- Email: [email protected]
Screening for hypertension
Fig 4.—The laser fiber after calibration is placed on the tissue at the top of the sulcus to start treatment. (Raffetto N. First phase nonsurgical laser periodontal treatment: A case study. Access 2009; 23 (8): 10. Reprinted with permission from the American Dental Hygienists’ Association.)
Fig 5.—Accumulated debris on the laser fiber is wiped off with a dry gauze to ensure laser efficiency. (Raffetto N. First phase nonsurgical laser periodontal treatment: A case study. Access 2009; 23 (8): 10. Reprinted with permission from the American Dental Hygienists’ Association.)
One month after the final treatment, the patient returned for an evaluation of tissue healing and the patient’s home care skills. No probing was performed. The patient reported no postoperative discomfort and demonstrated good compliance with the home care regimen. No inflamed tissue remained. Follow-up appointments after 3, 6, 9, and 12 months showed improved probing depths, clinical attachment level gains, absence of inflammation, and good tissue tone. The patient has maintained home care and his long-term prognosis is good.
reattach to the root surface and should not be disturbed by introducing a probe too early in the healing process.
Discussion.—The dental hygienist is able to deliver laser-assisted first-phase periodontal therapy to help patients achieve and maintain optimal levels of oral health. Used by properly trained and experienced operators, soft-tissue lasers can help treat periodontal disease. It may be wise to begin light probing 3 months after treatment and a definitive 6-point probing at 6 months. The fibers are tender as they
Clinical Significance.—Treatment of periodontal disease is designed to achieve adequate plaque control and occlusion, improve the periodontal condition with a gain in clinical attachment level, and help the patient maintain excellent oral hygiene. Soft-tissue lasers can be an important adjunctive tool in this process. Hygienists can perform this nonsurgical procedure.
Raffetto N: First phase nonsurgical laser periodontal treatment: A case study. Access 23:8, 10, 14, 2009 Reprints not available
Oral Medicine Screening for hypertension Background.—Hypertension, defined as chronic elevated blood pressure (BP) more than 140/90 mm Hg, contributes to diseases such as stroke and coronary heart disease, causing premature morbidity and mortality. Estimates of the prevalence of hypertension in the United
Kingdom are as high as 40% in the general population, with up to 32% in dental patients. Since up to 59% of the population visits the dentist regularly, the dental office may offer a BP screening site. Whether such screening would offer a health benefit was investigated.
Volume 55
Issue 2
2010
75
18% 39% 61%
82%
Fig 1.—Percentage of patients with high blood pressure reading in sample observed. (Courtesy of Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009.)
Methods.—All patients above the age of 18 years were offered BP screening before their dental checkup or treatment over the course of 3 days. All the patients were also requested to fill in Corah’s Dental Anxiety Scale (DAS) before treatment or examination to determine if their BP was related to perceived anxiety level. Patients having BP readings more than 140/90 mm Hg were advised to consult a physician for follow-up. Results.—A total of 114 patients, average age of 41.2 years, were screened. Of these, 39% (44 patients) had systolic readings exceeding 140 mm Hg, diastolic readings more than 90 mm Hg, or both (Fig 1). Eight had been diagnosed with hypertension and were taking medication for the condition (Fig 2). Sixty-three percent of these (5 patients) still had elevated BP levels. In 7 patients the BP screening identified readings more than 160/110 mm Hg. A DAS score more than 9 and elevated BP were noted in 39% of participants (17 patients). DAS score and elevated BP did not correlate (Fig 3). Discussion.—BP screening during the dental visit identified a significant number of patients who had elevated BP levels before their dental procedure or examination. In addition, several patients already undertreatment
76
Dental Abstracts
Undiagnosed with high B.P.
Hypertensive
Diagnosed hypertensives Fig 2.—Percentage of patients with high blood pressure. (Courtesy of Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009.)
for hypertension still had elevated BP levels, indicating inadequate control of their condition. No correlation was found between patient anxiety and BP, and so the white coat effect was minimal. Dentists can easily accomplish BP screening and refer patients with elevated levels to their physicians. 200
BP sys
180 160 140
BP (Sys)
Normal B.P.
120 10 0 80 60 40 20 0 0
5
10
15
20
25
DAS
Fig 3.—Scatter graph showing systolic blood pressure v DAS. (Courtesy of Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009.)
Clinical Significance.—Today we have BP measuring machines in our grocery stores and pharmacies. Because of the prevalence of hypertension in the general population and the identified links between disease and oral health, it makes sense for dentists to include screening for various aspects of the patient’s overall health, especially BP, during regular examinations. As shown here, not only can such screening identify patients with previously undetected hypertension, but it may be a good way to see if those being treated are receiving maximum benefit from their therapy.
Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009 Reprints available from S Beheshti; e-mail: shahryar_beheshti@ hotmail.com
Oral Surgery Emergency tracheotomy Background.—In a tracheotomy, a hole is created in the trachea to secure the upper airway. It is used in cases of reduced dead space, long-term endotracheal intubation, long-term mechanical ventilation after neuromuscular impairment, and surgical obstruction. Emergency tracheotomy or cricothyrotomy may be needed to supply adequate oxygen for patients who cannot be ventilated manually or intubated. A case report documents the performance of a tracheotomy for a dental patient. Case Report.—A 68-year-old woman who was having labored breathing while lying supine in the dental chair. She did not respond to verbal commands or stimulation. Her pulse rate was 75 per minute and blood pressure was 260/163 mm Hg. Her history included both lung cancer and hypothyroidism. A partial denture was being inserted while the patient was in the chair; she had not received any local anesthesia. A bag valve mask was used to provide mechanical ventilation, but the process was meeting significant resistance. Mechanical ventilation continued to be difficult even after oral airways were placed. The patient’s anatomy made it difficult to see her vocal cords (Table 1), and so the decision was made to perform endotracheal intubation. Drawbacks included the patient’s large neck, which obscured the cricoid cartilage, and her position in the dental chair, which failed to adequately stabilize her head and neck. Without accompanying anesthesia, a vertical incision 2 to 3 cm long was made midway between the cricoid
Table 1.—Mallampati Classification Class I: Class II: Class III: Class IV:
soft palate, fauces, uvula, pillars soft palate, fauces, portion of uvula soft palate, base of uvula hard palate only
Adapted from Mallampati SR, Gatt SP, Gugino LD, et al: A clinical sign to predict difficult tracheal intubation: A prospective study. Can Anaesth Soc J 32:429, 1985. (Courtesy of Sadda R, Turner M: Emergency tracheotomy in the dental office. Int J Oral Maxillofac Surg 38:1114-1115, 2009.)
cartilage and the sternal notch. A small amount of dark blood was noted. A hemostat was used to dissect the strap muscles laterally within the midline. The trachea was palpated and a 15 blade used to incise tracheal rings 2, 3, and 4. The endotracheal tube used was a size 8. It was placed in the trachea and connected to the bag valve mask. A carbon dioxide monitor and auscultation were used to confirm good ventilation. The tube was taped to the patient’s neck and sutures placed. An 18-gauge intravenous catheter was positioned in the right antecubital fossa. The patient’s heart rate fell to 60 beats/min, and no pulse was detected at the radial or carotid arteries. Atropine and epinephrine were begun as part of the pulseless electrical activity protocol. Pulse rate rebounded, but ventricular tachycardia developed. An electric shock at 360 volts was administered, which converted the patient to sinus rhythm, allowing her to be transported
Volume 55
Issue 2
2010
77
Fig 5.—Accumulated debris on the laser fiber is wiped off with a dry gauze to ensure laser efficiency. (Raffetto N. First phase nonsurgical laser periodontal treatment: A case study. Access 2009; 23 (8): 10. Reprinted with permission from the American Dental Hygienists’ Association.)
One month after the final treatment, the patient returned for an evaluation of tissue healing and the patient’s home care skills. No probing was performed. The patient reported no postoperative discomfort and demonstrated good compliance with the home care regimen. No inflamed tissue remained. Follow-up appointments after 3, 6, 9, and 12 months showed improved probing depths, clinical attachment level gains, absence of inflammation, and good tissue tone. The patient has maintained home care and his long-term prognosis is good.
reattach to the root surface and should not be disturbed by introducing a probe too early in the healing process.
Discussion.—The dental hygienist is able to deliver laser-assisted first-phase periodontal therapy to help patients achieve and maintain optimal levels of oral health. Used by properly trained and experienced operators, soft-tissue lasers can help treat periodontal disease. It may be wise to begin light probing 3 months after treatment and a definitive 6-point probing at 6 months. The fibers are tender as they
Clinical Significance.—Treatment of periodontal disease is designed to achieve adequate plaque control and occlusion, improve the periodontal condition with a gain in clinical attachment level, and help the patient maintain excellent oral hygiene. Soft-tissue lasers can be an important adjunctive tool in this process. Hygienists can perform this nonsurgical procedure.
Raffetto N: First phase nonsurgical laser periodontal treatment: A case study. Access 23:8, 10, 14, 2009 Reprints not available
Oral Medicine Screening for hypertension Background.—Hypertension, defined as chronic elevated blood pressure (BP) more than 140/90 mm Hg, contributes to diseases such as stroke and coronary heart disease, causing premature morbidity and mortality. Estimates of the prevalence of hypertension in the United
Kingdom are as high as 40% in the general population, with up to 32% in dental patients. Since up to 59% of the population visits the dentist regularly, the dental office may offer a BP screening site. Whether such screening would offer a health benefit was investigated.
Volume 55
Issue 2
2010
75
18% 39% 61%
82%
Fig 1.—Percentage of patients with high blood pressure reading in sample observed. (Courtesy of Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009.)
