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Uncontrolled hypertension at the dentist: a case report of integrated healthcare

British Dental Journal volume 235, pages 866–868 (2023)Cite this article

Abstract

Hypertension is a risk factor for major cardiovascular events and it is usually detected and managed by general medical practitioners (GPs) in primary care. However, it is estimated that 4.8 million adults are living with untreated high blood pressure (BP) in the UK. Health authorities are encouraging more collaborative work across health professions to find and refer individuals with undiagnosed hypertension. In this case, in 2022, a 65-year-old man with a previous history of hypertension, taking antihypertensive medication, attended a BP clinic at the University of Plymouth, Peninsula Dental School as part of a hypertension case finding pilot. His systolic and diastolic BP were 150 and 85 mmHg, respectively, and as per the trial protocol, a referral letter was sent to his GP for suspected further assessment and investigation. Then, an onward referral was made to secondary care and the participant was subsequently hospitalised for 13 days for treatment of heart failure and suspected acute coronary syndrome. This case report highlights that BP readings taken in a primary care dental setting can be very useful and recommends better integration of dental services into primary care to reduce the risk of major cardiovascular events.

Key points

  • Blood pressure readings taken in clinical dental settings may serve as an additional approach for hypertension monitoring (and case finding) in individuals with high cardiovascular risk.

  • Dental primary care settings and dental professionals can provide accurate blood pressure readings and medical histories to make appropriate referrals to GPs regarding their patients' cardiovascular health.

  • Integrated dental-GP care pathways and referral networks could potentially reduce the risk of major cardiovascular events and associated mortality.

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Acknowledgements

This study also operated in conjunction with Peninsula Dental Social Enterprise (PDSE) dental schools for the use of clinic facilities and computer integrated R4 systems to securely record and store patient data. The authors would like to thank PDSE staff, Aimee Matthews, Ana Tarczanyn and Louise Carr, and master's student, Tomas Nicholas, for aid with recruitment and data collection within PDSE dental schools. This study operated in conjunction with the University of Plymouth's Oral Microbiome Research Group (OMRG); equipment for anthropological measurements (blood pressure, BMI) was supplied within the OMRG group. Our study works in collaboration with the Office of the Chief Dental Officer in England and the CORE20PLUS5 programme.

Funding

This research was funded by a Faculty of Health PhD studentship and HEIF funding from the University of Plymouth.

Author information

Authors and Affiliations

  1. Peninsula Dental School, University of Plymouth, United Kingdom

    Amazon Doble, Robert Witton & Zoë Brookes

  2. School of Health Professions, University of Plymouth, Plymouth, PL4 8AA, United Kingdom

    Raul Bescos

  3. Office of the Chief Dental Officer, London, SE1 6LH, United Kingdom

    Shabir Shivji

Authors
  1. Amazon Doble
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  2. Raul Bescos
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  3. Robert Witton
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  4. Shabir Shivji
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  5. Zoë Brookes
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Contributions

Amazon Doble conducted case report initial follow-up. Amazon Doble and Zoë Brookes conducted the case report interview. Zoë Brookes, Raul Bescos and Robert Witton acquired the funds from the University of Plymouth. Amazon Doble, Raul Bescos, Robert Witton, Shabir Shivji and Zoë Brookes wrote and reviewed the manuscript. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Amazon Doble.

Ethics declarations

The authors declare no conflict of interest.

The study was conducted in accordance with the University of Plymouth's ethics and approved by the Ethics Committee of the University of Plymouth (ethics code 2684 and 26/05/2021) for studies involving humans.

Informed and written consent was obtained from the patient for both the initial hypertension case finding trial appointment and publication of this case report.

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Doble, A., Bescos, R., Witton, R. et al. Uncontrolled hypertension at the dentist: a case report of integrated healthcare. Br Dent J 235, 866–868 (2023). https://doi.org/10.1038/s41415-023-6546-6

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