Michigan School of Dentistry and Michigan Medicine to determine if differences exist. Methods: In this cohort study, EHRs of a population of 159,733 patients that the University of Michigan medical and dental clinics share in common were investigated for agreement in the reporting of 16 medications. After exclusion of minors and patients not seen in the last 5 y, records of 27,277 patients were examined. Results: The maximum percentage of agreement in medications reported in both records was 52% for levothyroxine, and the minimum was 7% for sildenafil. The medical record had a significantly higher number of unique medications than the dental record, suggesting higher underreporting in the dental setting. Conclusion: The lack of agreement in the report of medications with serious dental and medical implications argues in favor of unification of records and use of available technology to increase accurate medication reporting. Knowledge Transfer Statement: The results demonstrate a lack of agreement between medications reported in medical and dental records, which can have serious implications to patients’ health. A unified health record, employing available technology to increase accurate medication reporting, would mitigate this problem.

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“…With many studies that validate the acceptability of working on patients even with high blood pressure and elevated heart rates, [13] it is a common option in my practice to offer fillings without anesthesia. This is especially effective with fillings for young children on whom we place headphones with music (sometimes offering nitrous oxide alone or concomitantly with the headphones).…”

mentioning

confidence: 99%

Practical lessons from a general dentist of more than 50 years private practice plus 2 years of United States Air Force practice

Davis¹

2021

JGOH

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Having practiced over 54 years the art and science of general dentistry, many changes in philosophy and performance have occurred. Some are minor while others very major. This series of observations will treat some in detail while others very briefly. The physical locations have been in the Dallas, Texas area of the USA. Definitions of terms set the stage for discussion of the basis of dentistry. Support for the scientific as well as evidence-based approaches is laid forth. Filling materials have transitioned from amalgam to composite being most prevalent. Fluoride added to local water supplies has decreased the number of decayed/sensitive teeth, the timing of initial decay, and the prognosis for remediation. pH is a major player in the deterioration of tooth structure. New understandings of tooth brushing and oral hygiene have significantly improved the future for continuing dental health. Absence of fluoride in bottled water has taken a front-center stage for helping/hurting chances of keeping teeth free of decay. Fluoride varnishes have widespread acceptance in America. Failure to seek routine dental care has influenced the outcomes for many younger patients, especially those who have graduated high school, gone off to college or into the workforce. Such lack of routine preventive influence raises the costs of care when it is received, often leading to complaints from patients about the high costs of repair. The alternative is prevention with ongoing consistent 6-month recalls/repairs when problems initiate, rather than allowing problems of long duration. The USA dental insurance industry adverse impact on practicing dentists is a vital monologue. Revealing the dental insurance industry as a number one concern of many surveys of practicing dentists is a way of preparing international countries for learning from the flawed USA models. Recent Congressional law, HR 1418, the Competitive Health Insurance Reform Act, will address some of the most critical wrongs by placing the dental insurance industry into antitrust restraints. Current concerns about digital X-ray’s diagnostic potential are revealed. Conservative dentistry is promoted. Results of conservative practice from nearly 50 years are documented with photos and X-rays. Bonded bridge technology is highlighted for its valued impact.

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Canceling dental procedures due to elevated blood pressure

Cited by 9 publications

References 24 publications

Treatment deferral for elevated blood pressure at a dental school clinic

Treatment deferral for elevated blood pressure at a dental school clinic

Agreement in Medications Reported in Medical and Dental Electronic Health Records

Practical lessons from a general dentist of more than 50 years private practice plus 2 years of United States Air Force practice

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