Time for a little talk about some very important numbers. Can we please talk about your blood pressure? Do you know your numbers?
May is National High Blood Pressure Education month so today’s post couldn’t be timed better.
Here’s how I start my dental workday: I take blood pressure readings on every single patient I see, every single time, even if it is a short appointment. This week I had a patient with the blood pressure reading of 171/117mm/Hg – yikes! He was not overweight, and he was about my age (so he was not old at all). He appeared not to be concerned. Here’s why he should be: he is in imminent danger of having a stroke or heart attack.
High blood pressure is a sign of arterial inflammation. If your arteries are on fire, guess what! So’s your mouth. Your mouth is connected to your body, after all.
Blood Pressure Facts
High blood pressure is indeed a silent killer. People never know they have it until it is tested, or they have that heart attack. 500,000 Americans die annually due to hypertension as the primary or contributary cause. Worldwide, the statistics are no better with 7.6 million people dying due to elevated blood pressure, more than any other risk factor. Nearly half of the American population- 116 million people, have elevated blood pressure.
Heart attacks and strokes affect over 1.6 million Americans each year. 775,000 Americans die due to these heart attacks and strokes. In my research for this article, I learned that a majority of these heart attacks and strokes are silent and are more common in women.
Having high blood pressure at the age of 50 puts you at risk for Alzheimer’s dementia later in life.
High blood pressure is not just for old people either- 26% of 20-to-24-year old’s have it.
Heart disease kills one in three women, while breast cancer kills one in 34. Time to up your game, ladies! Ask for cardiovascular screening.
High blood pressure is frequently triggered by insulin resistance – prediabetes. High blood pressure affects every part of the body: blood vessels, vital organs, heart, brain, eyes, and kidneys. It stresses the body and contributes to a wide variety of health conditions.
Erectile dysfunction could be one of the first signs of arterial disease in men. These smaller arteries are affected first, and high blood pressure can block blood from flowing to the penis. Women can also experience sexual dysfunction due to elevated blood pressure. With reduced blood flow, they can have vaginal dryness, decreased sexual desire, and difficulty achieving orgasm.
Lifestyle is a big factor. Now – today- is a good day to address things that affect our immune response: high sugar intake, sedentary lifestyle, obesity, lack of exercise, smoking, sleep apnea, alcohol, mouth breathing, prediabetes and diabetes, as well as periodontal disease. All these play a big part in not only setting the stage for hypertension and cardiovascular diseases but also overall systemic health. and chronic diseases. And almost all of these things are within our control.
Genetics do play a part in our susceptibility to heart issues and blood pressure. Know your family history and share that with your primary care doctor. Our genes are not our destiny, so testing for and being aware of the potential issues before they do damage is the best preventive medicine there is. High blood pressure is not something you should “just live with.” My goal is to intervene years earlier and prevent this from even happening.
New Guidelines for Blood Pressure
In 2017 the American Heart Assocation set new guidelines for hypertension management and defined high hypertension as a blood pressure of 130/80mmHg and stage 2 hypertension at 140/90mmHg. Previously the 140/90 reading was the high end of normal. This is no longer the case.
Now we know that even a slight elevation of 120/80 mm/Hg is prehypertensive and renamed it stage 1, and even that level doubles the risk of heart attacks and strokes. The new targeted healthy blood pressure for the average person is 115/75mm/Hg.
That said, optimum blood pressure is different for everyone. For folks with narrow arteries, you may need that higher diastolic pressure to squeeze blood through. Each person needs to work closely with their doctor to customize their healthcare plan.
What is Blood Pressure?
Blood oxygen and nutrients are delivered through the blood vessel and into the tissues and organs. Blood pressure aids us in distributing white blood cells throughout the body to protect us against illness and diseases.
Blood pressure is read as a set of two numbers – the first or top number is called the systolic pressure and the second or bottom number is called the diastolic pressure. The heart muscle is nourished by diastolic pressure pushing nutrients and oxygen through the coronary arteries while the brain is flooded with oxygenated blood from the systolic pressure.
