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Oral Health, Blood Pressure, and Tobacco Use Project
State: Iowa Submitted Date: 2012
Problem Statement
  • High blood pressure does not usually present symptoms and an individual with high blood pressure may not know they have it.
  • People usually visit a dental office on a regular basis presenting well, rather than ill as they often present in a visit to a physician.
  • Dentists have a unique opportunity to screen and educate their patients on the health risks associated with hypertension.
Project Objective(s)

This was an evidence- and practice-based intervention over three years where ancillary health practitioners, oral health professionals, were utilized to assess blood pressure and tobacco use in their patients and refer to physicians as indicated.

An important aspect to this project was to determine the barriers, if any, to screening patients in the dental office. Also, it was important to measure the willingness of dental professionals to take on this new role in already busy practices.Can oral health professionals be recruited and trained to assess high blood pressure and tobacco use and make referrals to physicians to assist in the detection, treatment and control of hypertension?

Program Action
  • Over a three-year period, 2009-2012, the Department of Public Health Heart Disease and Stroke Prevention Program collaborated with the University of Iowa College of Dentistry to test several intervention strategies:
    • Could and would dental health professionals easily add blood pressure and tobacco use assessments and referrals to their routine practices?
    • Did curriculums at Iowa's dental school and five dental hygiene programs need to be improved regarding cardiovascular health and tobacco use screening and referral to ensured the awareness of new dental health professionals?
    • Could continuing education for already practicing dental health professionals inform, educate and inform, education and influence them to implement BP and tobacco use assessments and referral to thier practices?
  • The project targeted oral health providers: dentists, dental hygienists, dental assistants and clerical support staff.
Data/Other Information Collected

Pilot Practices screened over 1600 patients for high blood pressure and were followed up on at six-months and 12-months.  In the pilot, at initial screening, 64% of patients were pre-hypertensive, with a systolic blood pressure reading of 101-120.

However at six-month and 12-month recalls, the numbers had dropped significantly, to 46% at six months and to 49% at 12-months. The number with hypertension was 21%, and also lowered at six months and 12 months, but the decrease was not statistically significant.

In terms, of tobacco use, the predominant habit was smoking; reported by 18% of patients, similar to the overall smoking rate for Iowans , which was 16% at that time. At six-month and and 12-month follow-up, there was only a slight reduction in use that was not statistically significant. As smoking rates decline, those who continue to smoke are likely to be the most addicted, may have reduced the amount they smoke yet are unable to to quit, and the use of professional counseling beyond motivational interviewing may be important via a Quitline.

Impact / Accomplishment
  • The Iowa Primary Care Association trained and provided technical assistance to three Community Health Center Dental Clinics to 1) make work flow changes that included documenting and referring dental patients that screen for high blood pressure and tobacco use, and 2) train the dental staff on documenting blood pressure, tobacco use and Quitline referrals in the electronic medical record.
  • Of the 2535 comprehensive or periodic dental exams completed, 741 adults received blood pressure screening with 8% referred to a medical provider for high blood pressure and 68% reportedly completing the referral.
  • All of the participating dental practices expressed a willingness to continue the blood pressure and tobacco cessation screening and referral as a part of their routine practice beyond the pilot project.
  • A patient example: During a comprehensive dental exam, a patient’s blood pressure reading was high and he reported being a smoker. He was unaware he had high blood pressure or that it could cause other health problems. He was referred to the medical clinic for a consultation and since he’d expressed a desire to quit smoking, was given Quitline information. The patient reports that he is now taking his blood pressure medicine and has quit smoking. The dentist reports this patient’s oral health has also improved.
Challenges/Lessons Learned

Some barriers to successful screening in the dental office were encountered:
--Lack of accurate blood pressure monitors in each operatory
--Lack of privacy in open operatories, which could interfere with taking blood pressure readings, especially during winter months where removal of heavy clothing might be indicated
--Many dental providers seemed more reluctant to talk to patients about their tobacco use; indicating a need for further training on motivational interviewing techniques

Terry Y. Meek, Program Manager
Iowa Department of Public Health