Real-time autonomic assessment

June 1, 2005
I recently attended a conference that included medical doctors, chiropractors, massage therapists, naturopaths, and yes, dentists and dental hygienists.

I recently attended a conference that included medical doctors, chiropractors, massage therapists, naturopaths, and yes, dentists and dental hygienists. I was overjoyed at how the health-care practitioners mixed. The professionalism and interaction were exciting. I felt like I was back in college, with the mixture of health professionals sitting in the classroom all learning together.

While at the conference I took the time to visit the vendor area, and it was very interesting to see the different devices that some health innovators designed to scan the human body for imbalances.

With my curious nature I had to find out more. I wanted to be treated by all these health technology devices, so I got in line for my test. What I learned was that these techy health applications devices would dovetail nicely into our everyday dental hygiene departments. Why? The amount of information we can access in a short time is a big challenge for a dental hygiene appointment, yet we all know there is so much more we can assess about our patients’ health if given the right tools and time to do so.

I believe the future of health-care offices will include such devices. One such device I was tested with is called Nervexpress, a cutting-edge software application created by Dr. Alexander Riftone. Nervexpress literally increases our patients’ awareness, or health IQ. This software application is purchased with the accessories to complete a patient test, and can be installed on the computer in your operatory.

Dr. Riftone conceived the product for the Navy. Specifically, Nervexpress was designed for objective testing of the general health and special fitness conditions of Navy pilots, underwater divers, Navy Seals, and other personnel. Nervexpress was launched in 1992. It is the first product to provide the automatic quantitative assessment of the autonomic nervous system (ANS).

The heart rate variability (HRV) analysis is based on measuring variability in heart rate - specifically, variability in intervals between R waves, or “RR intervals.” This technology is achieved by using proprietary algorithms and a new approach based on one of the leading theories of artificial intelligence - Marvin Minsky’s Frame Theory. Nervexpress objectively and reliably evaluates the stature of the ANS during rest for up to 24 hours, as well as during the orthostatic test and Valsalva maneuver. Due to its highly sophisticated HRV analysis, it is the only system that enables precise recognition and classification of 74 ANS states with a corresponding description for each one.

The Nerve-Express System performs the following tasks:

• Assessment of ANS and the level of physical fitness based on posture (orthostatic test)

• Assessment of ANS based on performance of the Valsalva maneuver combined with deep breathing

• “Real-iime” assessment of ANS for up to 24 hours (similar to the Holter Monitor) with calculation and three-dimensional representation of the spectral function for each stage.

The autonomic response may be observed every two to three minutes by separate assessment of sympathetic and parasympathetic activity. The modality can be used for intensive care, anesthesia, and other long-term applications. I took the test to see how healthy my heart is and how fit I am. My outcome? I am way too stressed. Dr. Riftone pointed out I was fit, but my sympathetic condition was a bit on the high side. He said I needed more parasympathetic activity to calm me. I’m making plans for a vacation!

Why this technology is important for our dental patients. We first need to understand the autonomic nervous system to appreciate the value of the Nervexpress technology.

The ANS is the portion of the peripheral nervous system that functions independently and continuously, without conscious effort. This system controls visceral activities by regulating the action of smooth muscles, cardiac muscles, and various glands. It is concerned with regulation heart rate, blood pressure, breathing rate, body temperature, and other visceral activities. ANS has two divisions: the sympathetic nervous system, which is primarily concerned with regulation under stressful conditions, and the parasympathetic nervous system, which is primarily concerned with regulation under restful conditions.

Remember in hygiene school when we were graded on taking patient vitals such as blood pressure, pulse, and breathing? Since hygiene visits are disease model driven and not health model driven, we rush past the vitals. I am guilty of this. I start to be consistent about taking vitals, but I eventually stop these extra tasks due to time constraints. If I could implement a screening device that could cover all the steps, I would feel more secure with my patients’ health documentation gathering.

Dr. Thomas Bigger of Research Holter Laboratory, and professor of medicine and pharmacology at Columbia University, states: “The purpose of this evaluation was to compare the Nervexpress algorithms with the ‘gold standard’ CHRONOS algorithms to test the reliability of the Nervexpress algorithms for power spectral analysis of RR intervals. The CHRONOS algorithms have been shown to predict death in coronary heart disease and to quantify physical fitness, but they are accessed via Holter technology and are not packaged as a stand-alone office instrument. The Nervexpress algorithm is conveniently packaged for office use. If they are equivalent to CHRONOS, they would constitute a reliable office system useful for many purposes, including assessment of risk in cardiovascular disorders, quantification of drug effects on the autonomic nervous system, assessment of physical fitness, and documentation of benefit for cardiac, chiropractic, or orthopedic rehabilitation.”

Dr. Head confirmed in his final evaluation that the CHRONOS and the Nervexpress data comparison is in total agreement.

Wow! If dental offices could implement such technology for a minimal investment, wouldn’t that be a great service to offer patients at their annual dental hygiene visits? We could pick up heart conditions early enough to refer people to the medical community! We could also relate this with the gum disease and heart disease connection. What a powerful tool for patients with gum disease to double check them with the Nervepress.

I realize we do not have 15 minutes to spare in a hygiene visit for this task, but we could educate our patients to schedule such a scan with us before or after an appointment, or as an add-on if your office practices selective dental hygiene scheduling.

Dental offices in each area of the United States have medical billing codes that may cover this scan. You will need to find out in your area what medical insurance codes apply. As for the patient fee, I have heard from $30 to $50 per scan. Each scan takes about 15 minutes.

I could think of only three disadvantages. First, the device has a belt that needs to be placed on the skin below the rib cage. This may be a problem for some patients’ comfort levels. Second, it takes 15 minutes so you will need to pre-appoint patients before or after hygiene visits. Third, the dentist you work for may not support such new health screening technology. He or she may practice what I call disease model dentistry.

In conclusion, I have a close friend who is a medical doctor who has encouraged me to do these screenings at hygiene visits. He recently discovered 30 percent artery heart blockage on a 47-year-old healthy athletic male with no symptoms whatsoever. He informed me that this male patient could have dropped dead without any warning.

For what it’s worth, dentists and hygienists can really save lives.

For more information visit to find out more about this product. You can also contact Dr. Riftone at [email protected].

Victoria DaCosta, RDH, BS, is founder and president of Hy-Tech Solutions. A practicing dental hygienist for 18 years, DaCosta is a speaker, author, consultant, and an expert in the design of medical/dental software. She is also on the new technologies committee for the California Dental Hygienists’ Association. DaCosta can be contacted at