Oral Medicine and Medically Complex Patients E-Book
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Leading practical reference on managing in-hospital dental patients and medically complex outpatients with special health care needs
Oral Medicine and Medically Complex Patients, Seventh Edition provides succinct yet comprehensive information on in-hospital care and outpatient management of medically complex dental patients, as well as the management of surgical and non-surgical problems of the maxillofacial region.
This text follows a practical approach, organizing essential information into quickly referenced tables, easy to read diagrams, and step-by-step procedures. Replete with examples of hospital charting, notes, and consultations, the book provides thorough coverage of a broad scope of clinical problems and patient populations.
Oral Medicine and Medically Complex Patients, Seventh Edition features:
- Up-to-date information on patient examination, assessment, diagnosis, and procedures
- Additional charts and tables, over 100 new color clinical images, expanded coverage on maxillofacial prosthodontics and increasingly prevalent medical and orofacial conditions
- An emphasis on recent research, scientific findings and guidelines from the past decade that inform treatment options and provide a strong evidence base for oral health care
Oral Medicine and Medically Complex Patients, Seventh Edition contains essential information for general practice, oral medicine, maxillofacial surgery, and pediatric dentistry residents, dental students, dentists in non-traditional practice settings, and all community-based dental practitioners. This text serves the needs of an increasing number of dental students, residents in general practice and specialty training programs, and a wide spectrum of dental practitioners engaged in the care of both hospitalized and ambulatory patients.
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication
List of Contributors
Abbreviations
Acknowledgments
Introduction
Suggested Readings
1 Oral Health Management of the Hospitalized Patient
Introduction
Dental Admissions
The Admission Note
Admission Orders
Overview of Patient Admission Procedures
Preoperative Considerations
Treatment/Procedure in the Operating Room Under General Anesthesia or Deep Sedation
Intraoperative Considerations
Operative Notes
Brief Operative Note
Postoperative Orders
The Postoperative Note
Follow‐Up Notes
Discharge Notes and Requests
Discharge Summary
Examples of Hospital Charts
Suggested Reading
2 Outpatient Management of the Medically Complex Patient
Medical History
Bleeding Disorders
Specific Coagulopathies
Medications that Predispose to Bleeding
Cancer
Radiation Therapy to the Head and Neck Region
Cytotoxic Chemotherapy
Intravenous Antiresorptive Therapy and Medication‐Related Osteonecrosis of the Jaw
8
Cardiovascular Disorders
Diabetes Mellitus
Drug Allergy
Fever of Unknown Origin
Human Immunodeficiency Virus Infection
Liver and Spleen Disorders
Neurodevelopmental Disorders
Most Common Genetic Conditions Associated with Neurodevelopmental Disorders
Neurologic Disorders
Degenerative Neuromuscular Disorders
Orthopedic Disorders
Pregnancy
Psychiatric Disorders
Renal and Adrenal Disorders
Respiratory Diseases
Sickle‐Cell Anemia/Trait
Substance Use Disorders
Alcohol Use Disorder
Thyroid Gland Disorders
Suggested Reading
3 Oral Medicine: A Problem‐Oriented Approach
Probabilistic Diagnostic Approach
Patient History
Physical Examination
Mucosal Disorders
White Lesions
Red Lesions
Ulcerative Lesions
Exophytic Lesions
Pigmented Lesions
Orofacial Pain
Altered Taste
Xerostomia and Salivary Hypofunction
Malodor/Halitosis
Slow Healing
Altered Oral Function
Problems with Teeth
Suggested Reading
4 Consultations
Requesting and Answering Consultations
Requesting Consults from Other Services
Answering Consult Requests from Other Clinical Services
Responding to the Consulting Service
Consult Format
Examples of Consultation Requests from Other Clinical Services
Suggested Reading
5 Dental, Oral, and Maxillofacial Emergencies
