No.

I love having my blood pressure taken at the dentist's office. They are so careful to do it correctly. Unlike what I have experienced in many doctors office and even the hospital. My own doctor admits he would never go by a blood pressure taken as the first step on a visit. If he felt something was off he would do it himself. The right way.

My dentist cleans teeth. She doesn't have a hygienist in her office. And never.

Actually, that is exactly how my blood pressure being high was discovered. It was so high, they would not do the dental work I was there for. I was told to call my doctor and schedule an appointment immediately. I was shocked and so was my doctor. Had not had a problem and then all of a sudden there was one.

"The fact that it's not widely done as a practice"

That isn't a fact in the area I live in.

Actually I also kept telling a patient for several years I was sure he had diabetes because of the way his gums looked and never really responded to treatment. He was always getting bloodwork but they were not doing specific tests for diabetes (fasting and all those things).

Finally he was tested. His blood glucose was 770.

I am not saying this to toot my own horn, it's just that we and hygienists especially, are seeing the patient multiple times a year, and the hygienist is looking carefully at your whole mouth and head and face on a regular basis. Several cancers and other disorders were first picked up in our office rather than a physician's office.

My physician never "looks" at me. He mostly asked questions and records them on a laptop and his actual exam is very cursory.

"That isn't a fact in the area I live in."

The country is a much larger place than the area where you live. The experiences of people from diverse places here and there are what led to my comment suggesting the practice wasn't widely followed. I wouldn't base a broad statement on just my own personal experience.

I can see it being checked when a more substantive procedure is being done on a patient of a profile more likely to have blood pressure issues. And certainly if some form of anesthesia is to be used. But a hygienist is unlikely to be chair-side in such situations, the dental assistant would be involved instead.

Dental hygienists in many states are now licensed to administer local anesthesia.

No - she just asks about any medications/prescriptions I take.

Really, palimpsest? I don't think I'd be comfortable with that. I had a scary reaction to one of the numbing agents and now I have to have a different one.

"The country is a much larger place than the area where you live. "

Really??

Chi,

For the vast majority of patients the reaction can be unsettling, but it is self limiting.

Allergy to the local anesthetic itself, (an amide) is so rare as to be almost non-existent. (Many people were allergic to Novocaine (an ester), but this is no longer even available on the American market for dentistry). People use the term "Novocaine" generically. And people can't be allergic to epinephrine because our own body produces epinephrine.

What people can be allergic to is one of the preservatives in local anesthetics containing epinephrine, and they need to use a plain anesthetic.

The newest agent on the market also contains prilocaine, which can cause a rare reaction called methemoglobinemia, which can be fatal, (but is easily treated).

Most people who have a reaction have a sensitivity reaction to epinephrine which involves a rapidly accelerated heart rate (I've had it myself) but this reaction is completely self-limiting, although it is unsettling. I have patients who have this every time at least to some extent. In a healthy person this is not going to progress into something else.

The amount of epinephrine in the most common local anesthetic is 1:100,000 in concentration. This is 1/1000th the amount in an EpiPen or that used medically and even 1:100 is sometimes used medically.

In adults it is really one of the safest drugs that is administered by injection.

In children the danger comes in possible overdosage.

It's because of its relative safety that a decision was made to expand the ability to dental hygienists to administer this in many states.

The reactions are going to be allergy, which is rare and can be treated quickly with an EpiPen (or if a slower reaction some other agents); a self-limiting cardiovascular agent (which usually indicates no treatment other than suspending the procedure).

If for some reason a local anesthesia injection triggered some sort of Cardiovascular Accident, a dentist and a hygienist would have the same qualifications to treat this, unless one or the other had training in Advanced Cardiac Life Support. And the standard treatment would be immediate activation of 911 and the EMS.

I say this because I have had a number of patients over the years who insist they are allergic to any or all local anesthetic agents and until you know for sure this has to be taken seriously.

I had one patient who had had almost all dental procedures including a root canal done with No Local Anesthesia, because she was allergic to everything. She was sent to me for surgery. I said "There is no way I am going to do a two hour surgery with no anesthesia on you, you Have to see an allergist and be tested"

She wasn't allergic to anything. She had undergone multiple procedures without anesthesia because of some sort of harmless idiosyncratic reaction.

