We all learned that the standard of care in dentistry includes taking vitals. Generally it is one of the first clinical skills that we learn in school, so why it is that it is one of the first things to go when we graduate? There are a number reason for excluding blood pressure from our appointments the most likely one being time, viewing it as unnecessary, the occasional non-compliant patient, or not having the proper armamentarium.
I would like to address some of these myths with the start of a story. One day I was temping as a dental assistant at an office where we had just administered local anesthetic for a procedure when about 1 min after delivery the patient complained of chest pain. It was sharp and he was clutching his chest. The patient seemed to be in agony and the doctor ran for his emergency kit that included a very dusty blood pressure cuff and sphygmomanometer. I am not sure when the last time it was used but needless to say it after several minutes of finagling with the cords and pump it was not working. Luckily after a few more minutes the patient was able to calm down and we were fine to continue. Still without a blood pressure reading I might add. We were so lucky that we didn’t have a medical emergency on our hands.
I learned from this situation to take vitals prior to beginning treatment. What if this patient had blood pressure that was elevated to the levels of dismissal or sending them to the emergency room. We would not have even gotten to the state of anesthetic administration.
We take blood pressure to save us from those rare emergency situations. You may never find yourself in this situation but what about that one time you could have saved someone’s life by taking blood pressure by referring them to their physician or preventing a heart attack. I have always questioned in my mind if not taking blood pressure eventually even come back upon you and your licensure. What if somehow you were found negligent in not taking blood pressure like we are supposed to and a medical emergency occurs in your chair that could have been avoided by following blood pressure guidelines. I know I wouldn't want to risk my career on that.
At times we may be deterred from taking blood pressure because a patient questions our motives. At the beginning of the appointment I tell patients that I am going to take your blood pressure to make sure you are healthy for treatment today. If they question me I tell that it is the standard of care and it is not to diagnose high blood pressure but to make sure they are healthy enough for treatment that day.
Some may find blood pressure time consuming but because it is a screening and not to diagnose I recommend using an automatic wrist blood pressure cuff and having a manual cuff on hand in case you need a second opinion. I have seen these at harbor freight for $15. The convenience of this is that if it is cold outside one only has to undress the wrist instead of the whole arm and because it fits around the wrist it will fit on all body types large too small. I slap it on the wrist and have them place their arm over their heart during the assembly of my radiographs or during my health history interview.
I hope by reading this that you will decide to take charge and add a vital assessment back into your appointment. It can be fast, easy and is necessary.
Taken from Ester Wilkins Clinical Practice of the Dental Hygienist 9th edition, page 129
Hypertension stage 1: 140-159/90-99
Hypertension stage 2: >160/>100
Wow this Craigslist posting for a hygienist had me in awe! I read it in an article in the December 2012 issue of the RDH magazine entitled IS THERE REALLY A HYGIENE SHORTAGE?
The World Wide Web is an excellent resource for job searching, if one is careful of the sources used in seeking employment. Sites requiring a fee for job postings are often less packed with offers of part-time work making thousands of dollars weekly — postings worth ignoring. Success in career placement has been found on sites ranging from Monster.com to LinkedIn. The worst posting I witnessed this year came from Craigslist.org and was forwarded to me by a frustrated dental hygienist.
“Dental practice in ______ seeking motivated Hygienist. Looking for someone who can complete task at hand so that I do not have to come in and finish the Distal lingual of the lower right and distal buccal of the upper left on every single patient. Also need you to come to staff meetings with an upbeat attitude, focused on trying to find ways to connect with your patients and help keep your schedule full, rather than have a chip on your shoulder and fail to participate in any meaningful manner. Position will start as part time but with the right person can become full time. With this economy and WDS, times are terrible for practice owners. Most of us have taken 50%-75% pay cuts. The gravy days are over. Pay will start at $35 per hour. Bumping up to the high 40s of yesterday will be determined on your skill level, ability to complete tasks at hand without emotional flare up and attitude. Most importantly, you will be expected to help in keeping your schedule full rather than expecting the front desk personnel to do it all for you. If you want employment, and are willing to put in an effort, send your resume.”
To see the full article click the link below.
After I have the radiographs I review them with the patient stating
Lets look at the pics together. When we look for cavities we look for any dark area's in the enamel surface of your tooth." I then point out he enamel and show them any "suspicious" areas including caries close to the nerve chamber, abscesses, calculus etc. (If they have heard about areas of concern before the dr. comes in it increases case acceptance.)
"I am also looking at the bone that is supporting your teeth." I then show area's of any bone loss and where they SHOULD be and then state, " I am going to be taking measurements of the natural space between your tooth and gum to check the supporting structures of the teeth. I then tell them that I am going to start the apt with a cancer screening checking all of the tissues in the mouth. Then I explain that I will be taking the measurements in which I like to see that space be from 1-3mm deep without bleeding. As I tip them back I ask them what they are doing at home to care for their teeth daily. I NEVER want to accuse a pt of not flossing when they do it on a daily basis. It is a real de-motivator.
I had a patient with graves disease today. I had to review the contraindications concerning this disease. Here is all the info on it that I accumulated when I was studying for boards. ........
It is an autoimmune disease caused by antibodies that attach to specific sites of the thyroid gland causing it to produce too much hormone. Can cause inflammation around the eyes, (exophthalmos), thick skin over the lower legs, osteoporosis of alveolar bone. My patient had to kill her thyroid gland by drinking a radioactive chemical.