Leveraging the Connection Between Heart and Oral Health
While no definitive study has found a direct link between periodontal disease and heart disease, researchers believe there could be an association. Bacterial plaque in the oral cavity that leads to periodontal disease increases the overall inflammation level in our bodies and chronic inflammation is a key contributor to many health problems including: Coronary diseases, rheumatoid arthritis, and pancreatic cancer.
Because of these potential links and concerns, patients who are scheduled to undergo heart procedures, especially any type of bypass or valve replacement, should be cleared by a dental professional first.
Pre-Surgery Dental Clearance Exams
Prior to cardiac surgery, a patient's physician may request a dental evaluation to detect any current dental infection, including periodontal disease or active caries. Radiographs may also be indicated to rule out any periapical infection.
A thorough dental examination is an important step in a comprehensive screening protocol to minimize the risk of any post-op complications. It is one step in a battery of screening tests that minimize the risk of a patient developing post-op complications.
As a hygienist you know, it is very common for patients to take blood-thinning medications, which may or may not be related to cardiac surgery. It is important for clinicians to ask patients about any changes to medications prior to any dental treatment. Blood thinning medications are typically suspended prior to invasive dental treatment in consultation with the patient's physician.
Why Blood Pressure Measurement Is Important in Dentistry
In 2017, RDH Magazine published an article entitled “10 reasons why we must take dental patients' blood pressure ” where Linda Lawson, RDH, highlighted the importance of blood pressure checks at a dental hygiene visit.
Four of the most important reasons are listed below.
Screening for Hypertension
It’s easy to assume that patients come to the dentist relatively healthy, but what if they only look healthy? As a dental hygienist, you’re uniquely poised to help increase patient awareness about the risks of untreated hypertension by assessing blood pressure. In some cases, patients who don’t see their general practitioner as often as they see their dentist may be surprised to find out they have undetected, uncontrolled hypertension.
This gives patients the opportunity to address the "silent killer," which earned its name because most people don’t feel like they have high blood pressure until it’s significantly high and at a dangerous level. Left undetected, hypertension can cause serious damage to the heart, blood vessels, kidneys, eyes and more. Detected early, it can be controlled before any of this damage occurs.
Another reason for hypertension screening is to identify patients whose nervousness gets the best of their health.
Identifying Patients With White-Coat Syndrome
Pediatric patients and other patients often experience considerable stress and anxiety before and during dental visits. So much so, it can increase their blood pressure, causing what’s referred to as white-coat hypertension. This, too, can lead to damaging cardiac conditions. White-coat hypertension is a risk factor for heart attack, heart failure and stroke. And high blood pressure associated with white-coat syndrome can lead to organ damage.
Patients who are suffering with white-coat hypertension can benefit from relaxation techniques designed to ease their discomfort. These include controlled breathing techniques, listening to relaxing music and/or administering nitrous oxide sedation.
Pregnant patients also benefit from hypertension screening.
Reducing Adverse Pregnancy Outcomes
For years, pregnant women have avoided going to the dentist because of safety fears. However, public awareness about the benefits of dental care has helped supersede the risk. Hygienists have an opportunity to provide an extra level of screening for preeclampsia, a fairly common, yet serious condition that can occur during and after pregnancy.
Preeclampsia generally occurs during the second or third trimester; however, the disorder can occur earlier than 20 weeks past gestation in rare cases. By performing blood pressure screenings on pregnant and postpartum patients, hygienists can alert patients and encourage them to seek care.
Lastly, and certainly not the least important, is the role hypertension screening plays in the early detection of type 2 diabetes.
Recognizing Signs of Diabetes
Hypertension screening of patients during preventive dental visits helps identify other serious conditions, such as type II diabetes mellitus in its earliest stages, which can be characterised by high blood pressure. In fact, more than 66% of people with type 2 diabetes experience high blood pressure as a primary symptom.
The U.S. Preventive Services Task Force recommends testing asymptomatic adult patients for diabetes who have persistent high blood pressure greater than 135/80 mm Hg. This even applies to patients with no other symptoms. Early diagnosis of diabetes is critical for proper treatment, and just one screening can ensure a patient’s long-term health.
Even if patients aren’t scheduled for heart surgery or don’t experience hypertension, hygienists should remind patients that proper oral health care is important to their total health, and may help them avoid heart disease and other serious systemic conditions.
Talk to Patients About Oral Hygiene
For Adults
Of course, brushing teeth twice a day for at least two minutes may lower the risk of infection and other diseases. The American Heart Association (AHA) reports that people who brushed less than twice a day for less than two minutes had a three-fold increased risk for cardiovascular disease compared to those who said they brushed at least twice a day for at least two minutes.
A separate study published last month in the AHA journal Hypertension found that periodontal disease appears to worsen blood pressure and interferes with medications to treat hypertension.
For Children & Adolescents
A 2022 American Heart Association fact sheet on children and cardiovascular disease noted that pediatric patients can experience elevated blood pressure and hypertension as well. In fact, 13.3% of youth ages 8 to 17 years had elevated blood pressure and 4.9% had hypertension (2015-2016). This gives another reason to remind young patients about the importance of oral hygiene and tips, such as:
Use the "Show, Tell, Do" method with children to teach pediatric patients the aspects of a dental visit and to familiarize them with dental settings. It shapes the patient's response through desensitization and well-described expectations.
Another recommendation for children is "ask-tell-ask." This technique involves asking the patients about any planned procedures (ask), explaining the procedure through demonstration (tell) and inquiring how the child feels about the procedure (ask). The goal is to find out if the child has any concerns so the dentist/hygienist can address and assess the situation.
A good follow-up technique called "teach back" has the hygienist ask the child to teach back what they’ve just learned. The child could use puppets, a large toothbrush or a mirror to demonstrate what they’ve experienced or learned.
Parents can get into the act and "flip the lip" to check the oral health of their child. They simply turn the child's lips so that they can clearly see the teeth’s surfaces. This enables parents to be proactive in seeking dental attention or guidance when something doesn't look right. Calling the dentist the next day — even if for something “normal” that is simply explained — is better than waiting six months, only to discover that extensive dental work is required.
As preventive specialists, hygienists have the ability to screen and help with early detection of heart conditions and other serious health conditions through routine blood pressure monitoring.
For more information about how to help patients maintain proper oral health, both in and out of the practice, contact us.