-----

People also claim allergy to multiple antibiotics:

Stomach upset, nausea, and diarrhea (except a known severe type known as pseudomembranous colitis with a specific antibiotic) is Not an Allergy. An allergy is a rash, or anaphylactic reaction.

----
Sorry to get so didactic about this subject but there is a fair amount of fear and misinformation associated with these subjects.

The biggest source of reactions to local anesthesia are related to needle phobia.

Yes -- and so does eye doctor's nurse.

My reaction was not allergic but to the epinephrine. My heart started racing and I had a panic attack. Very unpleasant.

Yes, but this is a reaction that is limited physically. There is no "treatment" for it other than reassuring the patient. It goes away. The potential problem that you may have is that the dentist should have told you that this is an occasional but transient reaction and not to panic, and they should not contribute to your panic by overreacting. They should know that 1) it happens and 2) it is a self-limiting reaction. If you were hyperventilating they should have given you a paper bag for rebreathing and reassured you.

But as far as patient management, the dentist would not be capable of doing anything more than the hygienist could do, and honestly I think some hygienists are better at patient management regarding things like this.

My reaction was not allergic but to the epinephrine

I have never had what I call a severe reaction but it was noticeable to me that coming down after dental work was very difficult for me. So I get local anesthesia without it. It's on every medical chart, NO EPINPHRINE. Now having dental work is so much more pleasant and I never minded the work at all. It was the dreaded aftermath of jitters and sleeplessness that bothered me.

I have that same note in my chart, watchmelol. He uses some kind of alternative that does the job and doesn't make me feel like i'm dying.

Palimpsest, it doesn't matter to me that it's a limited reaction. Reassuring doesn't work as I have a panic disorder. Logic and reasoning are not effective in a panic attack, at least for me. I just feel more comfortable having a dentist administer my injections and monitoring my reaction. Other people might be fine with a hygienist doing it.

Yes, she does.

I don't remember for sure, but I think the dental hygienist did check my blood pressure. It may have been because I was a new patient and the Dentist wanted to have a 'check point' to compare with. Later, I was to have some extensive work done: Extract a tooth, grow some jaw bone, and install a post.

No. Never.

"Dental hygienists in many states are now licensed to administer local anesthesia."

This point I checked with my dentist relative, who said that administering the local effectively is such an essential part of the patient experience for a procedure that they would never trust it to someone else to do. It takes only a few minutes and then the patient is left for awhile for it to spread and become effective. Maybe that's personal preference but that's what I told.

Yes, recently anyway. In past years they didn't.

Actually epinephrine and pseudo-epinephrine can be quite dangerous for those with high blood pressure. Many decongestants have warning labels for that very reason.

I have a very high pain tolerance and several years ago needed a small filling done. I skipped the anesthetic with no problem. It was a bit uncomfortable but certainly not painful.

Here's a term for you "white coat syndrome" it's what we called elevated blood pressure due to the stress of an office or hospital visit.

It's pseudoephedrine, not pseudo-epinephrine. My look-up informed me that it and ephedrine are related but have different effects and different uses. Pseudoephedrine is what's used in Sudafed and other decongestants, and can be used as an ingredient for methamphetamine, which is why (at least in my area) it's kept behind the pharmacy counter and requires ID and a log-record to purchase.

Yes, Raye, you are mixing up epinephrine with ephedrine.

Epinephrine is an analog to norepinephrine which our own body produces as a neurotransmitter and hormone.

Of course the biggest problem with Ephedrine and Pseudoephedrine is that it is chemically similar to, and can be easily converted to methamphetamine (Meth).

I work in two facilities where dental hygienists administer local anesthesia, and there has been almost universal acceptance of this especially as a part of their own treatment.

However, in one of those places, hygienists also administer local anesthesia in place of one of the doctors, and most patients in that practice have accepted that as well. In fact, some of the patients have told me that several of the hygienists have a better technique that that particular doctor. There are several patients who have requested that I administer their anesthesia,followed by a particular hygienist in my absense, followed by that doctor as a last resort.

Are these "facilities" private practice dental offices, palimpsest?

