Risk Assessment and Oral Diagnostics in Clinical Dentistry E-Book

Dena J. Fischer

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 342

Veröffentlichungsjahr: 2012

Beschreibung

Many diseases can have an impact upon oral health and/or the safe delivery of dental care. Consequently, oral health care providers need to be comfortable with assessing the risk of providing dental care to their patients with systemic disease as well as the evaluation of oral conditions that may represent manifestations or consequences of systemic disease. Risk Assessment and Oral Diagnostics in Clinical Dentistry aims to enable the dental practitioner to comfortably and capably assess when medical conditions may impact dental care and diagnose oral conditions using routine testing modalities. This clinical guide contains succinct and detailed text with visual aids regarding how to obtain and perform diagnostic tests, how to interpret these tests, and the implications of tests results upon the management of medically complex dental patients and patients with oral conditions. Color photographs show conditions, testing equipment, and test results. An appendix highlights the ten most common oral medicine disorders encountered in dental practice.

Leseprobe

Contents

Authors

Preface

Acknowledgements

Part A Guidelines for Risk Assessment of SystemicConditions That May Complicate or Be Complicated by Dental Treatment

1 Basics of the Health History, Physical Examination, and Clinical Investigations

1.0 INTRODUCTION

1.1 Obtaining a complete medical history

1.2 Physical examination

1.3 Ordering and performing laboratory tests

1.4 Radiology studies

1.5 Suggested literature

2 Basic Tests and Evaluation Methods of Systemic Health

2.0 INTRODUCTION

2.1 Vital signs

2.2 Diagnostic fluids

2.3 General blood tests

2.4 Serum chemistry and electrolytes

2.5 Suggested literature

3 Potential for Bleeding

3.0 INTRODUCTION

3.1 Platelets

3.2 Coagulation

3.3 Suggested literature

4 Potential for Infection

4.0 INTRODUCTION

4.1 Medical conditions associated with an increased risk of oral infection

4.2 Medications associated with an increased risk of infection

4.3 Tests for evaluating infection risk

4.4 Implications of abnormal wbc tests on provisionof oral care

4.5 Antibiotic prophylaxis for dental procedures

4.6 Suggested literature

5 Potential for Poor Wound Healing

5.0 INTRODUCTION

5.1 Diabetes mellitus

5.2 Adrenal disorders

5.3 Bone metabolism

5.4 Other considerations

5.5 Suggested literature

Part B Guidelines for Diagnosis of Orofacial Conditions

6 Dental Caries and Periodontal Conditions

6.0 INTRODUCTION

6.1 Dental caries

6.2 Periodontal disease

6.3 Selected literature

7 Oral Infection

7.0 INTRODUCTION

7.1 Bacterial infection

7.2 Fungal infection

7.3 Viral infection

7.4 Factors that may contribute to infection

7.5 Selected literature

8 Salivary Conditions

8.0 INTRODUCTION

8.1 Implications of salivary hypofunction

8.2 Diagnostic tests for saliva and salivary glands

8.3 Diagnosis of salivary gland disorders

8.4 Sjögren syndrome

8.5 Suggested literature

9 Oral Neoplastic Disease

9.0 INTRODUCTION

9.1 Benign neoplasms of the oral cavity

9.2 Oral potentially malignant lesions

9.3 Oral squamous cell carcinoma

9.4 Other cancers of the oral cavity

9.5 Diagnostic tests

9.6 Adjunctive tests

9.7 Selected literature

10 Oral Complications Associated with Cancer Therapy

10.0 INTRODUCTION

10.1 Cancer pre-treatment risk assessment

10.2 Early effects of cancer treatment

10.3 Early/late effects of cancer treatment

10.4 Late effects of cancer treatment

10.5 Selected literature

11 Oral Manifestations of Autoimmune, Immune-Mediated, and Allergic Disorders

11.0 INTRODUCTION

11.1 Autoimmune conditions

11.2 Immune-mediated conditions

11.3 Allergic disorders

11.4 Suggested literature

12 Orofacial Pain Conditions

12.0 INTRODUCTION

12.1 Pain mechanisms

12.2 General classification of pain

12.3 Pain assessment

12.4 Classification and diagnosis of pain conditions

12.5 Selected literature

Appendix

Index

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Library of Congress Cataloging-in-Publication Data

Fischer, Dena Joi. Risk assessment and oral diagnostics in clinical dentistry / Dena J. Fischer, Nathaniel S. Treister, Andres Pinto. p. ; cm. Includes bibliographical references and index.

