Dentists should measure the blood pressure of every patient

University of Michigan dentistry student Sara Kellogg believes dentists could save lives simply by taking a few minutes to measure the blood pressure of every patient.

This isn’t just the opinion of one dentist-to-be. Kellogg has data to back it up.

In an article in the Sept. 10 issue of the Journal of Dental Education, Kellogg reports that after reviewing the records of patients treated at U-M School of Dentistry clinics in 1999, she found about one third had high blood pressure. More significantly, nearly half of those had never been diagnosed as hypertensive.

High blood pressure is called the silent killer because although it contributes to such potential killers as stroke and heart attack, those who suffer from it often have no signs or symptoms.

“As dentists, we have the opportunity to screen for this medical condition,” said Kellogg’s faculty advisor, Jack Gobetti, U-M professor of dentistry. “Blood pressure screening is going to be part of the modern dental office protocol.

“It is a tremendous public service to do this as a public health screening,” Gobetti said.

U-M student dentists are encouraged to follow the protocol to measure patients’ blood pressure before treatment, Gobetti and Kellogg noted. They told the story of one healthy-looking woman who came in for treatment and the student measuring her blood pressure thought the equipment must be faulty because it showed a reading of 226 over 136. After repeated checks, Gobetti confirmed that, yes, the equipment was working. The woman was referred to the emergency room and immediately put on medications to control her previously undiagnosed hypertension.

High blood pressure is defined as 140 over 90 or higher. Blood pressure of 120 over 80 is generally considered ideal. People between these categories are called pre-hypertensive, a category that also requires medical observation.

Kellogg noted that many people see their dentist more regularly than a physician and could get an early warning about high blood pressure when getting their teeth cleaned or having some other dental treatment done.

Kellogg would like to see every dentist take an initial blood pressure reading for every new patient, then record blood pressure with every follow-up visit.

The benefit is not only for the patient. Gobetti said anesthetic behaves differently in patients with high blood pressure and hypertensive patients typically bleed more during surgery, so dentists should know patients’ blood pressures before beginning treatment. Some patients, he said, should be referred for medical evaluation before receiving dental treatment, and should not be treated until their blood pressure is under control.

Few people relish the thought of a filling or root canal. Gobetti said a typical patient’s blood pressure might rise by 10 or 15 points because of nervousness just walking into a dentist’s office. However if the dentist has a record of blood pressure readings for the last few years of office visits, the dentist can see if a reading is particularly high for that patient.

A Health and Human Services study released in August states that about 31 percent of Americans suffer from hypertension, almost identical to the rates Kellogg found.

Still, Kellogg said that because the dental school tends to see a population that includes many patients without insurance or with minimal insurance, it is possible they are less likely to visit their doctors for check-ups than the general population. If that is the case, she said, it is even more important that dental schools around the country take the lead in making blood pressure determination a standard part of office visit procedure.

Kellogg began this research project while an undergraduate student at Kalamazoo College in western Michigan. She knew she wanted to come to Michigan for dental school, so she sought out a research project at U-M School of Dentistry to initiate her senior project, required by Kalamazoo for graduation.

Now beginning her second year of dental school, Kellogg already has won first place at the American Dental Education Association for her student research presentation. Gobetti applauded her ambition and dedication, and said she’s gotten an ideal educational experience about the demands and rewards of research.