I'm a bit puzzled why a hygienist would have any contact with a patient in a chair for a dental procedure. At the dental practices I have experience with (both single and multi-doctor private practices) , a hygiene visit is restricted to just that and if something more than than a periodic exam of just a few minutes (by the dentist) is to be done during that visit, it requires moving to a different chair so that the hygienist can use that same chair for the next cleaning patient.

Thx.

So glad I can count of Elmer to correct my misspelling, it's been awhile since I worked in the medical profession so it's not surprising.

Yes, dental local anesthetics can contain epinephrine and is still dangerous for patients with hypertension and some forms of heart disease.

Raye, it's not a matter of misspelling. You were confusing two different drugs altogether

NO patient with UNcontrolled hypertension should receive elective dental treatment. Epinephrine at normal dental doses is NOT contraindicated in patients with controlled hypertension. Epinephrine should be Limited to that contained in two cartridges of 1:100,000 concentration in patients with history of stroke, heart attack or with certain medications.

However, the Local Anesthetic Agent Itself has Cardiovascular Effects and in Local Anesthetic it is THAT AGENT which may be the Limiting Factor for some patients NOT the epinephrine. These are Dental concentrations of Epinephrine Not Medical.

Our Own Body Produces Norephinephrine and may produce More under stress during a procedure than is present in a typical anesthetic dose.

Elmer

I work in two private practices, one in an exclusive suburb, and one in the center of the city. I work in a university practice setting treating patients with complex medical issues including complex cardiovascular, brittle diabetics, organ transplant and immunocompromised patients. I teach in a college setting in a dental hygiene program where a lot of patients are referred from a public health setting.
I have taught the didactic portions of Pharmacology and teach the didactic and clinical portions of local anesthesia.

In the suburban practice, only the doctors administer local anesthesia. But the generalist also does not use any expanded function assistants to place fillings, and this would not be well -accepted by many of the patients in that practice even though it is common practice in my area. However, if the primary hygienist in that practice were to start administering it, a lot of patients would find that acceptable (and some would not). But this is because many of those patients are in that practice because she is there and would probably consider leaving if she left.

In the inner city practice, the hygiene schedule is purposely arranged so that they are administering the anesthesia for the general dentist, between their own patients, andthey also do it for their own patients. Then she just comes in and does her dental procedure. Most of the patients accepted this as soon as it was presented. I administer all my own anesthesia, because of the types of procedures I do.

There are no hygienists in the medically complex clinic, at least when I am there but if there were they would be expected to be licensed for local anesthesia.

In the dental hygiene program, the patients had to accept the hygienists providing local anesthesia because it is part of the curriculum. But since most of these patients' dental care is in the public health environment, which is often hurried, emergency-based and rudimetary, most of them report that the administration of local anesthesia by the students or faculty, or the overall level of care is superior to that they receive in public health.

Palimpsest - thanks for your info on anesthetics, you have quite a CV and it's been a while since I was in the med profession, I worked in the hospital setting. I've lost my Physiological Chemistry books but do remember the importance of those with hypertension and heart disease to be aware of the dangers of decongestants. Every so often we'd have someone in the emergency room thinking they were having a MI due to OTC decongestants.

Elmer J Fudd

"Are these "facilities" private practice dental offices, palimpsest?

I'm a bit puzzled why a hygienist would have any contact with a patient in a chair for a dental procedure. At the dental practices I have experience with (both single and multi-doctor private practices) , a hygiene visit is restricted to just that and if something more than than a periodic exam of just a few minutes (by the dentist) is to be done during that visit, it requires moving to a different chair so that the hygienist can use that same chair for the next cleaning patient."

Well I guess your experiences differ from others.

I stay in the same chair no matter what path the visit takes. And my hygienist is always there, no matter what is being done, either a cleaning, a crown, whatever.

Chess are you sure your hygienist is there when you are getting a crown?

Dental hygienists typically clean teeth for their workday, and this may include taking x-rays and some other supportive procedures.

Dental Assistants assist the Dr, and this may also include taking x rays and some other supportive procedures, and if your state allows Expanded Function Assistants they may place a filling after the dentist has prepared the tooth for it.