Medicolegal Aspects of Emergency Care
Emergency Department Medical Records
Intraoral Urgencies
Postoperative Emergencies
Odontogenic Infections
Maxillofacial Trauma
Temporomandibular Joint (TMJ) Emergencies
Suggested Reading
6 Medical Emergencies
Inpatient Emergency Support
Code Call
Syncope/Loss of Consciousness
Cardiac and Vascular Emergencies
Epilepsy: Seizures
Diabetic Emergencies
Allergic Reactions
Respiratory Difficulty
Bleeding/Hemorrhage
Drug Overdose and Toxicity
Malignant Hyperthermia
Venipuncture Complications
Suggested Reading
7 Maxillofacial Prosthetics
Diagnosis and Treatment Planning
Maxillary Defects
Obturator Prosthesis: Types
Immediate Surgical Obturator Procedures
Extraoral Prostheses
Conclusion
Suggested Reading
Appendices
Appendix 1: Biopsy
Types of Biopsy
Procedure
Biopsy Request Patient Information
Reporting
Appendix 2: Cincinnati Prehospital Stroke Scale (CPSS)
Suggested Reading
Appendix 3.1: New York Heart Association (NYHA) and Other Classifications of Cardiovascular Disability
Suggested Reading
Appendix 3.2: Classification of Blood Pressure for Adults Aged18 Years or Older
Suggested Reading
Appendix 4: Procedures to Ensure Hemostasis
Appendix 5: Corticosteroid Dose Equivalents
Commonly Used Topical Corticosteroid Doses in Dentistry
Suggested Reading
Appendix 6: Testing Cranial Nerves
Appendix 7.1: Dental Practice Drugs for Use During Pregnancy
Appendix 7.2: Appropriate Drugs for Use with Patients Who Are Breastfeeding
Suggested Reading
Appendix 7.3: General Guidelines for Drug Dosage Adjustment for Renal Failure
Suggested Reading
Appendix 8: Facial Pain: Diagnostic Features
Appendix 9.1: Hepatitis B Virus (HBV) Testing
Hepatitis B Surface Antigen (HBsAg) Test
Hepatitis B Surface Antibody (anti‐HBs) Test
Hepatitis B Core Antibody (anti‐HBc) Test
Hepatitis B e Antigen (HBeAg) Test
Hepatitis B e Antibody (anti‐HBe) Test
Appendix 9.2: Human Immunodeficiency Virus Testing
Antibody Tests
Antigen/Antibody Tests
Nucleic Acid Tests (NAT)
Rapid Tests
Home HIV Tests
Point‐of‐Care (POC) Tests
CD4 Count and Viral Load Tests
Key Points About PEP
Appendix 9.3: Tuberculosis Testing
TB Skin Test (TST)—Mantoux Tuberculin Skin Test
TB Blood Tests (Interferon‐Gamma Release Assays—IGRAs)
Suggested Reading
Appendix 10.1: Hospital Admission
Appendix 10.2: Emergency Room Admissions
Appendix 11: Operating Room
Appendix 12: Patient Transfer
Rationale
Pretransfer Assessment
Minimize Physical Barriers
Preparation for the Transfer
The Transfer
Appendix 13.1: Antibiotic Prophylaxis for Invasive Dental Procedures
Risk Assessment for Bacteremia and the Need for Prophylactic Antibiotics
Suggested Reading
Appendix 13.2: Antibiotic Prophylaxis for Prosthetic Joints
Suggested Reading
Appendix 14.1: Staging and Management of Bisphosphonate‐related Osteonecrosis
Staging of BRONJ
Management of BRONJ
Suggested Reading
Appendix 14.2: TNM Staging for Tumors of the Lip and Oral Cavity
Suggested Reading
Appendix 15: Venipuncture
Appendix 16.1: Drug Interactions: Common Drug Interactions in Dentistry
Appendix 16.2: Common Herbal Supplements and Interactions Significant in Dentistry
Suggested Reading
Index
End User License Agreement
List of Tables
Chapter 2
Table 2.1. Types of Insulin Therapy and Duration of Action
Table 2.2. Diagnosis of Prediabetes and DM
Chapter 3
Table 3.1. Selected Drugs Associated with Hyposalivation and Xerostomia
Chapter 6
Table 6.1. Causes and Treatment of Hypotension
Chapter 7
Table 7.1. Obturator Treatment Timeline
Table 7.2. Microvascular Reconstruction and Prosthetic Rehabilitation Timel...
Appendix 11
Table A11.1
Dress Code
Table A11.2
Scrub Technique
Appendix 13.1
Table A13.1a
American Heart Association Guidelines (2021)
Table A13.1b
Antibiotic Prophylaxis (AP) for a Dental Procedure: Underlying ...
Table A13.1c
Dental Procedures and Antibiotic Prophylaxis (AP)
Table A13.1d
Antibiotic Regimens for a Dental Procedure Regimen: Single Dose...
Table A13.1e
Summary of Findings and Suggestions
List of Illustrations
Chapter 2
Figure 2.1. (a) and (b). Superficial candida infection during cancer chemoth...
