Always determine the patient’s pulse rate and rhythm (see Table 2-3). The normal resting pulse rate is between 60 and 100 beats per minute (bpm). A patient with a pulse rate >100 bpm (tachycardia), even considering the stress of a dental office visit,
should be allowed to rest quietly away from the dental operatory to allow the pulse to return to normal before the start of dental treatment. If the patient’s pulse rate remains persistently high, medical evaluation of the tachycardia is appropriate because severe coronary artery disease or myocardial disease may be present. Note that the pulse rate normally rises about 5 to 10 bpm with each degree of fever. Rates that are consistently < 60 bpm (bradycardia) warrant medical evaluation although sinus bradycardia, a common condition, can be normal.
Although a healthy person may have occasional irregularities or premature beats (especially when under stress) a grossly irregular pulse can indicate severe myocardial disease (arrhythmia or dysrhythmia), justifying further cardiac evaluation before dental treatment is instituted. Cardiac consultation is necessary for the accurate interpretation of most pulse rate abnormalities.
Pulse rate abnormalities may be regular or irregular. Irregular rate abnormalities may be divided further into regularly irregular and irregularly irregular abnormalities.
It is usually unnecessary to measure the patient’s respiratory rate in the dental office unless cardiopulmonary disease is suspected or general anesthesia or another type of sedation is planned. However, the examiner should note whether the patient is breathing very rapidly, is short of breath, or is dyspneic. These symptoms alone may indicate the presence of pulmonary or cardiac disease, anemia, or acute anxiety.