Should Blood Pressure be Required in Dental Electronic Health Records?

The Federal Meaningful Use mandate program requires that certain data features be incorporated in certified electronic health records. Some dentists are concerned that requiring these measurements is unnecessary.  It can certainly be argued that some of the vitals required in EHRs might not be appropriate in dentistry, but how about blood pressure?

Since a seminal article in 2004, medical professionals have known that dentists can be pivotal in identifying and first diagnosing hypertension. In that study, one third of patients had high blood pressure, and half had never been diagnosed with hypertension. Similar findings have been replicated outside the United States (Engstrom et al). In Texas, the state standard of care for a dental exam includes taking blood pressure measurements.

In addition to providing medical information to patients, taking blood pressure measurements informs dentists about care. Also, anesthesia may affect hypertensive patients differently (for example, see Bronzo et al below).  Age and hypertension affect the risks of intravenous sedation during dental procedures as well (Ueno et al., 2012).There is also some evidence that periodontitis and hypertension may be linked (for example, Vidal et al).

In addition to the preventative role dentists can play as medical professionals in detecting and diagnosing hypertension, the prevalence of undiagnosed high blood pressure leads to complications during dental procedures. For improved clinical care, blood pressure is an important indicator that dentists can collect. In addition, for dentists seeking meaningful use incentives, it is a required measurement.

Lessons Learned:

  • Incorporating blood pressure measurement in EHR can inform dental anesthesia and treatment, as well as overall patient health.
  • Up to half of hypertensive patients have not yet been diagnosed, and dentists can be the medical providers to do so.
  • Hypertension affects reactions to anesthesia and may be linked to other oral conditions.
  • Blood pressure is a required measurement for meaningful use attestation.

Kellogg, Sara & Gobetti, John. (2004) Hypertension in a Dental School Patient Population. Journal of Dental Education, Sept 1, 68 (9): 956-964.

Engström, S., Berne, C., Gahnberg, L., Svärdsudd K.  (2011) Efficacy of screening for high blood pressure in dental health care. BMC Public Health, March 30, 11: 194.

Texas State Board of Dental Examiners (2006) SBDE Rule 108.7(2)(B). Last Accessed 3/23/2013: http://www.tsbde.state.tx.us/index.php?option=com_content&task=section&id=12&Itemid=109

Bronzo, A.L., Cardoso, C.G. Jr., Ortega, K.C., Mion, D. Jr. (2012) Felypressin increases blood pressure during dental procedures in hypertensive patients. Arquivos Brasileiros de Cardiologia. Aug, 99(2): 724-31.

Ueno, D., Sato, J., Nejima, J., Maruyama, K., Kobayashi, M., Kidetani, T., Sekiguchi, R. & Kawahara, H. (2012) Effects of implant surgery on blood pressure and heart rate during sedation with propofol and midazolam. International Journal of Oral and Maxillofacial Implants, 27(6): 1520-6.

Vidal, F., Fiqueredo, C.M., Cordovil, I. & Fischer, R.G. (2011) Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study. Oral Diseases, September, 17(6): 560-3.