Medical disorders and dentistry

NO patient should suffer any deterioration of health because of dental treatment. Therefore, it is essential to establish as clearly as possible, within practical limitations of the dental practice, the presence and significance of medical problems likely to affect oral care.

It is important to foster awareness of the magnitude of the medical history and patient assessment to determine whether a patient is fit to undergo dental treatment.

Health and life expectancy in many countries are increasing, mainly because of improved social conditions, preventive medicine, the improved ability to treat the main killing diseases – myocardial infarction (heart attack), cerebrovascular accidents (stroke) and improvements in medical care of hitherto fatal diseases.

There are also relatively new diseases such as AIDS, COVID and a range of other problems resulting from advances in medical and surgical care. Thus, more people are surviving with chronic illness, and the population of elderly people is increasing.

Oral health care has not always been forthcoming for patients with medical problems, and oral diseases are not always recognised as being part of a generalised disorder.

There is little–if any–excuse for the unwillingness of dentists to care for seriously ill patients, as it would be a clear professional error.

Compromised persons present, in general, few special treatment problems for the dental practitioner working with local analgesics only. Notwithstanding, although in rare circumstances, patients can die due to sequelae resulting from lack of oral health care. This is apart from the fact that death is relatively common in persons lacking the diagnosis and treatment of oral lesions, which may eventually prove to be cancerous.

The prevalence of medical disorders that might affect dental treatment depends on the type of patient. Although everyone should be questioned on their medical histories, the elderly, handicapped and the hospitalised should be especially medically assessed before dental treatment.

In societies where it is common for patients to request having their treatment done under general anaesthesia, there is a greater need to carry out a medical examination. It should be noted that although dental fear and anxiety are totally eliminated because the patient is asleep during the dental procedures, the serious medical risk involved when the general anaesthesia is induced should be a concern. In my opinion, dental fear and anxiety are not sufficient justification for general anaesthesia in dentistry.

The basic reason why it is so important for medical assessment be done on a patient seeking medical treatment, is that many dental procedures can impact negatively on
the patient’s well-being when certain medical conditions exist. In this country, dentists generally disregard their duty to adequately screen their patients, because it is not usual for a patient to sue a dentist for malpractice or professional negligence. Another major reason is that Guyanese dental patients are not accustomed to their dentists requesting heart tests, blood and urine tests etc., or being questioned about their medical histories. When this is done, patients often dismiss such as being inappropriate. This being the unfortunate reality, patients themselves should do their own screening for their own good or voluntarily submit information on their general health to the dental practitioner.


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