Figure 2.2. Aortic valve infective endocarditis.
Figure 2.3. (a) and (b). Jaundice due to liver failure.
Figure 2.4. (a–d). Face, upper back, lower leg, and stomach of a patient wit...
Chapter 3
Figure 3.1. Probabilistic understanding in the diagnostic process for oral m...
Figure 3.2. White lesions.
Figure 3.3. Immunosuppression from HIV leading to oropharyngeal candidiasis....
Figure 3.4. Leukoplakia area on the alveolar ridge.
Figure 3.5. Leukoplakia area on lateral border of tongue.
Figure 3.6. Oral lichen planus.
Figure 3.7. Hyperplastic candidiasis. (a) buccal mucosa. (b) lower labial mu...
Figure 3.8. Systemic lupus erythematosus.
Figure 3.9. Leukoplakic area with lichenoid appearance on ventral tongue/flo...
Figure 3.10. Leukoplakia on lateral border of tongue due to friction.
Figure 3.11. Mixed erythroplakia and speckled leukoplakia area in area that ...
Figure 3.12. Red lesions or lesions with a predominant red component.
Figure 3.13. Erythematous candidiasis.
Figure 3.14. Angular chelitis in a dry mouth patient.
Figure 3.15. Erythema and blister formation in mucous membrane pemphigoid.
Figure 3.16. Erosive lichen planus involving gingiva.
Figure 3.17. (a) Varix of buccal mucosa. (b) Hemangioma.
Figure 3.18. Ulcerative lesions.
Figure 3.19. (a) Traumatic ulcerative granuloma with stromal eosinophilia (T...
Figure 3.20. Tongue ulcer in patient with dry mouth.
Figure 3.21. Ulceration on hard palate caused by herpes simplex virus (HSV)....
Figure 3.22. Stevens‐Johnson syndrome.
Figure 3.23. Ulcerative lesions in oral lichen planus.
Figure 3.24. Ulcerative lesion in pemphigus vulgaris.
Figure 3.25. Oral aphthous ulceration.
Figure 3.26. Necrotizing sialometaplasia.
Figure 3.27. Bilateral necrotizing sialometaplasia.
Figure 3.28. Exophytic lesions.
Figure 3.29. Fibroma on the dorsal lateral surface of the tongue.
Figure 3.30. Mucocele on lower labial mucosa.
Figure 3.31. Pyogenic granuloma.
Figure 3.32. (a, b) Papilloma on the tongue.
Figure 3.33. (a) Drug induced gingival hyperplasia. (b) Calcium channel bloc...
Figure 3.34. Leukemic infiltrates.
Figure 3.35. Solitary gingival lesion diagnosed as squamous cell carcinoma....
Figure 3.36. Pigmented lesions.
Figure 3.37. (a) Amalgam tattoo. (b) Tattoo from amalgam removal from adjace...
Figure 3.38. Oral melanotic macule.
Figure 3.39. Early Kaposi’s sarcoma.
Figure 3.40. Lead poisoning from lead paint ingestion (Pica).
Figure 3.41. Postinflammatory pigmentation in patient with oral lichen planu...
Figures 3.42. (a) Geographic tongue. (b) Geographic tongue.
Figure 3.43. (a) Bulimia. (b) Lemon sucking.
Figure 3.44. Tetracycline intrinsically stained teeth.
Chapter 4
Figure 4.1. Low platelet count with spontaneous bleeding due to plaque and c...
Figure 4.2. Palatal ulceration from HIV.
Figure 4.3. Erythema multiforme.
Figure 4.4. Pregnancy gingivitis.
Chapter 5
Figure 5.1. Primary herpes in a child.
Figure 5.2. (a) Secondary herpes 45 minutes after prodrome. (b) Secondary he...
Figure 5.3. (a, b) Aphthous ulcer.
Figure 5.4. Aspirin burn.
Figure 5.5. Pizza burn.
Figure 5.6. Second molar palatal root abscess with palatal expansion.
Figure 5.7. Infraorbital swelling from right maxillary lateral incisor. Root...
Figure 5.8. (a) Noted in this axial view of a computed axial tomograph is a ...
Figure 5.9. Submandibular drainage from an infected mandibular primary incis...
Figure 5.10. (a–e) Intraoral incision and drainage.
Figure 5.11. (a–e) Extraoral incision and drainage.
Figure 5.12. Occlusal view of a submandibular salivary stone.
Figure 5.13. A cone‐beam CT scan illustrating a large radiopaque submandibul...
