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Efficacy of screening for high blood pressure in dental health care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
2011 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, 194- p.Article in journal (Refereed) Published
Abstract [en]

Background: There is consensus on the importance of early detection and treatment of high blood pressure. Dental care is one of few medical services to which a considerable proportion of the general population comes for regular check-ups. We tested the effects of blood pressure screening in dental care centres with subsequent workup of subjects screening positive in primary health care (PHCC). Methods: Altogether 1,149 subjects 40-65 years old or 20-39 years old with body mass index >25, and with no previously known hypertension, who came for a dental examination had their blood pressure measured with an Omron M4 (R) automatic blood pressure reading device. Subjects with systolic blood pressure readings above 160 mmHg or diastolic above 90 mmHg were referred to their PHCC for a check up. Outcome data were obtained by scrutiny of PHCC and hospital patient records for hypertension diagnoses during the three years following screening. Results: 237 (20.6%) subjects screened positive. Of these, 230 (97.1%) came to their PHCC within the 3-year follow-up period, as compared with 695 (76.2%) of those who screened negative (p < 0.0001). Of those who screened positive, 76 (32.1%) received a diagnosis of hypertension, as compared with 26 (2.9%) of those who screened negative. Sensitivity was 79.1%, specificity 84.8% and positive predictive value 30.1%. The number of subjects needed to screen to find one case of hypertension was 18. Conclusions: Co-operation between dental and primary care for blood pressure screening and work-up appears to be an effective way of detecting previously unknown hypertension.

Place, publisher, year, edition, pages
2011. Vol. 11, 194- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-152915DOI: 10.1186/1471-2458-11-194ISI: 000289681500001PubMedID: 21450067OAI: oai:DiVA.org:uu-152915DiVA: diva2:414433
Available from: 2011-05-03 Created: 2011-05-03 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Dental Health Care Cooperating with Primary Health Care as a Resource in Early Case Finding of Patients with Diabetes or Hypertension
Open this publication in new window or tab >>Dental Health Care Cooperating with Primary Health Care as a Resource in Early Case Finding of Patients with Diabetes or Hypertension
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives To investigate if there is an association between dental health status and high blood pressure, to test the effectiveness of screening for high blood pressure and high blood glucose performed by the dental health care in collaboration with primary health care and to investigate the direct costs for this type of screening organisation.

Study population and methods In Paper I 54 subjects with known hypertension and 141 with a high blood pressure in the dental office were compared with matched controls. In Paper II 1,149 subjects were screened for hypertension and in Paper III 1,568 subjects were screened for diabetes in dental care. Follow up was performed in co-operating primary health care centres. In paper IV the direct costs for screening and follow-up were calculated.

Results There was a significant association between deep periodontal pockets and high blood pressure, even when the influence of age, sex, smoking and number of teeth was taken into account. Among those being screened for high blood pressure and high blood glucose 20.6% and 9.9% respectively were referred to primary health care, and a hypertension or a diabetes diagnosis was found in 32.1% and 5.8% of those screening positive. For every 18th subject screened a hypertension case was found (“numbers needed to screen” (NNS)), and for every 196th a diabetes case. NNS for combined hypertension and diabetes screening was 15. The total direct costs for screening and follow up per diagnosis found were 5,298 SEK for hypertension, 19,100 SEK for diabetes, and  4,116 SEK for combined blood pressure and blood glucose screening.

Conclusions There was an association between dental health and hypertension. Screening for hypertension was highly efficient, while screening for diabetes was less so, because it is a less prevalent condition. Screening for both conditions appears to be the most efficient type of screening.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 72 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 742
Keyword
Screening, dental care, primary health care, high blood pressure, high blood glucose
National Category
Medical and Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-167527 (URN)978-91-554-8277-0 (ISBN)
Public defence
2012-03-30, Rudbeckssalen, Dag Hammarskjölds väg 20, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2012-03-08 Created: 2012-01-30 Last updated: 2012-03-29Bibliographically approved

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Engström, SevekSvärdsudd, Kurt F

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