Medical Management Guidelines for the Provision of Dental Care
|Reference||9191||1||July 3, 2012|
The purpose of this guide is to assist health care professionals (dental medical, nursing, pharmacy and allied) in recognizing commonly occurring medical considerations that frequently arise in the provision of dental care. The intended outcome of this guide is to provide oral health and access to care for the patients entrusted to our care. This necessitates that the health care professionals work together in an effort to exchange their expertise so as to maximize the dental and medical prognosis for the patient. This guide is not intended as a definitive text on the diagnosis and management of oral and maxillofacial pathology, nor is it a treatise on internal medicine. This guide includes the most commonly encountered medical issues that arise in the routine provision of dental care. The literature cited is current at the time of publication; the user of this guide should ensure that the literature utilized in their clinical decision making is current. Both medical and dental educators can utilize this guide as a template for modifying their curricula.
Siegel M. Medical Management Guidelines for the Provision of Dental Care. MedEdPORTAL; 2012. Available from: www.mededportal.org/publication/9191
Contains time-sensitive information that will likely be inaccurate, obsolete, or irrelevant by June 08, 2015
Contains Information Suitable for Patient Education
- To determine the need to request consultation with the medical or dental care provider.
- To develop an understanding of the commonalities of medical and dental patient management by working collaboratively with dental and medical professionals to foster a climate of mutual respect and shard values centered on the oral healthcare needs of patients.
- To allow for dental treatment plan modifications to accommodate the patient’s medical conditions and complexity.
- To utilize the published guidelines for antibiotic premedication of dental patients prior to invasive dental care to prevent indiscriminate of antibiotic medications.
- To apply guidelines for anticoagulation and steroid supplementation for dental procedures.
- To recognize the need to alter standard prescription protocols. The user will recognize the impact of drugs and medical therapies on oral health (including candidiasis, dental caries, periodontal disease, and xerostomia).
- To recognize treatment needs for oral conditions associated with AIDS, chemotherapy and chronic systemic conditions.
- To appropriately order medical or dental laboratory testing.
- To provide appropriate informed consent to the patient.
- To allow dentists to better understand the information they need to gain from working with the medical provider to ensure the safe provision of dental care.
- To allow physicians to understand the dental sequalae of systemic disorders so they better understand a dentist’s clinical queries.
- To support a team approach to oral, overall health maintenance, and treatment needs through responsive and respectful communication between dental and medical providers.
- Guide, Referral and Consultation (MeSH), Building Oral Health Capacity (BOHC) Collection
- Advanced Dental Education
- Clinical Exam
- Communication & Interpersonal Skills
- Patient Care
- Interpersonal & Communication Skills
- Interprofessional Collaboration
- Medical Knowledge
- Patient Care
- Clinical Sciences
- Clinical Exam
- Clinical Skills/Doctoring
- Oral Health
- Quality Improvement
- Professional & Faculty Development
- Professional School
- Dental Student
- Medical Student
- Professional School Post-Graduate Training
- Independent Study
Authors & Co-Authors
Michael Siegel, DDS
Nova Southeastern University
Sponsorship or Funding Source
This project is sponsored in part by funding from the Health Resources and Services Administration/Maternal Child Health Bureau grant #U44MC20223.
Effectiveness and Significance
The initial iteration of this guide (written by the author as a teaching tool, unpublished) has been made available to all dental students and specialty residents in the classroom and is directly accessible in our patient care electronic record (AxiUm). Users reference this guide in order to assess the patient in light of current medical guidelines that might alter the dental treatment plan. This guide is then used as the basis for the structuring of a medical consultation to the patient's primary care provider. Faculty have used this guide in ordering laboratory testing, consulting with the primary medical provider, in patient evaluation and in constructing lectures.
Special Implementation Guidelines or Requirements
A stand-alone document for use on a computer, smart phone, network or in hard copy to assist the medical or dental providers in direct clinical patient management.
This guide can be incorporated or linked to an electronic patient database to allow the clinician to access this information from within the electronic patient database and incorporate pertinent recommendations into individual patient records.
This guide can be used as a template for the development of interprofessional curriculum related to medical and dental topics. Both medical and dental educators can utilize this guide as a template for modifying their curricula.
This guide can provide the basis for case construction for case-based learning modules.
This guide can serve as a literature source as it lists current references associated with each topic.
This guide can be used as a basis for interprofessional communication by utilizing the consultation forms found in the appendices.
There is significant empiricism and inconsistencies between medical and dental providers when prescribing assessing the need for the prescription of antibiotic premedication, altering anticoagulants, supplementing steroids, managing hypertension, responding to infectious diseases and management of the other disorders addressed in this guide. This guide is based on currently published guidelines and serves as a baseline on which to foster interprofessional discussion on patient specific changes to the treatment plan. This guide offers both dental and medical providers insight to their counterparts considerations and has been shown to be effective in demystifying and providing a non-confrontational basis for interprofessional communication.
This information is made available under the Creative Commons license.
Publications, Presentations, and/or Citations for this Publication
- Aframian DJ, Lalla RV, Peterson DE. Management of dental patients taking common hemostasis-altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 03(Suppl):45-49.
