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Dentists alerted to hypertension detection
Dentists alerted to hypertension detection Nancy A . Resnick,
Chicago
Dentists were asked to help detect un recognized cases of high blood pressure among their patients at a National Den tal Leadership Conference on High Blood Pressure, Oct 28, at the ADA Head quarters Building. Physicians and heart association representatives were among the 140 participants at the conference cosponsored by the ADA, National Den tal Association, American Association of Dental Schools, Citizens for the Treat ment of High Blood Pressure, Inc., the HEW Bureau of Health Resources Devel opment, and the National Heart and Lung Institute. Conferees represented 16 state and 10 local dental societies, national dental and specialty organizations, 10 state and local dental divisions, and 32 dental schools.
By adding high blood pressure mea surement to their history taking, “ den tists can help in the current national effort to identify undetected cases of hypertension and to refer patients for medical treatment,” said Dale F. Roeck, Philadelphia, chairman of the ADA Coun cil on Dental Health. Dentists can read ily incorporate blood pressure screen ing of dental patients into routine office procedures, and many are already doing so, he added. Dr. Roeck said the Association’s par ticipation in the conference, funded by the National Heart and Lung Institute, was based on a Council on Dental Health resolution calling for dentists to include blood pressure measurement as part of taking and updating the patient’s health history. The resolution was approved by
The role of dentists in hypertension detection is discussed by conference participants (leftto right) Louis M. Abbey, Richmond, Va; Theodore H. Simpson, Philadelphia; Mr. Graham Ward, Bethesda, program coordinator, National High Blood Pressure Education Program, National Heart and Lung Institute; and Charles L. Berman, Hackensack, NJ.
the Board of Trustees for transmittal to the House of Delegates. M a g n itu d e o f P ro b le m . The scope and impact of the national hypertension problem was described by keynote speaker Jeremiah Stamler, MD, of Chi cago, chairman, department of com munity health and preventive medicine, Northwestern Medical School. “ Blood pressure is highly related to the risk of dying,” he said. Approximately 20 to 25 million Americans are known to be hy pertensive and another 12 million are asymptomatic and undetected. High blood pressure attacks not only the elderly, but also young and middleaged adults, Dr. Stamler said. Twice as many black persons than white are hy pertensive. Such afflicted persons run “ the increased risk of experiencing major cardiovascular events,” he said. D e n tis t’s R o le in D e te c tio n . “ With this documented prevalence of hypertension and the coexisting physiologic complica tions, it appears that more emphasis should be placed on detection by mem bers of the dental profession," said Theo dore H. Simpson, Philadelphia, chairman of the department of oral medicine, Tem ple University School of Dentistry. Routine dental office procedures could result in adverse effects if the patient has undetected high blood pressure, warned Dr. Simpson. Not only would prognoses of dental procedures be altered for hy pertensive patients, he said, but routine screening permits proper treatment plan ning, establishes records of legal value, and encourages cooperation with physi cians for joint management. “ The identity of this disease, therefore, should be con sidered part of the evaluation and profes sional management of all patients com ing into the dental practice," he said.
HIGH BLOOD PR E SSU R E D E T E C T IO N BY D E N T IS T S
P ro to ty p e P ro g ra m s . Prototype com
munity programs of dentist screening for hypertension were described by Charles L. Berman, director of the first such pro gram in Hackensack, NJ, and Robert E. Cary, Milan, Mo. Dr. Berman’s well-publicized program is cosponsored by the dental society and health department of Bergen County, with the department of continuing edu cation of Fairleigh Dickinson University School of Dentistry. Dr. Berman emphasized that dentists can no longer be concerned with oral health only. He suggested massive pub licity, dental personnel training sessions, and liaison with physicians and commun ity health organizations as being essential to an acceptance of the dentist’s new identity. Dr. Cary related the cooperation of den tists in the Northeastern Dental Society’s newly established screening program. Although the program in this rural area is only 1 month old, half the society's mem bers have already agreed to participate. Dr. Cary, who is the only dentist in his county and is also mayor of Milan, stressed the point that he is a very busy man. “ But I’m not too busy to take blood pressure,” he said. In establishing a blood pressure screen ing program in a rural dental practice or component society, Dr. Cary suggested a thorough study of all available informa tion, follow-ups on referrals, and contin uous encouragement to colleagues par ticipating in the program. He emphasized the importance of ensuring physicians that the participants were not diagnos ing or treating hypertension, but merely screening patients and referring them for further evaluation. Dental schools also must make an ef fort to promote high blood pressure screening, said Louis M. Abbey, Rich mond, Va, assistant professor of oral pathology, Medical College of Virginia, School of Dentistry, who described the program at the school. The program in volves screening, referral, and referral follow-up. Results of the program show that “ patients can be screened in dental settings quickly and efficiently providing proper preliminary planning for screen ing, referral, and follow-up is carried out,” Dr. Abbey said. In addition, “ patients are willing to accept a dentist as one who is concerned about their total health.” L e g a l Im p lic a tio n s . The dentist s re
iOWas^i^OMAMÊRiCÂNS W EHIGHBLOODPRESSURE!