Figure 5.14. The panoramic radiograph is unsurpassed in verifying mandibular...
Figure 5.15. Computed tomography is the gold standard for verifying midfacia...
Figure 5.16. Barton bandage.
Figure 5.17. Risdon wire technique. (a) The process of wiring and (b) wiring...
Figure 5.18. Closed reduction with Ivy loops. (a) Creation of the loop. (b) ...
Figure 5.19. Erich arch bar technique. (a) Initial introduction of the ligat...
Figure 5.20. Tooth fracture classification.
Figure 5.21. Regions of mandibular trauma.
Figure 5.22. LeFort midface fractures. (a) Sagittal view of skull. (b) Front...
Figure 5.23. (a–d) Simple, deep suture.
Figure 5.24. (a, b) Inverted simple suture.
Figure 5.25. (a, b) Running subcuticular suture.
Figure 5.26. (a–c) Simple interrupted skin suture.
Figure 5.27. (a–e) Vertical mattress suture.
Figure 5.28. (a–e) Running epithelial suture.
Figure 5.29. (a–e) Standard closures technique.
Figure 5.30. (a, b) Reducing an acute condylar dislocation.
Chapter 6
Figure 6.1. Evaluation of loss of consciousness.
Figure 6.2. Vasovagal syncope.
Figure 6.3. Evaluation of chest pain.
Figure 6.4. Suspected cardiac event.
Figure 6.5. Hypotension.
Figure 6.6. Shock.
Figure 6.7. Hypertension.
Figure 6.8. Seizures.
Figure 6.9. Insulin shock.
Figure 6.10. Anaphylaxis.
Figure 6.11. Evaluation of shortness of breath.
Figure 6.12. Airway obstruction.
Figure 6.13. Foreign body or instrument swallowed or aspirated.
Figure 6.14. Emesis and aspiration.
Figure 6.15. Bronchospasm.
Figure 6.16. Hyperventilation syndrome.
Figure 6.17. Laryngospasm.
Figure 6.18. Evaluation of drug overdose.
Figure 6.19. Malignant hyperthermia.
Chapter 7
Figure 7.1. Types of craniofacial–oral defects and commonly used maxillofaci...
Figure 7.2. Hemimaxillary defect in the edentulous maxilla due to squamous c...
Figure 7.3. Maxillary defect in the partially edentulous maxilla due to squa...
Figure 7.4. Maxillary defect in the edentulous maxilla due to medication ind...
Figure 7.5. Maxillary defect in an unrepaired bilateral cleft palate.
Figure 7.6. Maxillary defect in the partially edentulous maxilla without obt...
Figure 7.7. Maxillary defect in the partially edentulous maxilla with a toot...
Figure 7.8. Maxillary defect with an implant‐supported fixed prosthesis with...
Figure 7.9. Maxillary defect with an implant‐supported fixed prosthesis with...
Figure 7.10. Fibula free flap reconstructed (with skin paddle) left neo‐mand...
Figure 7.11. Fibula free flap reconstructed (with skin paddle) left neo‐mand...
Figure 7.12. Fibula free flap reconstructed (with skin paddle) left neo‐mand...
Figure 7.13. Obturator with a speech aid pharyngeal “bulb.”
Figure 7.14. Obturator with a speech aid pharyngeal “bulb” (intraoral view)....
Figure 7.15. Removable partial prosthesis with a speech aid pharyngeal “bulb...
Figure 7.16. Palatal augmentation prosthesis.
Figure 7.17. NAM appliance for a unilateral cleft palate.
Figure 7.18. The wax prototype for a nasal prosthesis.
Figure 7.19. An auricular prosthesis that is retained by a craniofacial impl...
Figure 7.20. A definitive silicone‐based nasal prosthesis.
Figure 7.21. An example of an oral positioning device used to immobilize and...
Figure 7.22. Head and neck radiation therapy patient setup with thermoplasti...
Figure 7.23. Maxillary impression made in alginate (irreversible hydrocolloi...
Figure 7.24. Trimmed gypsum cast of a maxillary impression to be used for fa...
Figure 7.25. Line mark 1–2 mm beyond gingival margins to delineate the perip...
Figure 7.26. Vacuum thermoplastic sheet that has been adapted over the maxil...
Figure 7.27. Trimming the thermoplastic material for fabricating a protectiv...
Figure 7.28. Trimming the thermoplastic material with rotary instrumentation...
Figure 7.29. Smoothing margins of a thermoplastic protective tray with heat ...