Systolic pressure measures the force the heart exerts on the walls of the arteries each time the heart beats.
Diastolic pressure measures the force the heart exerts on the walls of the arteries between beats when the heart muscle is resting and refilling with blood.
High blood pressure causes an inflammation in the arteries, which is then the spark that starts the fire for most chronic diseases. Chronic disease is the leading cause of death. Let’s change that! My goal is to live to a healthy 100 years old. Being aware of these little things from the start and we can all live healthier lives.
Knowing Your Numbers in the Dental Office
I have had patients question why I take blood pressure- not many, but a few have had issues with this. They feel I am invading their health privacy. Or, they have already had this conversation with their primary care doctor and don’t want to be nagged. Consider it a loving nag, we want to help you save your life and live a long time. We are committed to your overall health and taking your blood pressure is part of a comprehensive examination. And it might just save your life.
For many people, the dentist and dental hygienist are the only medical professionals they see on a consistent basis. I ask folks when they last saw their primary care doctor and their reply: years or (and I cringe at this answer) never. Your dental healthcare providers are no different from your medical healthcare providers. Many serious medical conditions are first detected in the mouth. Your dental hygienist is your first line of defense in detecting and preventing many oral conditions and diseases. We focus on overall health, not just mouth health.
The Oral-Systemic Connection
Really, there is no such thing as ” just a cleaning” or “just a filling”. We need to figure out why you are getting cavities and bleeding gums. There is a much bigger issue related to the systemic health of the body that is causing this breakdown.
Cardiovascular disease does indeed affect your mouth- it can contribute to dry mouth, resulting in tooth decay. Bleeding gums mean that your arteries are on fire and inflamed. This becomes a diagnostic tool connecting hypertension to diabetes and periodontal disease. High blood pressure is closely linked to diabetes. When I see consistent readings in my patients above 135/80mm/Hg, I always refer them to their primary care doctors for further evaluation and treatment.
One of the keys to that longer, healthy life is to be dedicated to oral health with regular dental hygiene care and doing excellent self-care- and oral hygiene at home. Your dental hygienist should be your favorite superhero healthcare provider. Maintaining oral health helps to prevent so many chronic diseases – type 2 diabetes, rheumatoid arthritis, erectile dysfunction, and dementia to mention but a few.
Standard Of Care
In my dental office it is the standard of care to take blood pressure readings on every patient every single time a patient sits in the chair. (That is just the beginning of treatment and care but it sets the stage for the rest of the appointment.) Dental care is about so much more than scraping or drilling on teeth. We are a medical office that focuses on the health of the mouth and how it relates to the rest of the body. That’s why we look at blood pressure as part of your dental office appointment. If your blood pressure is high, your body’s on fire and in “crisis – red alert” mode. (Yes, I am repeating this because there should be NO doubt that even a “little bit of bleeding” means INFLAMMATION and DISEASE.)
A standard of care refers to informal or formal guidelines that are generally accepted in the medical community for the treatment of a disease or condition. The degree of care (watchfulness, attention, caution, and prudence) that a reasonable person should exercise under the circumstances.
The standard of care evolves over time. Adding blood pressure screening to every dental exam is new to many offices but both the American Heart Association and the American Dental Association have both strongly recommended this be part of comprehensive dental care.
Dental Anxiety and White Coat Syndrome
Too often, I have patients tell me they have what is termed “white coat syndrome” or “white coat hypertension”. They get anxious in a medical setting and have a higher blood pressure reading than what they get at home. With White Coat Hypertension, blood pressure readings on average tend to be about 10mmHg higher for the systolic, and 5mmHg diastolic, in a clinic than at home, but could be as much as 30mmHg higher. If you have white coat hypertension, your blood pressure could creep up into high blood pressure.
It is normal to have a slight rise in blood pressure due to dental anxiety and stress in the office. When we know that, we can help you relax with music, nitrous oxide, topical numbing gels, local anesthetics, weighted blankets, television, hypnotherapy, medications, and a fabulous drug-free tool called the Alpha Stim.