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C. L. Hallquist, Philadelphia, manager of Public Education Services, Merck, Sharp and Dohme, has his blood pressure read by Dr. Berman. sponsibility to take blood pressure was explored by attorney Bernard J. Conway, ADA assistant executive secretary for legislation and legal affairs. Blood pres sure screening by dental personnel is not without its legal implications. Aside from the dentist’s authority to take blood pres sure readings, Mr. Conway said that the large concept involves “ the dentist's re sponsibility to conduct a sufficient eval uation of his patient’s total health condi tion to ensure that his treatment of the patient’s oral diseases will not aggravate other health problems.” Mr. Conway explained that the legal concepts that apply to hypertension screening by dental personnel evolved from court decisions rather than statu tory law. Although only California, Mich igan, and Pennsylvania mention “ physical evaluation” as part of the dental law, “ the dental law in all the states, impliedly at least, authorizes the dentist to take physi cal evaluations.” To illustrate the dentist’s responsibility to take blood pressure readings, he re lated two court cases of malpractice, based on complications arising from treatment of hypertensive patients. He said the negligent act “ in many instances is an omission to act rather than the com mission of an act.” In both cases, the ver
dicts of malpractice could have been avoided if proper medical histories and blood pressure tests were taken. The question of what the dentist does with the information he obtains regard ing blood pressure is also pertinent. The dentist is acting illegally if he uses the results to prescribe something for the patient’s medical condition, Mr. Conway pointed out. “ But if the dentist uses blood pressure or other tests to determine how to proceed with his dental treatment plan, in my opinion he is acting legally and pro fessionally as he should to help his pa tient,” he said. Conference discussion group recom mendations called for the development of guidelines for dentists in hypertension screening programs, dental society par ticipation in programs, the dissemination of education materials for the dentist’s office, publicity from national, state, and local dental organizations, and continu ing education courses in hypertension detection for dentists and their auxil iaries. Information on the dentist’s role in hy pertension detection is available from the ADA Council on Dental Health. Mrs. Resnick is a staff writer for the Council on Dental Health. R esnick: HYPERTENSION CONFERENCE ■ 1263
Chicago
Dentists were asked to help detect un recognized cases of high blood pressure among their patients at a National Den tal Leadership Conference on High Blood Pressure, Oct 28, at the ADA Head quarters Building. Physicians and heart association representatives were among the 140 participants at the conference cosponsored by the ADA, National Den tal Association, American Association of Dental Schools, Citizens for the Treat ment of High Blood Pressure, Inc., the HEW Bureau of Health Resources Devel opment, and the National Heart and Lung Institute. Conferees represented 16 state and 10 local dental societies, national dental and specialty organizations, 10 state and local dental divisions, and 32 dental schools.
By adding high blood pressure mea surement to their history taking, “ den tists can help in the current national effort to identify undetected cases of hypertension and to refer patients for medical treatment,” said Dale F. Roeck, Philadelphia, chairman of the ADA Coun cil on Dental Health. Dentists can read ily incorporate blood pressure screen ing of dental patients into routine office procedures, and many are already doing so, he added. Dr. Roeck said the Association’s par ticipation in the conference, funded by the National Heart and Lung Institute, was based on a Council on Dental Health resolution calling for dentists to include blood pressure measurement as part of taking and updating the patient’s health history. The resolution was approved by
The role of dentists in hypertension detection is discussed by conference participants (leftto right) Louis M. Abbey, Richmond, Va; Theodore H. Simpson, Philadelphia; Mr. Graham Ward, Bethesda, program coordinator, National High Blood Pressure Education Program, National Heart and Lung Institute; and Charles L. Berman, Hackensack, NJ.
the Board of Trustees for transmittal to the House of Delegates. M a g n itu d e o f P ro b le m . The scope and impact of the national hypertension problem was described by keynote speaker Jeremiah Stamler, MD, of Chi cago, chairman, department of com munity health and preventive medicine, Northwestern Medical School. “ Blood pressure is highly related to the risk of dying,” he said. Approximately 20 to 25 million Americans are known to be hy pertensive and another 12 million are asymptomatic and undetected. High blood pressure attacks not only the elderly, but also young and middleaged adults, Dr. Stamler said. Twice as many black persons than white are hy pertensive. Such afflicted persons run “ the increased risk of experiencing major cardiovascular events,” he said. D e n tis t’s R o le in D e te c tio n . “ With this documented prevalence of hypertension and the coexisting physiologic complica tions, it appears that more emphasis should be placed on detection by mem bers of the dental profession," said Theo dore H. Simpson, Philadelphia, chairman of the department of oral medicine, Tem ple University School of Dentistry. Routine dental office procedures could result in adverse effects if the patient has undetected high blood pressure, warned Dr. Simpson. Not only would prognoses of dental procedures be altered for hy pertensive patients, he said, but routine screening permits proper treatment plan ning, establishes records of legal value, and encourages cooperation with physi cians for joint management. “ The identity of this disease, therefore, should be con sidered part of the evaluation and profes sional management of all patients com ing into the dental practice," he said.
