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Hypertension Screening Guidance for Michigan Oral Health Professionals

Hypertension Screening Guidance for Michigan Oral Health Professionals

Wednesday, April 21, 2021

Medical professionals can be prepared to engage in referrals and patient updates with oral health professionals, who are an important member of a person’s rounded health care team.  They can also take the initiative to set up such a partnership.  A dental visit may be the only routine care visit that a patient receives. As a standard of care, dental visits provide the perfect opportunity to screen for hypertension and refer patients to their primary care provider for further evaluation. Many patients trust their oral health providers and welcome their interest in their overall health, not only their oral health.  Bi-directional communication between medical and dental providers about their shared patients’ hypertension is one strategy for reducing the incidence of cardiovascular events.

The American Dental Association (ADA) recommends that all dental care providers become involved in the detection and management of hypertension. The ADA recommendation is for oral health professionals to measure blood pressure of all new patients, all patients at least annually, and patients with diagnosed hypertension at each visit. 10 The American Dental Hygienists’ Association standards for clinical practice outline taking and recording blood pressure as part of a general health history assessment and risk assessment, which would necessitate that registered dental hygienists record this at every initial visit and every recall/recare visit.  Regular blood pressure measurement begins on patients 18 years old and older, as well as those below 18 if they have a history of hypertension.

In 2016, the Michigan Department of Health and Human Services Oral Health Program, along with the MDHHS Diabetes Section, the MDHHS Heart Disease and Stroke Prevention Unit, and the Michigan Delta Dental Foundation, sent a survey to Michigan oral health professionals (including dentists, dental hygienists, and dental assistants) in order to:

  • Assess screening procedures for hypertension and diabetes by oral health professionals.
  • Assess the knowledge of oral health professionals to facilitate referrals for diagnosis and care for hypertension and diabetes.
  • Quantify the referrals for high blood pressure readings and elevated blood glucose levels by oral health professionals.
  • Determine if oral health professionals perform any follow up after making referrals for patients with high blood pressure readings and elevated blood glucose levels.
  • Determine any educational needs they had in learning more about these topics.
A 31% response rate was achieved, with a good range of Michigan counties represented. Results from the study indicated the need to increase oral health professionals’ knowledge of proper hypertension screening methods and to provide guidance in referring for care. An internal MDHHS advisory committee recommended developing screening guidelines for oral health professionals specific to dental settings to aid providers in identifying patients with high blood pressure and in determining the appropriateness of follow-up care and patient referral. With limited funding, it was agreed to prioritize hypertension guidance and develop diabetes screening guidance in the future. The MDHHS Oral Health Program collaborated with the MDHHS Heart Disease and Stroke Prevention unit (HDSP) to assemble an expert advisory committee facilitated by the Michigan Public Health Institute. The advisory committee met a number of times and completed its work in early 2020. The final guidance can be downloaded here.