Dental care professionals realize that the key component of any
thorough dental hygiene appointment is patient assessment. While there
are several tools used for conducting screenings and examinations for
oral health, other aspects of patient health that may be related to
dental heath are often overlooked. A patient's blood pressure is one of
these parameters. Appropriate monitoring of blood pressure can not only
improve outcomes of dental care, but also play a role in improving the
overall health of patients.
According to the American Heart Association, nearly one third of
adults have hypertension (defined as sustained high blood pressure of
140 /90 mmHg and above). Uncontrolled high blood pressure greatly
increases the risk of heart disease and stroke - the first and third
leading causes of death in developed nations. Because there are no
symptoms, many people with hypertension do not know they have it. The
only way to tell is to have an accurate check of your blood pressure.
Similar to the pressure created by water flowing through a garden
hose, blood pressure refers to the force exerted by circulating blood on
the walls of our arteries and blood vessels. Blood pressure is commonly
measured by inflating a cuff on the upper arm and watching the pressure
indicated by a blood pressure gauge while listening to the Korotkoff
sounds at the brachial artery with a stethoscope. The cuff must first be
inflated enough to stop all the blood from flowing through the artery.
Then, as the pressure in the cuff is gradually released with a valve,
the occlusion of the artery is reduced. The point at which blood begins
to flow again is signaled by the first Korotkoff sound. This is an
indication of the peak blood pressure in the arteries and is referred to
as systolic blood pressure. Continued reduction of the pressure in the
cuff eventually allows the blood to flow completely unobstructed again.
This point is signaled by the disappearance of the Korotkoff sounds and
is considered a reliable indication of diastolic blood pressure.
The accuracy of a blood pressure (BP) device or monitor is often
determined by comparing its measurement relative to the measurement of
an observer using a mercury sphygmomanometer and stethoscope on the same
patient. The human observer with this setup in a controlled
environment, with a meticulously prepared patient, and the practice of
careful measurement is considered to be the gold standard of
non-invasive blood pressure measurement. Measurements taken in this
manner are the basis for the levels that are the current definitions of
high BP or hypertension, 140/90, and normal BP, 120/801.
If you have ever used an automated monitor to measure blood pressure,
you probably have encountered a reading you thought was too high. In
these situations, clinicians usually take a measurement themselves using
a sphygmomanometer and stethoscope to either confirm the reading or
question whether the monitor is working properly. If the reading is
confirmed, you and your patient may be surprised to realize that your
patient’s BP is not what you expected. Alternatively, if the reading is
different, you may wonder if your monitor is calibrated or operating
correctly. Regardless of the situation, why is this happening at all?