A dentist my friend was observing had a patient come to him. he took blood pressure of the patient and discovered it was HIGH... 190/110. This patient came back for a followup appointment and his blood pressure was 194/110. The patient refuses to see a physician for the condition. The dentist said he should go to the hospital then when he had time but he again refused saying that he hated physicians. Would it be ok in this case for a dentist to prescribe blood pressure medication? if he needs to help the patient but the patient refuses to see his primary? wouldnt it be worse to do nothing at all and let the bp keep a rising? i know its out of scope of dentistry but i was just curious because this is a weird situation.
Not so hypothetical situation
- Thread starter RootCanal
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I wouldn't even begin to touch this because if ANYTHING went wrong you are cooked. Refuse to see patient until after he sees physican and gets BP under control.
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Absolutely not. We are not qualified to make an "official diagnosis" of Hypertension, let alone manage it pharmacologically. You would open up an entire world of problems... complications/side-effects fromt he drugs, electrolyte management etc.
Not something any of us should get into. If this patient's BP is so severe, the dentist should just tough it out and refuse treatment until the patient sees an MD and the BP is stabilized. If its something emergent, they can have the tooth taken out by an OMFS.
This patient "hates seeing MD's" but you can rest assured that they would "love to sue a Dentist" for practicing outside of their scope of training.
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I agree with the previous posters. Don't ever put your hard earned career at risk by going down that road. I know as a dentist that you really want to help that patient out, but until they are willing to help themselves out by improving their health status you would be doing them a disservice by performing treatment on them.
There are plenty of patients out there. You don't want to be messing around with the ones who refuse sound medical treatment to get their health in order just because they "hate physicians."
Refuse to treat this patient based on medical conditions contrary to having dental work done and don't practice outside the scope of what is accepted for dentists. Treating blood pressure disorders is more in the realm of physicians just like extracting a tooth is more for dentists to do.
I remember one patient that came into the office. His overall complexion was yellow and his eyes were severely jaundiced. He obviously had some late stage hepatic failure going on. He wanted a tooth pulled, but I took one look and said that he really should go to the hospital as his tooth was the least of his problems. Honestly I thought the guy was going to die in the reception room he looked so ill.
There are plenty of patients out there. You don't want to be messing around with the ones who refuse sound medical treatment to get their health in order just because they "hate physicians."
Refuse to treat this patient based on medical conditions contrary to having dental work done and don't practice outside the scope of what is accepted for dentists. Treating blood pressure disorders is more in the realm of physicians just like extracting a tooth is more for dentists to do.
I remember one patient that came into the office. His overall complexion was yellow and his eyes were severely jaundiced. He obviously had some late stage hepatic failure going on. He wanted a tooth pulled, but I took one look and said that he really should go to the hospital as his tooth was the least of his problems. Honestly I thought the guy was going to die in the reception room he looked so ill.
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If the patient hates the physician, what's the likelihood that he will like the dentist? He just came because he is in pain, if his problem is solved, what's the probability that this guy will be a loyal patient?
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There is one other consideration...but again...it is a risk.
If time and time again this patient records a high blood pressure but shows absolutely no signs of ill health due to it, it is possible to do minorly invasive dentistry...like a cleaning...without suddenly making his BP sky rocket. A lot of that has to do with the patient themselves. But on a general level...everyone else is more than right about what to do.
If time and time again this patient records a high blood pressure but shows absolutely no signs of ill health due to it, it is possible to do minorly invasive dentistry...like a cleaning...without suddenly making his BP sky rocket. A lot of that has to do with the patient themselves. But on a general level...everyone else is more than right about what to do.
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Jeff, i wouldn't even do that, the patient could have a heart attack and it could have nothing to do with anything the dentist did. But if they are in your chair at the time and you knew their BP ahead of time you are screwed.
Plus by agreeing to any treatment on a patient like this, you are actually doing them a disservice. There is 0% chance they'll see a physician if you agree to do some of their dental work despite their BP. If you don't think its bad enough to refuse treatment then they don't think its bad enough to go to the doctor.
Plus by agreeing to any treatment on a patient like this, you are actually doing them a disservice. There is 0% chance they'll see a physician if you agree to do some of their dental work despite their BP. If you don't think its bad enough to refuse treatment then they don't think its bad enough to go to the doctor.
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Treating someone for their blood pressure condition is definitely outside the scope of practice for a dentist. If you find that the patient has stage 3 hypertension, than contact the patients doctor (if he has one) to see if he requires immediate treatment. Otherwise, defer dental treatment until the hypertension is controlled.
djeffreyt does have a point. If the patient is asymptomatic and reports that BP has been high in the past, it's possible to perform routine care. Although that's a risk I doubt many would want to take. I'm going to side with juggamynugga on this one. 🙂
djeffreyt does have a point. If the patient is asymptomatic and reports that BP has been high in the past, it's possible to perform routine care. Although that's a risk I doubt many would want to take. I'm going to side with juggamynugga on this one. 🙂
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i would just want proof that it was high in the past. How do you get that if they don't even have a primary care physician? As i'm sure you guys know patients aren't always completely up front about their medical issues for one reason or another when sitting in the dental chair.
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Document their BP, then STRONGLY reccommend they see an MD, if they don't see an MD for their BP, then dismiss them as a patient.
I'd be so blunt as to tell them that if they don't get their BP checked and treated by a physician, then the risk of them having some type of cardiovascular event in your chair is far too high. Also remind them that in many cases, hypertension is a very treatable disease that can greatly extend their lifespan when undercontrol.
I'd be so blunt as to tell them that if they don't get their BP checked and treated by a physician, then the risk of them having some type of cardiovascular event in your chair is far too high. Also remind them that in many cases, hypertension is a very treatable disease that can greatly extend their lifespan when undercontrol.