Although a dental hygienist may have also trained to be an assistant it's not common in most areas to assist the dentist for a procedure because their time and training is better utilized in direct patient care.

Things vary, some dentists also do all the cleanings for their patients, and don't have assistants. But I would say a combo assistant and hygienist is the exception rather than the rule.

"I guess your experiences differ from others"

Sure. Especially because what happens in your area is what you assume happens everywhere. A less than broad view.

I'd like to hear from palimpsest. As I said before, hygienists in a private practice typically have dedicated chairs for the days they work. Part of the reason is that those chairs get booked in whatever the time increment for cleaning is - often it's hourly, and it's easiest to lead patients to and from one or multiple stations for hygienists having that regular schedule. Hygienists often work days the dentist is off, doing routine cleanings without an exam, and in my experience, they use their normal work stations on those days too.

Procedures involve the dentist, different equipment and different assistants, and so are often done using other operatories. Again, it makes scheduling easier. And usually the hygienist is busy elsewhere. Dental assistants work with the dentist on procedures and there's hardly room or need for more than one assistant/helper per patient chair.

I've never had local anesthesia administered by a dental hygienist, just by the dentist herself. Probably because I only need numbing for a filling or root canal, and she is the only one who does those.

As for switching chairs/rooms, at my current dental office the rooms and chairs are used for all procedures, no switching required. At my previous dental office, the cleaning rooms were separate from the dentist lair where he performed root canals, fillings, and other scary stuff.

In one practice there are dedicated dental operatories and dedicated hygiene operatories and both are there at the same time. They don't even have the same equipment exactly.

In the other office the rooms are more universal but some are considered hygiene rooms and one is an overflow room.

In both offices the hygienist may see ASA I or ASA II patients of record without a dentist being present, if the patient does not also need an exam. In one office this is limited to maybe two days a month and in the other it rarely happens. This varies by state. This was not allowable in my state until a few years ago. Hygienists in my state cannot administer local anesthesia if there is not a dentist present in the office.

Some offices have separate X-ray rooms too, so the patient may move from chair to chair, and in some offices the patient does not move at all. This depends pretty much on the individual practice.

"Sure. Especially because what happens in your area is what you assume happens everywhere. A less than broad view."

I assumed NOTHING. LOL!!!! You were the one making that assumption dude - that was the whole point of my post. Good grief.

Before my old dentist retired when I needed a crown his hygienist was his assistant. If the person is trained and it is a small office why not?

In my dentist's office he has an area that has three chairs. Two are used by the hygienists and he does come in to check your teeth if necessary or once a year which ever comes first. The third chair is where he does any thing like crowns and other dental procedures. The hygienists are employees but the oral surgeon office that I was sent to for a root canal had rows of hygienists chairs and each was assigned to a certain person. I was put in the wrong chair when I was initially sat down.

Dental assisting and dental hygiene programs aren't the same. Is there enough overlap? Maybe at a basic level? Maybe in one direction but not the other? I can't say, maybe palimpsest can help here too. I think hygienists earn quite a bit more than RDAs, so maybe they can assist capably when needed?

I think in a busy dental office, the hygienists are often booked for their entire working day and are paid a percentage of production or per capita so I'm not sure there's time to spare to do other, non-cleaning tasks.

Elmer they are not the same but there is no rule that a person may not take additional or different training. While not assistants/hygienist this area seems to have more than their share of doctors who are also attorneys. Some practice one. Some practice the other. Then they become involved in politics and do neither. One of my Doctors even had a religious degree.

Oh boy. Not sure how I stumbled upon this thread.

To answer the OP, no BP taken. I will say this. In my younger years, my former dentist used to ALWAYS offer a set of headphones to listen to while he did ANY work. I got curious one time, opened my eyes and LO and behold, there was a needle going into me. Never knew all those years.....

Sure maifleur, but I think that's an aside. In my area, recurring teeth cleanings can run $100-$200. The hygienist's share varies but is often 40-50% of the charge.

Depending on how busy the hygienist is (some work part time), annual earnings can be $80K or more. By comparison, I think dental assistants make less than $50K per year and some quite a bit less. If the hygienist is paid for production (as is frequently the case), and they're booked for the day, there's no time available for other tasks. Nor is there any incentive to spend an hour assisting (at perhaps a lower pay rate) instead of doing another cleaning, unless they have an open block of time.