Methods.—All patients above the age of 18 years were offered BP screening before their dental checkup or treatment over the course of 3 days. All the patients were also requested to fill in Corah’s Dental Anxiety Scale (DAS) before treatment or examination to determine if their BP was related to perceived anxiety level. Patients having BP readings more than 140/90 mm Hg were advised to consult a physician for follow-up. Results.—A total of 114 patients, average age of 41.2 years, were screened. Of these, 39% (44 patients) had systolic readings exceeding 140 mm Hg, diastolic readings more than 90 mm Hg, or both (Fig 1). Eight had been diagnosed with hypertension and were taking medication for the condition (Fig 2). Sixty-three percent of these (5 patients) still had elevated BP levels. In 7 patients the BP screening identified readings more than 160/110 mm Hg. A DAS score more than 9 and elevated BP were noted in 39% of participants (17 patients). DAS score and elevated BP did not correlate (Fig 3). Discussion.—BP screening during the dental visit identified a significant number of patients who had elevated BP levels before their dental procedure or examination. In addition, several patients already undertreatment
76
Dental Abstracts
Undiagnosed with high B.P.
Hypertensive
Diagnosed hypertensives Fig 2.—Percentage of patients with high blood pressure. (Courtesy of Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009.)
for hypertension still had elevated BP levels, indicating inadequate control of their condition. No correlation was found between patient anxiety and BP, and so the white coat effect was minimal. Dentists can easily accomplish BP screening and refer patients with elevated levels to their physicians. 200
BP sys
180 160 140
BP (Sys)
Normal B.P.
120 10 0 80 60 40 20 0 0
5
10
15
20
25
DAS
Fig 3.—Scatter graph showing systolic blood pressure v DAS. (Courtesy of Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009.)
Clinical Significance.—Today we have BP measuring machines in our grocery stores and pharmacies. Because of the prevalence of hypertension in the general population and the identified links between disease and oral health, it makes sense for dentists to include screening for various aspects of the patient’s overall health, especially BP, during regular examinations. As shown here, not only can such screening identify patients with previously undetected hypertension, but it may be a good way to see if those being treated are receiving maximum benefit from their therapy.
Sproat C, Beheshti S, Harwood AN, et al: Should we screen for hypertension in general dental practice? Br Dent J 207:275-277, 2009 Reprints available from S Beheshti; e-mail: shahryar_beheshti@ hotmail.com
Oral Surgery Emergency tracheotomy Background.—In a tracheotomy, a hole is created in the trachea to secure the upper airway. It is used in cases of reduced dead space, long-term endotracheal intubation, long-term mechanical ventilation after neuromuscular impairment, and surgical obstruction. Emergency tracheotomy or cricothyrotomy may be needed to supply adequate oxygen for patients who cannot be ventilated manually or intubated. A case report documents the performance of a tracheotomy for a dental patient. Case Report.—A 68-year-old woman who was having labored breathing while lying supine in the dental chair. She did not respond to verbal commands or stimulation. Her pulse rate was 75 per minute and blood pressure was 260/163 mm Hg. Her history included both lung cancer and hypothyroidism. A partial denture was being inserted while the patient was in the chair; she had not received any local anesthesia. A bag valve mask was used to provide mechanical ventilation, but the process was meeting significant resistance. Mechanical ventilation continued to be difficult even after oral airways were placed. The patient’s anatomy made it difficult to see her vocal cords (Table 1), and so the decision was made to perform endotracheal intubation. Drawbacks included the patient’s large neck, which obscured the cricoid cartilage, and her position in the dental chair, which failed to adequately stabilize her head and neck. Without accompanying anesthesia, a vertical incision 2 to 3 cm long was made midway between the cricoid
Table 1.—Mallampati Classification Class I: Class II: Class III: Class IV:
soft palate, fauces, uvula, pillars soft palate, fauces, portion of uvula soft palate, base of uvula hard palate only
Adapted from Mallampati SR, Gatt SP, Gugino LD, et al: A clinical sign to predict difficult tracheal intubation: A prospective study. Can Anaesth Soc J 32:429, 1985. (Courtesy of Sadda R, Turner M: Emergency tracheotomy in the dental office. Int J Oral Maxillofac Surg 38:1114-1115, 2009.)
cartilage and the sternal notch. A small amount of dark blood was noted. A hemostat was used to dissect the strap muscles laterally within the midline. The trachea was palpated and a 15 blade used to incise tracheal rings 2, 3, and 4. The endotracheal tube used was a size 8. It was placed in the trachea and connected to the bag valve mask. A carbon dioxide monitor and auscultation were used to confirm good ventilation. The tube was taped to the patient’s neck and sutures placed. An 18-gauge intravenous catheter was positioned in the right antecubital fossa. The patient’s heart rate fell to 60 beats/min, and no pulse was detected at the radial or carotid arteries. Atropine and epinephrine were begun as part of the pulseless electrical activity protocol. Pulse rate rebounded, but ventricular tachycardia developed. An electric shock at 360 volts was administered, which converted the patient to sinus rhythm, allowing her to be transported
Volume 55
Issue 2
2010
77