The problem with an already elevated blood pressure is that anxiety could raise it to a level that provokes a medical emergency. I, of course, would like to think my patients are not anxious when they see me (I am such a gentle and encouraging person, after all) and I never wear a white coat, but I do understand the dental office setting is anxiety-provoking. Please let your dental provider know if you are nervous. They have many tools at their disposal to help you manage and reduce your dental fears and anxieties.
Ideally, you know what your normal numbers are and then if we see a rise in the dental setting, we can help you and adjust our procedures.
I want each patient to have a blood pressure baseline noted in their chart prior to treatment so we know what is normal for you and can give you the proper dosage and kind of anesthetic that is safe for your body. We can avoid a hypertensive crisis in the dental office and safeguard your health.
Back to my patient- my guess is he had no idea there was a problem. High blood pressure often has no signs or symptoms, thus the reason it is called the silent killer.
The Highs and Lows of Blood Pressure Numbers
Normal (Healthy) is between 90/60 mmHg to 120/80mmHg
It is possible to have blood pressure that is too low. This is called “Hypotension” and it could also be a cause for concern. It could signify an underlying medical condition. Dizziness, fainting, blurred vison, or a lack of concentration should trigger a trip to the doctor to find out why this is happening.
It may be a sign of dehydration.
Severely low blood pressure can deprive your body of enough oxygen to carry out its functions, leading to damage to your heart and brain.
Then again, it might be normal for you as long as you have no symptoms. Know your body.
Hypertension – is elevated 120-129 systolic and diastolic is less than 80 mm Hg
High: Hypertensive Stage 1 – 130 to 139 or diastolic is 80 to 89
High: Hypertension Stage 2 – 140+ or Diastolic 90+
Crisis: 180+ or diastolic 120+ retake in five minutes. If it does not come down this may be a hypertensive urgency and call the doctor. If there are signs such as shortness of breath, confusion, blurred vision, chest pain, or irregular heartbeat, this may be a hypertensive emergency. Call 911.
The Tools We Use
The tried-and-true tool hanging from every doctor’s neck is the stethoscope. Combine that with the sphygmomanometer (blood pressure cuff) and you have the gold standard way to measure blood pressure. “Sphygmos” is Greek for beating of the heart or pulse and a “Manometer” measure the fluid pressure.
I use a wrist cuff because I find it is a good screening tool. It makes taking blood pressure fast and easy so I can do it every time. It will monitor the blood pressure, as well as give me a reading for pulse rate and even tell me if there is an irregular heartbeat. Is it as good as the sphygmomanometer? For me it is a good screening tool. If the reading on the wrist is high, I pull out our cuff and stethoscope and try it that way. If it consistently reads high, then I refer my patient to their primary care doctor where they can use their more accurate diagnostic tools. It is important to follow the recommended instructions to get accurate readings.
Heart Healthy Action
Living a heart healthy lifestyle just makes sense for so many reasons. Chronic disease takes its toll on all our body parts. Stress reduction, deep restful sleep, weight management, exercise, real healthy food, and even optimism all helps us have a healthier life.
Some Light Reading
As May is blood pressure screening education month, here is your homework. Please read this informative book.
You are ultimately in charge of your own health. Most doctors spend maybe 15 minutes with you addressing symptoms. You need to get to “why” the symptoms are occurring and then get to the “how” to fix and even better, prevent it from ever happening. Knowledge is key. Educate yourself and your family.
Please take heart healthy actions today, protect your arteries and brain, and improve your overall health. Lifestyle matters. Prevention starts even for young people.
High blood pressure is treatable with the help of your primary care providers and is something you should not just “live with”. Dropping your readings by even 5mm/Hg will decrease your risk of heart attack and stroke by 10%.
This book by Drs Bale and Doneen will help you know what kind of heart screenings to request. Take charge of your health.
Make your Heart Sing. Please take your blood pressure! And if your dental office doesn’t do it, please ask them to include it during every exam. Know your numbers. High blood pressure is a silent killer. It’s that important.
Biological Oral Health Specialist and Avid Blood Pressure Taker