Figure 7.30. Completed thermoplastic protective tray for the maxilla.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication
List of Contributors
Abbreviations
Acknowledgments
Introduction
Begin Reading
Appendices
Appendix 1 Biopsy
Appendix 2 Cincinnati Prehospital Stroke Scale (CPSS)
Appendix 3.1 New York Heart Association (NYHA) and Other Classifications of Cardiovascular Disability
Appendix 3.2 Classification of Blood Pressure for Adults Aged18 Years or Older
Appendix 4 Procedures to Ensure Hemostasis
Appendix 5 Corticosteroid Dose Equivalents
Appendix 6 Testing Cranial Nerves
Appendix 7.1 Dental Practice Drugs for Use During Pregnancy
Appendix 7.2 Appropriate Drugs for Use with Patients Who Are Breastfeeding
Appendix 7.3 General Guidelines for Drug Dosage Adjustment for Renal Failure
Appendix 8 Facial Pain
Appendix 9.1 Hepatitis B Virus (HBV) Testing
Appendix 9.2 Human Immunodeficiency Virus Testing
Appendix 9.3 Tuberculosis Testing
Appendix 10.1 Hospital Admission
Appendix 10.2 Emergency Room Admissions
Appendix 11 Operating Room
Appendix 12 Patient Transfer
Appendix 13.1 Antibiotic Prophylaxis for Invasive Dental Procedures
Appendix 13.2 Antibiotic Prophylaxis for Prosthetic Joints
Appendix 14.1 Staging and Management of Bisphosphonate‐related Osteonecrosis
Appendix 14.2 TNM Staging for Tumors of the Lip and Oral Cavity
Appendix 15 Venipuncture
Appendix 16.1 Drug Interactions
Appendix 16.2 Common Herbal Supplements and Interactions Significant in Dentistry
Index
Wiley End User License Agreement
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Oral Medicine and Medically Complex Patients
Seventh Edition
Edited by
Peter B. Lockhart, DDS, FDS RCSEd, FDS RCPS
Department of Otolaryngology,Head and Neck SurgeryWake Forest University School of MedicineCharlotte, NC, USA
Lauren L. Patton, DDS
Division of Craniofacial and Surgical Care,Adams School of DentistryUniversity of North Carolina at Chapel HillChapel Hill, NC, USA
Michael Glick, DMD, FDS RCSEd
Center for Integrative Global Oral HealthUniversity of PennsylvaniaPhiladelphia, PA, USA
Perry H. Dubin, MD, MPH
Department of MedicineMemorial Sloan Kettering Cancer CenterNew York, USA
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Dedication
We dedicate this book to our families for their support and for maintaining an environment conducive to this effort.
Peter B. LockhartLauren L. PattonMichael GlickPerry H. Dubin
List of Contributors
Perry H. Dubin, MD, MPHDepartment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Catherine Hong, BDS, MSFaculty of Dentistry, National University of Singapore, National University Center for Oral Health, Singapore, Singapore
Kentaro Ikeda, DDS, MPHDepartment of Surgery, Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA, USA
Deepak Kademani, DMD, MDOral and Maxillofacial Surgery, Minnesota Oral and Facial/Head and Neck Surgery, Minneapolis MN, USA
Sarah Kay Youny Lee, DDS, MSDivision of Prosthetic & Esthetic Dentistry, Department of Dental Specialties, Mayo Clinic, Rochester MN, USA
Joel J. Napeñas, DDSDepartment of Oral Medicine/Oral and Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
Bernadette Quah, BDS, MDSFaculty of Dentistry, National University of Singapore, National University Center for Oral Health, Singapore, Singapore
Eric C. Sung, DDSRegenerative and Reconstructive Sciences, University of California School of Dentistry, Los Angeles, CA, USA
Abbreviations
AAMC
Association of American Medical Colleges
AAO‐HNS
American Academy of Otolaryngology and Head and Neck Surgery
AAOMS
American Association of Oral and Maxillofacial Surgeons
AAOS
American Association of Orthopedic Surgeons
ABCDs
Airway, breathing, circulation, disability
ACLS
Advanced Cardiac Life Support
ACS
Acute coronary syndrome
ACTH
Adrenocorticotropic hormone
ADA
American Dental Association
ADHD
Attention deficit hyperactivity disorder
ADP
Adenosine diphosphate
AED
Automated electronic defibrillator
AHA
American Heart Association
AHRQ
Agency for Healthcare Research and Quality
AIDS
Acquired immunodeficiency syndrome
AJCC
