I HAVE found that fit and healthy-looking patients attending the dental clinic for treatment sometimes have a serious systemic disease and are under drug therapy. Either or both can significantly affect dental management or even the fate of the patient. In addition, in this country, patients are not accustomed to being questioned by a dentist about matters such as pregnancy and sexually transmitted diseases. Very often, since most patients are fit and healthy, the dentist’s index of suspicion may not be significant. But whatever the circumstances, the fact remains that any medical disorder or medication being taken should be reported to the attending dentist.

Corticosteroid can mask the presence of many severe diseases because it acts by suppressing the effects of trauma and infection. If sedation or general anaesthesia is administered, there is rapidly developing hypotension (low blood pressure), collapse and death. Patients on or who have been on corticosteroid therapy within the past year are therefore at risk from adrenal crisis if they are not given supplementary corticosteroids before and during periods of stress, including dental treatment.

Diabetes affects about two persons for every hundred in Guyana but is recognised in only half of those with the disease. The prevalence is only increasing and it is, therefore, a relatively frequent problem in dental management. Dental disease and treatment may disrupt the normal pattern of food intake and can interfere with diabetic control, but a little forethought will prevent diabetics from collapsing in the waiting room at lunchtime from hypoglycemia caused by missing a meal. Treatment is best carried out just after breakfast and the normal anti-diabetic medication to allow the patient to eat lunch.

It is important to know whether a woman is pregnant since any dental procedure involving drugs, radiography (X-ray) or general anaesthesia is best left until after four weeks of conception. Radiography should be reduced to an absolute minimum. Although there is no known risk of abnormal from most drugs commonly used in dentistry, drug administration should also be done when absolutely necessary. Besides, if a woman

should give birth to a baby with defects, no matter at what stage of the pregnancy the dentist had prescribed a drug, the dentist might very well run the risk of the woman blaming him for her misfortune.
Anyone who it has been established suffers from a faulty heart should first rinse the mouth thoroughly with a potent mouthwash such as chlorhexidine before having an extraction. Bacteria from the mouth can cause a damaged heart valve to become chronically infected causing endocarditis which kills a third of all its victims. It is quite probable that serious illness and death occur in patients who present medical conditions which originated largely from some dental disease but which the attending physicians fail to identify as such. One typical example of this is brain abscess developing from a necrotic tooth fare-up.