Dentist’s Guide to Medical Conditions and Complications

Book Preface

Dental care today holds many challenges for the dental practitioner. Patients live longer, often retaining their own dentition, have one or more medical conditions, and routinely take several medications.

Along with excellence in dentistry, the practicing dentist has the dual task of staying updated with the current concepts of medicine and pharmacology and should rightfully be called the “Physician of the Oral Cavity.”

The integration of medicine in the dental curriculum has become a necessity, and this integration must begin with the freshman class for the students to gain maximum benefi t and for the change to also gain credibility. The integration of medicine is best achieved when done in a case-based or problem-based format and correlated with the basic sciences, pharmacology, general pathology, oral pathology, and dentistry. There needs to be a true commitment and constant reenforcement of the integration in all the didactic and clinical courses.

The integration of medicine, pharmacology, and medically compromised patient care is best achieved when done in a pyramidal process, through the four years of dental education.

The foundation should instill a basic knowledge of:

1. Standard and medically compromised patient history taking and physical examination
2. Symptoms and signs of highest-priority illnesses along with the common laboratory tests evaluating those disease states
3. Anesthetics, analgesics, and antibiotics used in dentistry
4. Prescription writing

“Normal” patient assessment, when stressed in the fi rst year, prepares students to better understand the changes prompted by disease states during the second year of their education, when didactic and clinical knowledge of highest-priority illnesses, associated diagnostic laboratory tests, and the vast pharmacopia used for the care of those diseases is added on. Case-based scenarios should be used to solidify this information.

The progressive learning up to the end of the second year prepares the student to “care” for the patient “on paper”. With the start of the clinical years, the student is prepared to apply this knowledge toward “actual” patient care during the third and fourth years of education.

During the third year the student should participate in medical and surgical clinical rotations in a hospitalized setting and complete a Hospital Clerkship Program where the student is exposed to head-and-neck cancer care, emergency medicine, critical care, anesthesia, hematology, oncology, transplants, cardiothoracic surgery, etc. This will widen the student’s knowledge, broaden clinical perception, and further enhance the link between medicine and dentistry.

During the clinical years, the students should complete faculty-reviewed medical consults for all their medically compromised patients, prior to dentistry. This patientby- patient health status review will help correctly translate their didactic patient-care knowledge in the clinical setting.

The text is a compilation of materials needed for the integration of medicine in dentistry. It is a book all dental students and dental practitioners will appreciate both as a read and chairside.

The text provides information on epidemiology; physiology; pathophysiology; laboratory tests evaluation; associated pharmacology; dental alerts; and suggested deviations in the use of anesthetics, analgesics, and antibiotics for each disease state discussed.

The student will greatly benefi t from the sections detailing history taking and physical examination; clinical and applied pharmacology of dental anesthetics, analgesics, and antibiotics; stress management; and management of medical emergencies in the dental setting.