American Joint Committee on Cancer
AKI
Acute kidney injury
ALL
Acute lymphoblastic leukemia
ANC
Absolute neutrophil count
ANUG
Acute necrotizing ulcerative gingivitis
A/P
Assessment/Plan
AP
Antibiotic prophylaxis
aPTT
Activated partial thromboplastin time
ASA
American Society of Anesthesiologists
ASD
Autism spectrum disorders
AVR
Aortic valve replacement
BLS
Basic life support
BMI
Body mass index
BMS
Burning mouth syndrome
BP
Blood pressure
BRONJ
Bisphosphonate‐related osteonecrosis of the jaw
BUN
Blood urea nitrogen
CAD–CAM
Computer‐assisted design and computer‐assisted manufacturing
CBC
Complete blood count
CC
Chief complaint
CDC
Centers for Disease Control and Prevention
CEJ
Cemento‐enamel junction
CKD
Chronic kidney disease
CMV
Cytomegalovirus
CN
Cranial nerves
COPD
Chronic Obstructive Pulmonary Disease
CPR
Cardiopulmonary resuscitation
CRF
Chronic renal failure
CT
Computed tomography
CVA
Cardiovascular accident
C&S
Culture and Sensitivity
DBP
Diastolic blood pressure
DDAVP
Desmopressin acetate (generic name)
DKA
Diabetic ketoacidosis
DM
Diabetes mellitus
DMARDS
Disease‐modifying antirheumatic drugs
DOAC
Direct oral anticoagulants
DSM‐5
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
DVT
Deep venous thrombosis
EACA
Epsilon amino‐caproic acid
EBL
Estimated blood loss
EBV
Epstein–Barr virus
ECG
Electrocardiogram
ED
Emergency department
EEG
Electroencephalogram
EM
Erythema multiforme
EMS
Emergency medical services
ENE
Extra nodal extension
EPT
Electric pulp test
ESR
Erythrocyte sedimentation rate
ESRD
End stage renal disease
ETT
Endotracheal Tube
FDA
Food and Drug Administration
FEV1
Forced Expiratory Volume in 1 second
FH
Family history
FUO
Fever of unknown origin
GDD
Global developmental delay
GERD
Gastroesophageal reflux disease
GI
Gastrointestinal
GOLD
Global Initiative for Chronic Obstructive Lung Disease
GSD
Glycogen storage diseases
GVHD
Graft‐versus‐host disease
HAART
Highly active antiretroviral therapy
HAV
Hepatitis A virus
HBOT
Hyperbaric Oxygen Therapy
HbS
Hemoglobin‐S
HBV
Hepatitis B virus
HCT
Hematocrit
HCV
Hepatitis C virus
HDV
Hepatitis D virus
HEENT
Head, Eyes, Ears, Nose, Throat
HIV
Human immunodeficiency virus
HMW
High molecular weight
HNNK
Hyperglycemic hyperosmolar nonketotic coma
HPI
History of the Present Illness
HSCT
Hematopoietic stem cell transplant
HSV
Herpes simplex viruses
HTN
Hypertension
ICH
Intracranial hemorrhage
ICU
Intensive care unit
IE
Infective endocarditis
IMPT
Intensity modulated proton therapy
IMRT
Intensity modulated radiation therapy
INR
International normalized ratio
INSTIs
Integrase strand transfer inhibitors
IV
Intravenous
JIA
Juvenile idiopathic arthritis
JVD
Jugular venous distention
KS
Kaposi Sarcoma
KVO
Keep vein open
LE
Lupus erythematosus
LVAD
Left ventricular assist device
MAP
Mean arterial pressure
MAT
Medication‐assisted treatment
MDR
Multidrug‐resistant
MFP
Maxillofacial prosthetics
MI
Myocardial infarction
MMF
Maxillomandibular fixation
MMSE
Mini‐Mental State Exam
MRI
Magnetic resonance imaging
MRONJ
Medication‐related osteonecrosis of the jaw
MS
Multiple sclerosis
MTA
Mineral trioxide aggregate
MVC
Motor vehicle collision
NAM
Nasoalveolar molding
NNRTIs
Non‐nucleoside reverse transcriptase inhibitors
NPO
Nothing by mouth
NRTIs/NtRTIs
nucleoside/nucleotide reverse transcriptase inhibitors
NSAIDS
Nonsteroidal anti‐inflammatory drugs
NUG
Necrotizing ulcerative gingivitis
NUP
Necrotizing ulcerative periodontitis
OHCP
Oral health care professional
OI
Osteogenesis imperfecta
OLP
Oral lichen planus
OR
Operating room
ORIF
Open reduction with internal fixation
ORN
Osteoradionecrosis
OUD
Opioid use disorder
PA
Posterior–anterior
PCP
Pneumocystis carinii
pneumonia
PD
Parkinson’s disease
PDH
Past dental history
PERRLA
Pupils equal, round, react to light and accommodation
PET
Position emission tomography
PIs
Protease inhibitors
PJI
Prosthetic joint infection
PMH
Past medical history
PMI
Point of maximal impulse
PT
Physical therapy; prothrombin time
PTSD
Post‐traumatic stress disorder
PTT
Partial thromboplastin time
QD
Every day
RAS
Recurrent aphthous stomatitis
