This will be one of my more brief blog posts.
Last May I wrote about the discovery of malignant hypertension in three patients who presented for tooth extractions. All of them had systolics over 200 and diastolics over 120! Yeeeeee-ikes! The patients were all in denial and insisted I go ahead with the extractions. Of course, I didn’t. And, I sent them to see their physicians.
When a patient has one foot in the grave and the other on a banana peel, I don’t want to be the one nudging them over. While the patients were frustrated with my insistence on not doing the extractions, I explained the real dangers including cardiac and cerebrovascular (stroke) events.
You’re not “just a dentist.”
Just this morning, the son (Ron) of one of the aforementioned patients came in for his routine recall visit. He told me his father had a stroke in September. And, then he said, “YOU found it!” Ron’s dad was in inpatient physical rehab through January – FOUR MONTHS.
Ron also told me that his dad was PISSED when I wouldn’t extract his tooth because of his blood pressure. He said, “Your dentist is full of shit.” But, Ron pressed on, convincing his dad that I had his best interests at heart.
So, here’s how it went with Ron’s dad when I saw him the first time last April… He had a tooth bothering him (which needed extraction). His BP was 176/119 and a pulse of 109. He admitted not taking his BP meds. And, he tried to pass it off as “white coat syndrome.” No dice. So, I sent him home with pain meds and recommended he get back on his BP meds.
He came back 4 days later. BP: 209/120 Pulse: 118. We waited 10 minutes and took it again. BP: 191/101 Pulse: 106. He still tried to claim “white coat syndrome.” I’m still not buying it. No treatment for you. Go see your doctor STAT! Not tomorrow. Not next week. Don’t even go home. Go straight to your doctors office now.
He returned the next day and we got a BP of 155/81, Pulse: 118. Extraction was done with no complications.
So easy, even a Dental Warrior can do it.
Hypertension is an insidious disease. It can irreversibly damage multiple organ systems. And, it can even kill – sometimes quickly, sometimes slowly. Dentists are in a perfect position to screen patients for hypertension. Just do it! You might even save a life.
Copyright protected by Digiprove © 2013 The Dental Warrior®
Pingback: Check Those BPs! | The Dental Warrior
so do you take BP on every pt? and if not how did you screen this particular pt would have high bp?
was the pt obese? 😀
I take a BP on every patient that will have an extraction.
How would you handle someone that truly does have white coat? Like literally show you documentation of their daily readings?
Hi Frank,
Thanks for visiting my blog. In my experience, elevated BP due to “white coat syndrome” will usually go down if the patient is given some time to calm down / relax.