Good dentists are busy and the same is true for good hygienists too.

Never. My hygienist has been cleaning our teeth every six months for years.

The percentage of production is an uncommon way to pay a hygienist. And 40 to 50 percent of production would be incredibly high if paid by that method. Most hygienists are paid an hourly rate with minimal benefits compared to a corporate based position. It is a relatively high paying position with a lot of flexibility considering it's an associate degree.

Thanks for the insiders view palimpsest.

I've been at the same dentist since moving here in 1999, and never have had my BP checked in the dentist's office.

The kid of a friend of mine was looking at practices to buy and I assisted him with financial reviews of the ones he was interested in. My information came from what I saw then.

It did vary. Whether it was an actual production calculation, or a high hourly wage number ($40-60 per hour) paid only for patient chair hours, it's the same.

It seems to be common that all dental practices pay for few or no employee fringe benefits for employees, whether talking about a receptionist at the low end or a hygienist at the high end. Remember that these are small businesses and the highest cost for many is employee wages. I'd suspect the same was true for the one or two horse or small partnership medical practices that, at least in my area, are becoming few and far between compared to how they once were.

The dentist that I had when I was young worked without an assistant most of the time. One did not have a hygienist. In both practices if he needed assistance the person at the front desk would come in and do it. But that was a simpler time and neither one of them dealt with insurance or had huge incomes or overhead.

When I was in school, there was one main switchboard, and several of the departments had direct numbers. A student took over main switch board when she ate her lunch. She also passed out paychecks and pay stubs. There was one secretary receptionist in each department. There was two people in clinic management. There were three or four people who worked in the insurance office, with one interacting with the students.

There is now a call center. There are three to four front desk peoplewho also answer phones as well as a coordinator in each clinic. There are layers and layers and layers of administrative staff that never existed when I was in school. There are probably 200 people doing the job of two dozen.

The class size has not increased. The patient pool has not increased. Tuition of course has gone through the roof. Everything is much more complex than it used to be.

When I first worked at the practice I have been at for 20 years the owner had an assistant and a front desk person and a part time hygienist. The current owner has two and a half assistants, almost two hygienists, a front desk person and there should be two, and there is a technology person who is not an employee but is probably there for several hours every month. Again, I am not sure that the patient population has increased dramatically.

A busy dentist can use their own time more wisely and so make a lot more money and provide better care to more patients by having an adequate number of capable staff and using their capabilities properly. As with lawyers, accountants, and other professionals, some still prefer to be worker bees (oh no, that term again) and do a lot of work on their own that in more modern practices are done by staff members. We know one dentist like that, he does a lot of the cleanings himself and refers out to others procedures that are other than straight forward vanilla. Duh, why bother, but that makes him happy. I've heard from other dentists that know him who've said from talking to him about specifics, his skills seem (to them) to be not very good. So maybe he limits what he does to keep himself out of trouble and to save his patients from hack jobs. He's a nice guy, I guess he's just not God's gift to the world of dentistry.

Hygienist has been taking BP for at least 8 years (since move to new dentist). I think it's a nice screening tool since hypertension is rampant and frequently untreated. BTW, I did not have any medical conditions or take any prescription meds when this was started.

We're in awe of the knowledge that our dentists have, when it comes to medications, health, etc.

Earlier this year, hubby was having trouble with his phosphorous levels. A normal level is .8 It turns out that his monthly bone-strengthening injections was depleting his phosphorous.

He had a dental app't and he was telling the dentist this. She asked what his levels were, and he said .27 (they're assessed by blood tests). She said that she wasn't doing anything on him at those levels. So I'm really glad they know they're stuff.

This is a young husband and wife team that took over our retired dentist. We love them to pieces. No they don't do blood pressure, but always ask what meds we're on and when we last saw the dr.

My dentist did not take my blood pressure. I had five fillings redone for old fillings that were ruined or and had fallen out and a cleaning today. All went well I have little residual soreness. :-). Personally I tend towards low blood pressure. Maybe it isn't a thing here in Canada.