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Monitoring Patient Vitals
Getting basic medical information from patients helps clinicians and assistants keep patients healthy
On patients’ first visit to a dental office, they often expect questions regarding their oral health—how often they brush and floss, whether or not they use an oral rinse, if they grind their teeth—but this information should only be part of the equation. More dental practices are asking patients to complete medical history forms and routinely checking patients’ vital signs, such as their blood pressure and pulse.
There are many reasons to keep up-to-date medical information at a dental practice, especially as the link between oral health and overall physical well-being becomes more apparent. Research reports that individuals who are lax with their oral hygiene not only compromise their oral health, but also increase their risk of developing an infection in the lining or valves of the heart.1 Other researchers have discovered that periodontal disease can be an early indicator of diabetes.2
The links between oral and overall health make it important for dental professionals to widen their scope beyond the oral cavity. Reviewing a patient’s medical background should be standard procedure. Assistants should also be educated on how to check a patient’s vital signs, and what is considered within a normal range.
Taking Advantage of an Opportunity
Oral healthcare professionals are given a unique opportunity when it comes to diagnosing overall health issues in their patients, because patients tend to see their dentists twice a year, and their doctors only once a year. As such, dental professionals are often the first health professionals to take notice of a wide range of health issues ranging from cancer to high blood pressure3 to diabetes.1
A complete medical history allows the dental assistant to be aware of any health issues that the patient may be at risk for. This also makes the assistant conscious of any medical conditions the patient already has, what medications the patient is on, whether or not the patient has any allergies and sensitivities, and any other issues that may be critical during a medical emergency.
Dental professionals should be equipped to check a patient’s temperature, pulse, respiration and blood pressure.
The average “normal” body temperature of a healthy adult, when taken orally, is 98.6° F. A body temperature slightly above or below 98.6° F is also acceptable, as “normal” temperature can vary from person to person.4
Pulse indicates the rhythm, strength, and rate of one’s heartbeat. Measured in beats per minute, the normal pulse rate for an adult is between 60 and 100 beats per minute, and for a child 70 to 120 beats per minute. When taking a patient’s pulse, a dental assistant should also take note of the strength of the pulse. An overly strong or weak pulse can be a mark of a health problem. An assistant should also take note of whether the pulse is regular or irregular.4 A normal pulse will become easier to recognize with practice.
After taking a patient’s pulse, a dental assistant should also observe the patient’s respiration. This is best done without the patients’ knowledge, as they can change their breathing patterns if they know they are being watched. Without letting go of the patient’s wrist, the assistant can observe whether the patient is breathing normally or is taking labored breaths. Count the number of breaths the patient takes for 15 seconds. Multiply that number by four to ascertain breaths per minute.5 A healthy adult takes between 12 and 20 breaths per minute.4
There are two factors to take into account when measuring a patient’s blood pressure: systolic and diastolic pressures. Systolic pressure measures the amount of pressure that arteries endure when blood is pumped into them, making them stretch. Diastolic pressure measures the amount of pressure when the heart is not pumping blood and arteries are at their normal size.4
Blood pressure is measured in millimeters of mercury (mm Hg). For a healthy male, desirable blood pressure is between 100 and 140 mm Hg for systolic and 60 and 90 mm Hg for diastolic. For a healthy female, desirable blood pressure is between 90 and 130 mm Hg for systolic and between 50 and 80 mm Hg for diastolic.4
Blood pressure can be indicatory of a patient’s overall health. High blood pressure can cause damage to blood vessels, increasing the likelihood of a stroke, heart attack, or kidney disease.6 Low blood pressure may stem from other medical ailments, and can cause dizziness and poor circulation to the extremities.7 Monitoring their patients’ blood pressure may alert dental assistants to possible health problems unrelated to the oral cavity.
Monitoring Vitals During Procedures
Many procedures require the patient to undergo either local or general anesthesia. Assistants know that patients who are high-risk for reactions or in delicate health need to be monitored. Monitoring a patient’s vitals during these procedures is crucial to ensure the patient’s safety. There are three reasons to monitor vitals during procedures8:
- It helps assistants or the clinician detect acute medical emergencies that could require immediate attention.
- It may reveal that a patient is reacting badly to the procedure before there is a true medical emergency, while the reaction can be reversed.
- It aids clinicians and assistants in evaluating the efficacy of any emergency treatments or preventatives measures rendered.
Talking to Your Patients
Because many patients are not accustomed to having their vitals checked at a dental office, it is important for dental assistants to be prepared to explain the reasoning behind any new procedures. Assistants should be able to express to their patients the links between oral and overall health, how certain dental issues can be indicators of more serious conditions, and how the patient’s twice-yearly appointment is an important part of their overall health.
1. Good dental hygiene may help prevent heart infection. American Dental Association. http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/ADA/2011/article/ADA-03-Good-dental-hygiene-may-help-prevent-heart-infection.cvsp?source=http://www.dentalindia.com. Updated March 23, 2011. Accessed September 12, 2011.
2. Diabetes can be identified in dental office. American Dental Association. http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/ADA/2011/article/ADA-06-Diabetics-Diagnosed-by-Dental-Visit.cvsp?source=http://www.dentalindia.com. Updated June 8, 2011. Accessed September 13, 2011.
3. Dentist. Health Careers Center. http://www.mshealthcareers.com/careers/dentist.htm. Updated 2004. Accessed September 14, 2011.
4. Heiserman DL, ed. Taking Vital Signs. http://www.free-ed.net/sweethaven/MedTech/Vitals/default.asp. Updated 2006. Accessed September 12, 2011.
5. Rathe, R. Vital Signs. http://medinfo.ufl.edu/year1/bcs/clist/vitals.html. Updated December 19, 2000. Accessed September 12, 2011.
6. How to Take a Blood Pressure. http://www.drugs.com/cg/how-to-take-a-blood-pressure.html. Updated 2011. Accessed September 13, 2011.
7. Maloney VR. Learn How to Take Blood Pressure. http://www.bloodpressure-drs-practical-guide.com/howtotakebloodpressure.html. Accessed September 13, 2011.
8. Fukayama H, Yagiela JA. Monitoring vital signs during dental care. Int Dent J. 2006;56(2):102-108.