HIGH BLOOD PR E SSU R E D E T E C T IO N BY D E N T IS T S
P ro to ty p e P ro g ra m s . Prototype com
munity programs of dentist screening for hypertension were described by Charles L. Berman, director of the first such pro gram in Hackensack, NJ, and Robert E. Cary, Milan, Mo. Dr. Berman’s well-publicized program is cosponsored by the dental society and health department of Bergen County, with the department of continuing edu cation of Fairleigh Dickinson University School of Dentistry. Dr. Berman emphasized that dentists can no longer be concerned with oral health only. He suggested massive pub licity, dental personnel training sessions, and liaison with physicians and commun ity health organizations as being essential to an acceptance of the dentist’s new identity. Dr. Cary related the cooperation of den tists in the Northeastern Dental Society’s newly established screening program. Although the program in this rural area is only 1 month old, half the society's mem bers have already agreed to participate. Dr. Cary, who is the only dentist in his county and is also mayor of Milan, stressed the point that he is a very busy man. “ But I’m not too busy to take blood pressure,” he said. In establishing a blood pressure screen ing program in a rural dental practice or component society, Dr. Cary suggested a thorough study of all available informa tion, follow-ups on referrals, and contin uous encouragement to colleagues par ticipating in the program. He emphasized the importance of ensuring physicians that the participants were not diagnos ing or treating hypertension, but merely screening patients and referring them for further evaluation. Dental schools also must make an ef fort to promote high blood pressure screening, said Louis M. Abbey, Rich mond, Va, assistant professor of oral pathology, Medical College of Virginia, School of Dentistry, who described the program at the school. The program in volves screening, referral, and referral follow-up. Results of the program show that “ patients can be screened in dental settings quickly and efficiently providing proper preliminary planning for screen ing, referral, and follow-up is carried out,” Dr. Abbey said. In addition, “ patients are willing to accept a dentist as one who is concerned about their total health.” L e g a l Im p lic a tio n s . The dentist s re
iOWas^i^OMAMÊRiCÂNS W EHIGHBLOODPRESSURE!
W HYDEN|STSSHOULO MgASUREBLfOD'fRESSURES flEAOH
OEPAftmcm OCNTA! DENTAL; eCiiCATION
OENTJST
C. L. Hallquist, Philadelphia, manager of Public Education Services, Merck, Sharp and Dohme, has his blood pressure read by Dr. Berman. sponsibility to take blood pressure was explored by attorney Bernard J. Conway, ADA assistant executive secretary for legislation and legal affairs. Blood pres sure screening by dental personnel is not without its legal implications. Aside from the dentist’s authority to take blood pres sure readings, Mr. Conway said that the large concept involves “ the dentist's re sponsibility to conduct a sufficient eval uation of his patient’s total health condi tion to ensure that his treatment of the patient’s oral diseases will not aggravate other health problems.” Mr. Conway explained that the legal concepts that apply to hypertension screening by dental personnel evolved from court decisions rather than statu tory law. Although only California, Mich igan, and Pennsylvania mention “ physical evaluation” as part of the dental law, “ the dental law in all the states, impliedly at least, authorizes the dentist to take physi cal evaluations.” To illustrate the dentist’s responsibility to take blood pressure readings, he re lated two court cases of malpractice, based on complications arising from treatment of hypertensive patients. He said the negligent act “ in many instances is an omission to act rather than the com mission of an act.” In both cases, the ver
dicts of malpractice could have been avoided if proper medical histories and blood pressure tests were taken. The question of what the dentist does with the information he obtains regard ing blood pressure is also pertinent. The dentist is acting illegally if he uses the results to prescribe something for the patient’s medical condition, Mr. Conway pointed out. “ But if the dentist uses blood pressure or other tests to determine how to proceed with his dental treatment plan, in my opinion he is acting legally and pro fessionally as he should to help his pa tient,” he said. Conference discussion group recom mendations called for the development of guidelines for dentists in hypertension screening programs, dental society par ticipation in programs, the dissemination of education materials for the dentist’s office, publicity from national, state, and local dental organizations, and continu ing education courses in hypertension detection for dentists and their auxil iaries. Information on the dentist’s role in hy pertension detection is available from the ADA Council on Dental Health. Mrs. Resnick is a staff writer for the Council on Dental Health. R esnick: HYPERTENSION CONFERENCE ■ 1263