When Lee Trautman went to the dentist for a routine checkup, the last thing he expected was a warning about his blood pressure. Thanks to Kaiser Permanente’s close integration of medical and dental care, severe hypertension he didn’t know he had was discovered and treated before it caused serious harm.
As part of this integrated approach, Kaiser Permanente has developed tools and resources for dental providers to help connect members with medical providers for patients with preventative care gaps. Licensed Practical Nurses (LPNs) have also been placed in several of its dental offices. Their presence helps members stay on track with preventive care and identify medical issues that might otherwise go unnoticed.
“We’ve helped people catch diabetes, cervical cancer, and breast cancer early,” said Nikki Barker, LPN, at the Cedar Hills Dental Office in Beaverton, Oregon. “I’ve heard from doctors who said that if their patient had come in later, the outcome would have been much worse. It really makes a difference.”
In Trautman’s case, that difference came down to a blood pressure check. His primary care physician had previously prescribed a low dose of medication after noticing his blood pressure was trending up. After that, his numbers improved, and Trautman assumed everything was under control.
During a dental visit, Barker saw that Trautman was due for a blood pressure check and offered to take it right then. His reading was high: 168/74. Barker helped him schedule a follow-up appointment with his physician, who adjusted his medication. Soon after, his blood pressure returned to a healthy range.
Looking back, Trautman believes stress from a recent accident may have contributed to the spike. At the time, though, he felt fine.
“If this had continued, I probably would have had a stroke, and that’s pretty scary,” Trautman said. “It would have really changed my retirement. If there hadn’t been a nurse at the dental office, this wouldn’t have been caught. It only took a few minutes to prevent all that.”
Dr. Daniel Pihlstrom, a dentist at the Cedar Hills Dental Office, said Trautman’s experience reflects the kind of preventive care Kaiser Permanente’s medical-dental integration is designed to provide.
“Having an LPN working with us elevates the culture of the entire dental office,” Dr. Pihlstrom said. “It increases our awareness of patients’ medical needs and supports a truly team-based approach to total health.”
Barker is fully integrated into daily clinic operations and attends staff meetings. Dr. Pihlstrom said her presence influences how the whole team approaches care.
“When you have someone trained and focused on medical care practicing alongside you, it changes how everyone thinks,” he said.
All Kaiser Permanente dental offices offer members care gap reminders, blood pressures checks, and can even administer flu vaccinations. But without an LPN, some offices are limited to the types of care gaps they can address.
“With an LPN in the office, we can close care gaps in the moment,” Dr. Pihlstrom said. “The real value is having someone with the knowledge, skills, and time to act right away. Patients do better when care happens immediately.”
After a dental visit with a hygienist or dentist, members are introduced to the in-office nurse. The nurse reviews their care plan to see if they are due for medical services.
“We do vaccines, blood pressure checks, and blood draws. We give out colon cancer screening kits and help schedule appointments,” Barker said. “That might include a Pap test, mammogram, physical exam, or a child’s well-visit — all before the member leaves our office.”
Trautman values being able to take care of multiple needs in one visit. At one appointment, he received dental cleaning, a flu shot, and a blood pressure check — without extra trips or appointments.
But the benefits go beyond convenience. The added medical touchpoint gives patients a chance to raise concerns they may not have discussed with their doctor or issues that come up between visits.
“All kinds of things come up when people have time to talk,” Barker said. “You never know what you’ll learn just by listening one on one.”
Now nearly 75 and recently retired, Trautman spends his time swimming and working out. At his most recent dental visit, Barker checked his blood pressure and smiled.
“This is perfect,” she said.
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