Final_Research_Proposal

Research Proposal

Blood Pressure Screenings at Dental Hygiene Visits

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April 29th, 2015

Bethany Bates

Amanda Milardo

Marlene Casenova

Oriana Rodriguez

Blood Pressure at Dental Hygiene Visits

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Chapter 1 - Introduction

Problem: This study will determine if registered dental hygienists are taking blood

pressure on patients at dental hygiene visits to provide comprehensive patient

care.

Significance of the problem:

Routine blood pressure and vitals screening are an important factor to a person’s

overall health. To provide comprehensive patient care at dental hygiene

appointments, vitals should be taken as a screening precaution and to avoid

medical emergencies. The American Heart Association suggests that 33% of

U.S. adults over the age of 20 have hypertension (Heart Disease, 2014). Dental

hygienists should complete essential screenings to prevent medical emergencies

and provide early disease detection.

This study will determine the quantity of dental hygienists that are providing blood

pressure screenings for detection of hypertension. This holds great significance

because it allows us to find out how many dental offices emphasize the

importance of blood pressure screenings. Furthermore, determining how many

dental hygienists are following through with the duties outlined in the dental

hygiene scope of practice. Our results will determine the amount of dental

hygienists that are performing these screenings, and if not, what is restraining

them.


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Terms:

Blood pressure stages: normal (systolic less than 120 diastolic less than 80),

pre-hypertension (systolic 12-139 and diastolic 80-89) and hypertension (systolic

140 or higher and diastolic 100 and higher).

Pulse: (60-100 beats per minute) and respiration (12-20 beats per minute)

Prevention: Preventing the progression of hypertension and/or cardiovascular

disease, as well as preventing medical emergencies in dental settings is also part

of the dental hygienist’s job.

Early detection: Detection of disease before progression. Early detection of

hypertension is key to maintaining optimum systemic and oral health. Many

patients don’t have diagnosed hypertension and are not aware that they have it.

Diagnosed hypertension: Diagnosed hypertension is assessed by health care

physicians and can be promptly treated with pharmacotherapy or non-

pharmacotherapy.

Limitations:

This study will be limited to registered dental hygienists practicing in private

practice and public health settings in the state of Connecticut.

Delimitations:

This study excludes current dental hygiene students, dental hygienists that are

sales representatives, dental hygiene administrative positions, dental hygiene

educators, and dental hygiene advocates.


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Assumptions:

We assume that dental hygienists know the importance of blood pressure

screenings.

We assume that registered dental hygienists are educated on taking vitals and

determining normal versus abnormal readings.

Chapter 2 -‐ Literature Review

In light of the growing awareness of oral health and its connections to systemic

health, this study is designed to determine if registered dental hygienists are

taking vitals and blood pressure readings at dental hygiene appointments to

provide comprehensive patient care. By taking vitals at dental hygiene

appointments, the dental hygienist can assure the patient that sufficient care is

being taken by screening for hypertension, preventing medical emergencies, and

taking medical conditions into consideration that will interfere with treatment.

Many people are not aware that they have high blood pressure; this is why it is

known as the “silent killer.” A review of the existing literature suggests that 33%

of US adults over the age of 20 have hypertension (AHA, 2014). If dental

hygienists took regular vital signs and blood pressure readings at the patient’s

dental hygiene visits, they will have the ability to inform patients of their disease

status, prevent further advancement of the disease and prevent medical

emergencies. A potential problem that dental hygienists face in preventing them


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from completing these practices is not having enough time to take vitals and

blood pressure screenings (Greenberg, 2010).

The American Heart Association also states that 6% of Americans have

undiagnosed hypertension (2014). During a dental hygiene appointment, dental

hygienists have the option to provide patient comfort with the use of local

anesthetics. To a normal, healthy patient, this is ideal treatment; to a patient with

undiagnosed hypertension, this could raise a patient’s blood pressure even more

than it is already raised. According to a study on the influence of local

anesthetics on heart rate, local anesthetics that contain epinephrine could raise a

patient’s heart rate to a noticeable extent (Ketabi, 2012). Increased heart rate

can increase the chances of a medical emergency including myocardial

infarction, stroke, or angina (Thompson, 2007).

Dental Hygienists are taught the ADPIED method treatment of care. The first

letter “A” stands for the assessment stage. It is imperative that dental hygienists

take patients’ blood pressure at routine visits to assess health needs and provide

patients with the best treatment of care. If the patient is found with high blood

pressure during his or her dental visit, further investigation should be made to

address the need of the patient. It is important to know whether the patient’s

hypertension is controlled or uncontrolled. It has been proven that some

hypertension medications can cause xerostomia, lichenoid reactions, gingival

growth, severe bleeding, and delayed healing (Thompson, 2007). If the patient


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has uncontrolled hypertension, he or she is at a higher risk for angina,

myocardial infarction, or stroke. It is also known that most patients have dental

anxiety which could potentially increase the risk for medical emergencies

happening in a dental setting (Sproat, 2009).

