Vital Signs: Tapping into Lifelines
See the entire picture of your patient’s health
Measuring patient vitals provides the dental team with the opportunity to measure a patient’s overall health, yielding important clues that can help with dental care. The links between oral and overall health make it essential for dental professionals to widen their scope beyond the oral cavity. Vital signs, which include blood pressure, pulse, temperature, and respiration, can be excellent barometers for how the body should be functioning, and some can help indicate the patient’s emotional state.
Although not frequently performed by dental offices,1 monitoring vital signs offers significant benefits for both dental team and patient. Dentists and dental assistants can identify acute medical emergencies that may require an immediate action. Also, problems may be revealed before a true medical emergency occurs outside the dental office—the patient may not have been aware of these issues. Checking vital signs can also provide pertinent information for the dental team should a medical emergency occur in the dental office.2
Patients may be feeling anxious when undergoing extensive dental procedures and may have physical reactions, such as increased blood pressure. Monitoring patient vitals is particularly important for medically compromised patients and elderly patients.2 In patients with high blood pressure, for example, patients have a much greater risk for conditions such as stroke and heart attack. About 87% of strokes are ischemic, which are caused by narrowed or clogged blood vessels in the brain.3
“Dental practices should have a written protocol for taking and reporting patient vitals,” says Kathy Zwieg, LDA, CDA. “Such a protocol might entail what the dental assistant should do if results raise concern or which patients warrant this check and the frequency.” Also, health history charts in the patient’s records should have spaces for recording this information.
Known as the silent killer, high blood pressure typically has no signs other than high readings taken during a visit with a medical or dental provider.
“It is often said that blood pressure can be the eyes for a litany of medical issues,” Zwieg says. “It’s important for dental assistants to take blood pressure because it is an indicator of how the patient is doing that day.”
Left unchecked, high blood pressure can damage the heart, brain, kidneys, and eyes.4
Conversely, very low blood pressure when it causes symptoms can be a concern. When patients have dizziness, lightheadedness, fainting (also called syncope), and other symptoms of low blood pressure, an underlying cause may be a factor.5
Blood pressure is the force of blood against the walls of arteries and is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). The measurement is written one above or before the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mm Hg (millimeters of mercury) is expressed verbally as “120 over 80.”6 Normal blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Regardless of race, age, or gender, anyone can develop high blood pressure, or hypertension. An estimated 1 in 4 American adults has high blood pressure, which is typically a lifelong condition, once diagnosed.
Dental assistants can take blood pressure measurements by using a sphygmomanometer, which has a pump to inflate a cuff, a dial to be used to record the reading, a cuff that is wrapped around the arm, and a valve. To eliminate the risk for human error or dealing with a patient’s clothing that might not be easy to adjust, some dental practices are using electronic or digital devices that do not require a stethoscope. Some of these devices measure blood pressure through the wrist.
“When taking blood pressure, be sure the patient’s legs are not crossed and the arm is straight; bends can restrict blood flow and impact the reading,” Zwieg says.
Taking a patient’s temperature is important because this can help determine if an infection is present. The average “normal” body temperature of a healthy adult, when taken orally, is 98.6° F. If the temperature is high, be sure to call the dentist’s attention to the reading.
For the dental office, several types of thermometers are available—digital, tympanic (the ear), disposable thermometer tapes, and standard glass; however, it’s wise to avoid the standard glass thermometer, which contains mercury and can be damaged more easily.1 Digital thermometers are popular because they are convenient and easy to read, with plastic probe covers available. Disposable thermometer tapes can be inaccurate if stored near a heat source.
The pulse is the number of heartbeats each minute. Pulse rate could indicate other medical conditions, providing indicators for cardiac conditions, such as atrial fibrillation—a fast, irregular heartbeat—and tachycardia—a rapid heart beat. Although pulse rate can be measured in a number of places in the body where the artery is close to the skin, such as the neck and the temple, the wrist is the commonly used in the dental office.
Some factors that could affect heart rate are: higher air temperatures, body position (standing up could increase pulse), body size (extreme obesity may increase pulse), and medication use.7
To take a pulse, use a watch with a second hand. Use gentle pressure with two or three fingers, rather than the thumb. Count the number of pulsations in 15 seconds and then multiply that by four for the pulse rate. Most adults have a pulse in the range of 60 to 100 beats. In patients with high blood pressure, the carotid artery in the neck should be used.1
A dental assistant will measure respiratory rate by the number of breaths in 15 seconds. The average respiration rate for an adult is 12 to 20 breaths. For teenagers, it’s 15 to 25; for toddlers, it’s 20 to 30; and for infants, it’s 25 to 40. Patients may unconsciously alter their breathing when they are told that their respiration is being checked.1
“One trick I used when I was a paramedic was that we would say to the patient, ‘We’re just going to check your pulse now.’ And you just go from checking the pulse to checking respirations by watching the patient’s chest rise and fall,” says Zwieg.
Talking to the Patient
A strong rapport with the patient is the cornerstone to good patient care. Taking vital signs is only part of the scope. “If blood pressure or another reading is concerning, the dental assistant should engage the patient in conversation to find out basics that will help the dental team,” Zwieg says. “Ask the patient if he or she is taking blood pressure medication. If so, the assistant should ask if the patient took the medication that day. Another good leading question is: ‘When was the last time you had your blood pressure checked?’”
Taking vital signs can help provide key pieces to the puzzle for the dental team and assist the patient with being healthier overall.
1. Protzman S, Clark J, Leeuw W. Management of medical emergencies in the dental office. Dental Care Web site. http://www.dentalcare.com/en-US/dental-education/continuing-education/ce131/ce131.aspx?ModuleName=coursecontent&PartID=4&SectionID=-1. Accessed December 17, 2013.
2. Fukayama H, Yagiela JA. Monitoring of vital signs during dental care. Int Dent J. 2006;56(2):102-108.
3. Stroke and high blood pressure. American Heart Association. Accessed December 17, 2013. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Stroke-and-High-Blood-Pressure_UCM_301824_Article.jsp#
4. Mayo Clinic Web site. High blood pressure (hypertension). http://www.mayoclinic.com/health/high-blood-pressure/HI00062. December 17, 2013.
5. Low Blood Pressure. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Low-Blood-Pressure_UCM_301785_Article.jsp#. Accessed December 16, 2013.
6. National Heart, Lung, and Blood Institute Web site. Your Guide to Lowering High Blood Pressure. http://www.nhlbi.nih.gov/hbp/bp/bp.htm. Accessed December 17, 2013.
7. All About Heart Rate (Pulse). American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/All-About-Heart-Rate-Pulse_UCM_438850_Article.jsp