ISBN 978-0-8138-2118-4 (pbk. : alk. paper) – ISBN 978-1-118-48324-4 (ePDF/ebook) –ISBN 978-1-118-48327-5 (ePub) – ISBN 978-1-118-48338-1 (mobi)I. Treister, Nathaniel S. II. Pinto, Andres, 1972– III. Title.[DNLM: 1. Diagnosis, Oral–methods. 2. Dentistry–methods. 3. Mouth Diseases–diagnosis.4. Risk Assessment. WU 141]617.6′01–dc23

2012029835

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Authors

Dena J. Fischer,DDS, MSD, MSAssistant ProfessorUniversity of Illinois at Chicago College of DentistryDepartment of Oral Medicine and Diagnostic SciencesChicago, Illinois

Nathaniel S. Treister,DMD, DMSCAssistant Professor of Oral MedicineDirector of Postgraduate Oral MedicineHarvard School of Dental MedicineAssociate SurgeonBrigham and Women's HospitalBoston, Massachusetts

Andres Pinto,DMD, MPH, FDS, RCSEDAssociate Professor of Oral Medicine and Community HealthDirector of Oral Medicine ServicesUniversity of Pennsylvania, School of Dental MedicineAttending PhysicianThe Children’s Hospital of PhiladelphiaHospital of the University of Pennsylvania, Perelman School of MedicinePhiladelphia, Pennsylvania

Preface

For the past few decades, the United States and world populations have increased, partly because people are living longer, resulting in individuals with chronic disease living long and robust lives. Many medical conditions can have an impact upon oral health and/or the safe delivery of dental care. For example, a patient with diabetes has an increased risk of developing periodontal disease, or a patient with a history of atrial fibrillation on prophylactic anticoagulant medication may be at a greater risk of post-operative bleeding following a surgical procedure. Consequently, oral health care providers need to be comfortable with assessing the risk of providing dental care to their patients with systemic disease as well as evaluation of oral conditions that may represent manifestations or consequences of systemic disease. This clinical guide will address these two major topics. First, we will discuss guidelines for risk assessment of systemic conditions that may complicate or be complicated by dental treatment. Next, we will review guidelines for diagnosis of oral conditions to assist in the diagnosis of orofacial conditions within the scope of dental practice.

Risk assessment of systemic health is of key importance and should be addressed upon first interaction between a dental provider and patient. After obtaining a thorough medical history (chapter 1) and vital signs (chapter 2), patients should be assessed for their potential for bleeding (chapter 3), potential for infection (chapter 4), potential for poor wound healing (chapter 5) and their general ability to withstand dental treatment. Patients with signs and symptoms of suspected disease or known disease that is not well managed require referral to a medical provider for thorough evaluation prior to providing elective dental care.

In patients with known medical conditions, diagnostic testing is typically utilized to monitor disease status and response to or compliance with treatment. In the first section of this clinical guide, we will discuss the common diagnostic tests utilized in medical settings, the interpretation of abnormal test values, and the clinical implications of abnormal findings. Dental providers should have a thorough understanding of and ability to interpret the results of diagnostic tests to better communicate with medical colleagues and to understand the disease status of their patients.

The second section of this clinical guide addresses diagnosis of orofacial disease and oral manifestations of systemic disease. Following a thorough extraoral and intraoral clinical examination, hard and/or soft tissue abnormalities should be assessed through the diagnostic process, which involves determining a differential diagnosis while taking into consideration the disease process and the system/tissue/cell type(s) involved. We will review clinical signs and symptoms of common oral conditions as well as diagnostic tests and procedures that can be utilized to determine a definitive diagnosis. The definitive diagnosis is essential in developing a plan of treatment and time interval for follow-up and monitoring.

We hope this clinical guide will be a useful tool for dental students in training, dental residents, and practicing dentists throughout the span of their professional lives. It has been designed to be an easy-to-use reference with features such as clinical images, alert boxes, and guidelines, so that the busy clinician can quickly look up information about his/her patients to assist in guiding appropriate treatment. While the majority of dental patients can be treated with minimal risk of complications, dentists must be well informed and confident to fully address the oral health care considerations of their entire practice.

Dena J. Fischer, DDS, MSD, MSNathaniel S. Treister, DMD, DMScAndres Pinto, DMD, MPH, FDS, RCSEd

Acknowledgements

With love and gratitude to our families, colleagues, and most importantly our patients, who provided us with the expertise to develop this clinical guide.

Part A

Guidelines for Risk Assessment of Systemic Conditions that may Complicate or be Complicated by Dental Treatment

1  Basics of the Health History, Physical Examination, and Clinical Investigations

1.0 INTRODUCTION

This chapter sets the foundation for this clinical guide by describing the basic principles and processes of clinical evaluation of the patient. Risk assessment first and foremost depends on obtaining a comprehensive medical history. In addition to physical examination, the ­clinician must determine whether any other clinical investigations are indicated prior to providing oral health care. These elements provide an essential basis for the clinical guide.

1.1 Obtaining a complete medical history

A wide variety of medical conditions and their treatments have the potential to affect oral health and may require specific considerations prior to providing dental care. In order to adequately assess a patient’s health and determine risk for developing complications, a complete medical history must be obtained and updated on a regular basis. Whether paper or electronic medical records are utilized, this information should be clear and easy to locate. Contact information for the patient’s primary care physician and any relevant medical specialists should also be recorded and accessible. Details of all telephone, email, or mail correspondences with the patient or his/her medical providers, as well as laboratory reports, should be included in the patient’s chart.

While a self-completed health history form can be useful in screening for certain medical conditions and risks, this should be used to guide, rather than replace, the medical interview. The oral health care provider and patient should be facing each other in a comfortable and relaxed manner during the interview, and translators should be used when necessary. When there are any questions or items in the medical history requiring greater detail or clarification, the patient’s primary care physician should be consulted.