Dental health care providers are responsible to identify high blood pressure and

provide immediate medical referral to the patient’s primary physician. According

to Sproat’s research study done in 2009, many practitioners do not feel that

dentists should perform blood pressure screenings at dental visits because it can

bring confusion to the patients about their overall health. In contrast, The British

Hypertension Society (BHS) indicates the need for an extended role for health

care providers such as nurse practitioners, pharmacists and other health care

professionals for hypertension detection purposes, early diagnosis, and early

treatment of the disease.

Chapter 3 -‐ Methodology

This study will determine if registered dental hygienists are taking blood pressure

on patients at dental hygiene visits to provide comprehensive patient care.

Sample: A survey composed of ten questions will be directed towards Registered

Dental Hygienists in the State of Connecticut. The survey will answer the

question of the number of dental hygienists who complete blood pressure

screenings on their patients during dental hygiene visits or what barriers they

might face in incorporating this preventive screening practice.


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Research Design: The research design will be mixed-methods; qualitative and

quantitative. Qualitative because the study will be completed utilizing a survey,

questioning dental hygienists under what circumstances they complete blood

pressure or what barriers they might face. Quantitative methods will be used to

summarize the results of the study.

Methods: This study will be utilizing a survey with a combination of open-ended

and multiple-choice questions.

Data Collection: Registered dental hygienists working in the State of Connecticut

will be able to complete the survey online. The survey link will be posted on the

Connecticut Dental Hygienists’ Association (CDHA) Facebook page and

potentially on their website.

Statistical Analysis: For this research study, descriptive statistics will be utilized.

The research study will be conducted based on a ten question survey that will be

available to registered dental hygienists working in the state of Connecticut. The

data collected from the survey will be summarized using a Pie chart. In addition,

the survey will be using the measures of central tendency (mean, median, and

mode) in order to summarize the responses from the surveys.

Research Question: Are registered dental hygienists taking proper blood

pressure screenings/precautions on each patient.

Hypothesis: Registered dental hygienists are taking proper screening

precautions on patients by taking blood pressure readings at each appointment.


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Equipment/Materials: For our research study we will be using both paper and

computer based software to analyze and summarize the data. No costs will be

involved.


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References

Bell, K. P., Phillips, C., Paquette, D. W., Offenbacher, S., & Wilder, R. S. (2011).

Incorporating Oral-Systemic Evidence into Patient Care: Practice

Behaviors and Barriers of North Carolina Dental Hygienists. Journal of

Dental Hygiene, 85(2), 99-113.

Greenberg, B. L., Glick, M., Frantsve-Hawley, J., & Kantor, M. L. (2010).

Dentists’ attitudes toward chairside screening for medical conditions.

Journal of The American Dental Association (JADA), 141(1), 52-62.

Greenberg, B. L., Kantor, M. L., Jiang, S. S., & Glick, M. (2012). Patients'

attitudes toward screening for medical conditions in a dental setting.

Journal of Public Health Dentistry, 72(1), 28-35. doi:10.1111/j.1752-

7325.2011.00280.x

American Heart Association Heart (2014, January 1). Disease and Stroke

Statistics-2014 Update. Retrieved March 11, 2015, from

http://circ.ahajournals.org/content/early/2013/12/18/01.cir.0000441139.02

102.80

Hughes, C. T., Thompson, A. L., & Browning, W. D. (2004). Blood Pressure

Screening Practices of a Group of Dental Hygienists: A Pilot Study.

Journal of Dental Hygiene, 78(4), 1-9.


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J, F.-F., JL, N.-O., J, L.-P., E, P.-S., & Tomas-. (2010). Screening for

hypertension in a primary care dental clinic. Med Oral Patol Oral Cir Bucal,

15(3):e467-72.

Ketabi, M., Sadighi Shamami, M., Alaie, M., & Sadighi Shamami, M. (2012).

Influence of local anesthetics with or without epinephrine 1/80000 on

blood pressure and heart rate: A randomized double-blind experimental

clinical trial. Dental Research Journal, 9(4), 437-440.

Nelson, D., Kennedy, B., Regnerus, C., & Schweinle, A. (2008). Accuracy of

Automated Blood Pressure Monitors. Journal of Dental Hygiene, 82(4), 35.

Patel, N., Broadfield, L., & Mellor, A. (2014). Medical profile of patients accessing

hospital-based emergency dental care. Oral Surgery (1752-2471), 7(1),

26-32. doi:10.1111/ors.12063

Sproat, C., Beheshti, S., Harwood, A. N., &Crossbie, D. (2009). Should we

screen for hypertension in general dental practice?.British Dental Journal,

207(6), 275-277. doi:10.1038/sj.bdj.2009.815

Thompson, A. L., Collins, M. A., Downey, M. C., Herman, W. W., Konzelman Jr.,

J. L., Ward, S. T., & Hughes, C. T. (2007). Prevalence and severity of

hypertension in a dental hygiene clinic. Romanian Journal of Stomatology,

53(2), 89-94.


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Tuthill, J. M., Smith, S. J., Hatton, M. N., & Dunford, R. (2014). Attitudes toward

Monitoring Blood Pressure and Blood Sugar at a New York State Dental

School. New York State Dental Journal, 80(5), 32-36.

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