Dental care for patients with heart failure: an update.

BACKGROUND: Heart failure (HF) is a common clinical syndrome that affects an estimated 5.7 million Americans. It is a growing health problem, particularly in people 65 years or older. Therefore, the probability that dental practitioners will have patients who have HF is increasing. METHODS: The authors reviewed medical literature from 2000 through 2009 to determine the incidence, classifications, pathophysiology and advances in the medical diagnosis and treatment of HF. They also reviewed available dental literature during the same period to formulate treatment recommendations for dental care of people who have HF. RESULTS: Medicine has made advances in understanding and treating HF. These advances have resulted in the development of revised classification systems, a more structured approach to patient assessment and improved therapeutic options. CONCLUSIONS: Dentists need to be aware of advances in the diagnosis and treatment of HF. Keeping in mind the potential for morbidity in patients who have HF, identifying and accurately assessing these patients is imperative for clinical management. CLINICAL IMPLICATIONS: Often it is necessary for dentists to consult with patients' physicians to coordinate care and determine whether treatment can be rendered appropriately in a routine dental setting or whether advanced support, monitoring or both are necessary.

Prevalence and severity of hypertension in a dental hygiene clinic.

AIM: The purpose of this study was to assess the prevalence and severity of hypertension in a dental hygiene clinic and evaluate factors related to the disease. METHODS AND MATERIALS: Records of 615 patients, treated by dental hygiene students during 2003, were reviewed. Data collected included systolic and diastolic blood pressure, presence of diabetes and renal disease, non-modifiers (race, gender, and age), and modifiers (marital status, smoking habits, and occupation). RESULTS: According to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) classification, 154 (25%) of the subjects had normal blood pressure readings, 374 (60.8%) had prehypertension, and 87 (14.1%) had stage 1 hypertension. Statistical analysis showed a significant difference in the JNC7 classification between groups when considering the non-modifiers' race (p=.02) and the modifiers' smoking habits (p=.03) and occupation (p=.01). A statistically significant difference in the JNC7 classification existed between groups with diabetes (p=.00). The majority of patients had blood pressure readings in the prehypertension stage. CONCLUSION: Based on these results, the researchers recommend clinical policy modifications which include: additional documentation for blood pressure readings in the prehypertension stage, lowering the systolic reading from 160 mmHg to 140 mmHg when adding hypertension alert labels, and noting prehypertension/hypertension on the dental hygiene care plan with the appropriate interventions.

New national guidelines on hypertension: a summary for dentistry.

BACKGROUND: Periodically, the National Heart, Lung, and Blood Institute publishes recommendations on the prevention, detection, evaluation and treatment of high blood pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure--known as "JNC 7"--substantially revises previous recommendations. METHODS: This report represents the consensus opinion of a coalition of 39 major professional, public and voluntary organizations and seven federal agencies. All currently available literature on hypertension was reviewed by a select committee of experts on hypertension (including one of the authors [L.M.P.]) and was used to formulate this new report. RESULTS: The authors present highlights of the JNC 7 report. In addition, they offer the findings of their review of dental literature dealing with patients who have hypertension, into which they integrate information from the JNC 7, and update dental management recommendations. These new guidelines provide key messages to all health care professionals and are designed to improve the diagnosis and treatment of people with hypertension. CONCLUSIONS: Because hypertension affects nearly 50 million people in the United States and underlies most cardiovascular disease, its diagnosis and control should be of concern to all health care providers. Many people have undetected hypertension, and current levels of detection and control need to be improved. CLINICAL IMPLICATIONS: All health care providers, including dentists and members of the dental team, need to be involved in detection and management of this important public health problem. The dentist can play an important role in the detection and management of hypertension.

Treating patients with drug-induced gingival overgrowth.

The purpose of this paper is to review the causes and describe the appearance of drug-induced gingival overgrowth, so that dental hygienists are better prepared to manage such patients. Gingival overgrowth is caused by three categories of drugs: anticonvulsants, immunosuppressants, and calcium channel blockers. Some authors suggest that the prevalence of gingival overgrowth induced by chronic medication with calcium channel blockers is uncertain. The clinical manifestation of gingival overgrowth can range in severity from minor variations to complete coverage of the teeth, creating subsequent functional and aesthetic problems for the patient. A clear understanding of the etiology and pathogenesis of drug-induced gingival overgrowth has not been confirmed, but scientists consider that factors such as age, gender, genetics, concomitant drugs, and periodontal variables might contribute to the expression of drug-induced gingival overgrowth. When treating patients with gingival overgrowth, dental hygienists need to be prepared to offer maintenance and preventive therapy, emphasizing periodontal maintenance and patient education. The affected gingiva presents a bulbous and irregular appearance and requires special modifications in the delivery of dental hygiene care. Dental hygienists play a vital role in the prevention and control of this condition because of the significant correlation between plaque/gingivitis and gingival overgrowth.