RBC
Red blood cell
RIF
Rigid internal fixation
ROS
Review of systems
RRMS
Relapsing‐remitting multiple sclerosis
RRT
Rapid response team
RT
Radiation therapy
RT‐PCR
Reverse transcriptase polymerase chain reaction
RAU
Recurrent aphthous ulcers
SBP
Systolic blood pressure
SCC
Squamous cell carcinoma
SH
Social history
SNRIs
Selective serotonin reuptake inhibitors
SOB
Shortness of breath
T3
Triiodothyronine
T4
Thyroxin
TD
Tardive dyskinesia
TID
Three times per day
TMJ
Temporomandibular joint
TUG
Traumatic ulcerative granulomas
TUGSE
Traumatic ulcerative granuloma with stromal eosinophilia
TXA
Tranexamic acid
URI
Upper respiratory infection
VPD
Velopharyngeal dysfunction
VTE
Venous thromboembolism
vWD
von Willebrand’s disease
vWF
von Willebrand’s factor
vWD
von Willebrand’s disease
VZV
Varicella Zoster virus infection
WBC
White blood count
YO
Year old
Acknowledgments
We wish to acknowledge Anne Olson for her skills as a medical artist, Dr. Peter Jacobsen for his contributions to appendices related to his field of expertise, past contributors to this book, and our students and residents over the years who challenge and inspire us.
Peter B. LockhartLauren L. PattonMichael GlickPerry H. Dubin
Introduction
In 2021, the National Institute of Dental and Craniofacial Research (NIDCR) released Oral Health in America: Advances and Challenge, which was an update to the Oral Health in America: A Report of the Surgeon General published in 2000. This latest publication reiterated that oral health is inextricably linked to general health and well‐being, and reviewed advances and ongoing challenges in oral health with an emphasis on disparities and inequalities of burden of disease and access and affordability of oral health care. There is an ongoing concern about the availability of oral health care for people with complex medical and physical conditions, and those with nonsurgical problems of the maxillofacial region. Some patient populations have better access than others to oral health care services, as well as sources of funding and advocacy groups. Access is further complicated by a longstanding shortage of dentists trained to manage these problems and patient populations. Dental students generally have minimal exposure to medically complex patients and clinical problems that define the specialty area of oral medicine in the United States. Thus, there is an increasing need for medical center‐based training programs in hospital dentistry and oral medicine. These pre‐ and postdoctoral trainees will be called upon to manage oral health for the growing population of both ambulatory and hospitalized medically complex patients and provide appropriate care for those with oral mucosal diseases. This book provides support for these health professionals in all stages of learning and professional development.
Providing dental care to people with disabilities and a wide variety of medical illnesses is practiced by a relatively small but dedicated group of clinicians. Some have postdoctoral training in medical center‐based residencies, and some may have acquired these skills during their careers. Patients with special needs make up a broad range of medical, physical, and emotional conditions, many of whom require dental care in the nontraditional settings of a hospital‐based emergency department, an operating room under sedation or general anesthesia, and/or as an inpatient at the bedside. Clinical space, specialized equipment, and trained support staff are also important elements to facilitate access to oral care for patients with special needs. Larger hospitals may have fully staffed and equipped dental departments that provide care for hospitalized patients, as well as for ambulatory medically complex patients from the surrounding community. Most hospitals in the United States, however, offer neither inpatient nor outpatient special needs dental services, and in these communities, people with complex medical conditions must seek oral health care from a wide variety of community‐based medical and dental practitioners.
