I am very happy that Dr. Brown appreciated the study and the efforts we have made to carry out such a clinical study.
I agree with all considerations noted by Dr. Brown, and I completely agree that mental stress is related to many complicated physiological concerns, and that it is very hard to control all variables (age, postural issues, and so on) that can influence the cardiovascular response to a stressful situation.
However, the aim of the study was not to give more insight into the role of some variables (age, family history for hypertension, hypertensive status, kind of stressor, and so forth) in influencing cardiovascular activity during a stressful situation, but instead to evaluate the most sensitive clinical parameter at our disposal to differentiate four different periods, each presumably characterized by a different autonomic and cardiovascular activity.
In fact, to control as many variables as possible, we studied each parameter at the same time, and in the same subject, during the four considered periods, and heart rate variability (HRV) resulted in being the most sensitive in differentiating the periods.
Our goal in the future is to apply the procedure of monitoring HRV in patients with heart disease who are undergoing operative dental procedures, hoping that HRV might be a useful monitoring tool to detect even initial cardiac impairments, so the dentist can immediately stop the intervention to prevent cardiovascular emergencies.
I agree with Dr. Brown that the routine utilization of HRV as a measure for the determination of clinical risk in the practice of dentistry still has a long way to go.