Formal, hospital‐based advanced educational programs for recent dental school graduates began in the United States in the 1930s with one‐year, elective “rotating dental internships.” Over the following decades, these residencies gained popularity among dental students who recognized their lack of training in this discipline. This then helped to create demand for expansion in the number of these programs. One and two‐year general practice residencies (GPRs) became more uniformly structured and formal accreditation guidelines by the American Dental Association’s Commission on Dental Accreditation (ADA CODA) set standards for these programs (available online at: https://coda.ada.org/standards). ADA CODA standards also exist to support specialty advanced education programs in oral medicine.
Many GPR programs integrate dental residents into a medical center such that they have parity with their medical and surgical colleagues in training structure and exposure to hospital‐based care. They focus on aspects of clinical and didactic training beyond that available at the pre‐doctoral or dental school level to include exposure to difficult cases of infection, trauma, bleeding, and pain, as well as to a wide spectrum of nonsurgical problems of the maxillofacial region. Such complex oral health care services require at least a basic understanding of physical risk assessment, general medicine, principles of anesthesia, and exposure to a variety of other disciplines and skills. Medically complex patients also require the integration and coordination of dental and medical care plans through interdisciplinary consultation and teamwork.
In the United States, there are two professional groups that have been in existence for over 80 years to support oral health professionals with a commitment to these patient populations. The Special Care Dentistry Organization (SCDA; https://www.scdaonline.org) which, in addition to hospital dentistry, also represents the fields of geriatric dentistry and dentistry for persons with disabilities. The other group is the American Academy of Oral Medicine (AAOM; https://www.aaom.com), which has a focus on two major groups, medically complex patients and the people with nonsurgical problems of the maxillofacial region. These two clinical disciplines are organized and practiced somewhat differently throughout the world. In some countries, medically complex patients and oral medicine are separate disciplines, and in others they are combined under one dental specialty, as is the case in the United States. In 2020, the National Commission on Recognition of Dental Specialties and Certifying Boards recognized Oral Medicine as the 11th ADA‐recognized dental specialty in the United States and is defined as “the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of medically‐related diseases, disorders and conditions affecting the oral and maxillofacial region” (https://ncrdscb.ada.org/recodnized‐dental‐specialties). Like‐minded individuals are encouraged to explore membership opportunities in these professional groups that hold annual scientific conferences with continuing education offerings.
Future challenges include defining and approving an internationally accepted baseline training for oral medicine at both the dental school and postdoctoral level, further integrating medicine and dentistry, building interdisciplinary teams, developing collaborative care systems, improving reimbursement for oral health services, and supporting research in this area. The further development of specialty examinations, credentialing, and international cooperation in the form of scientific meetings and research will translate into better care for these patient populations.
Suggested Readings
Al‐Amad, S.H., Bankvall, M., Okoh, M. et al. (2023). World Workshop on Oral Medicine VIII: Barriers to Research in Oral Medicine: Results from a Global Survey.
Oral Surg Oral Med Oral Pathol Oral Radiol
136 (5): 585–594. doi:10.1016/j.oooo.2023.06.013.
Glick, M., Greenberg, M., Lockhart, P.B., and Challacombe, S. (ed.) (2021).
Burket’s Oral Medicine
, 13the. Wiley Blackwell.
Lockhart, P.B. (2020). The impact of Oral Medicine's Global Efforts on Advancing Oral Health Care, Discovery, and Dissemination of Best Practices.
Oral Surg Oral Med Oral Pathol Oral Radiol
130 (1): 1–3. doi:10.1016/j.oooo.2020.03.045.
Patton, L.L. and Glick, M. (2016).
The ADA Practical Guide to Patients with Medical Conditions
, 2nde. Wiley‐Blackwell.
Riordain, R.N., Farag, A.W., Villa, A. et al. (2023). The World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research Project.
Oral Surg Oral Med Oral Pathol Oral Radiol
135 (6): 699–702. doi:10.1016/j.oooo.2022.11.023.
Tyler, M.T., Miller, C.S., Lockhart, P.B., and Patton, L.L. (2020). American Academy of Oral Medicine: 75 Years of Bringing Medicine and Dentistry Back Together.
Oral Surg Oral Med Oral Pathol Oral Radiol
129 (2): 91–94. doi:10.1016/j.oooo.2019.11.002.
U.S. Department of Health and Human Services. (2021). Oral health in America: Advances and Challenges. National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD.
https://www.nidcr.nih.gov/sites/default/files/2021‐12/Oral‐Health‐in‐America‐Advances‐and‐Challenges.pdf
. Accessed May 8 2024.