- Brennan MT, Wynn RL, Miller CS. Aspirin and bleeding in dentistry: an update and recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 104(3):316-23.
- Department of Anesthesia and Critical Care. Medications that should be discontinued prior to surgery. U. of Chicago Pritzker School of Medicine,
- Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O’Gara P, Whitlow P.
Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. J Am Dent Assoc 2007; 138(5):652-5.
- Yepes JF, Sullivan JA, Castellanos AL, Sollecito TP. Hypercoagulability syndromes: what the dentist
needs to know. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 104(1):3-11.
ANTIRESORPTIVE AGENT-INDUCED OSTEONECOSIS
- Migliorati CA, Casiglia J, Epstein J, Jacobson P, Siegel M, Woo S-B. Managing the care of patients with bisphosphonate-associated osteonecrosis: An American Academy of Oral Medicine position paper. JADA 2005; 136:1658-1668.
- American Dental Association Council on Scientific Affairs. Hellstein JW, Adler RA, Edwards B, Jacobsen PL, Kalmar JR, Koka S, Migliorati CA, Ristic H. Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis―executive summary of recommendations. J Am Dent Assoc 2011; 142(11):1243-1251.
- American Dental Association Council on Scientific Affairs: Dental management of patients receiving oral bisphosphonate therapy. J American Dental Association 2006;137(8):1144-50. Updated on: J Am Dent Assoc 2008;139;1674-1677
- Badros A, Terpos E, Katodritou E, et al. Natural history of osteonecrosis of the jaw in patients with multiple myeloma. Journal of Clinical Oncology 2009; 26:5904-5909.
- Bergman SA. Perioperative management of the diabetic patient. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2008; 103(6):731-7.
- Friedlander AH, Chaudhuri G, Altman L. A past medical history of gestational diabetes: its medical
significance and its dental implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(2):157-63.
- Lalla RV, D'Ambrosio JA. Dental management considerations for the patient with diabetes mellitus. J Am Dent Assoc 2001;132(10):1425-32.
- Roberts HW, Mitnitsky EF. Cardiac risk stratifiation for postmyocardial infarction dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91(6):676-81.
- Herman WW, Ferguson HW. Dental care for patients with heart failure: an update. J Am Dent Assoc 2010;141(7):845-53.
- Little JW, Falace DA, Miller CS, Rhodus NL, eds. Dental Management of the Medically Compromised Patient. Mosby Elsevier, Inc., ed. 7, St. Louis, 2008.
- Yagiela JA. Adverse drug reactions in a dental practice: interactions associated with vasoconstrictors. J Am Dent Assoc 1999;130(5):701-9.
- Brand HS, Gortzak RA, Palmer-Bouva CC, Abraham RE, Abraham-Inpijn L. Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment. Int Dent J 1995;45:45-8.
- Davenport RE, Porcelli RJ, Iacono VJ, Bonura CF, Mallis GI, Baur PN. Effects of anesthetics containing epinephrine on catecholamine levels during periodontal surgery. J Periodontol 1990;61:553-8.
- Montebugnoli L, Servidio D, Miaton RA, Prati C. Heart rate variability: a sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure. J Am Dent Assoc 2004;135(12):1718-23.
- Muzyka BC, Glick M. The hypertensive dental patient. J Am Dent Assoc 1997;128(8):1109-20.
- Gillcrist JA. Hepatitis viruses A, B, C, D, E and G: implications for dental personnel. J Am Dent Assoc 1999;130(4):509-20.
- Golla K, Epstein JB, Cabay RJ. Liver disease: Current perspectives on medical and dental management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 98(5):516-21.
- Baccaglini L, Atkinson JC, Patton LL, Glick M, Ficarra G, Peterson DE. Management of oral lesions in HIV-positive patients. Oral Surg Oral
- Clinician's Guide to Treatment of HIV-infected Patients. Patton LL and Glick M, editors, American Academy of Oral Medicine, New York, 3rd edition, Copyright 2001.
- Epstein JB, Cabay RJ, Glick M. Oral malignancies in HIV disease: changes in disease presentation, increasing understanding of molecular pathogenesis, and current management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100(5):571-8.
- Glick M, Abel SN, Muzyka BC. Dental complications after treating patients with AIDS. J Am Dent Assoc 1994;125(3):296-301.
- Patton LL, Shugars DC. Immunologic and viral markers of HIV-1 disease progression: implications for dentistry. J Am Dent Assoc 1999;130(9):1313-22.
- Little JW. The impact on dentistry of recent advances in the management of hypertension. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90(5):591-9.
- Muzyka BC, Glick M. The hypertensive dental patient. J Am Dent Assoc 1997;128(8):1109-20.
- Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The seventh report of the joint national committee on detection, evaluation and treatment of high blood pressure. JAMA 2003;89(19): 2560-72.
- Schjerning Olsen AM, Fosbol EL, Lindhardsen J, Folke F, Chsarlot M, Selmer C, Lamberts M, Olesen JB, Kober L, Hansen PE, Torp-Pedersen C, Gislason GH. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction. Circulation 2011; 123:2226-35.
- Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis guidelines from the american heart association. A guideline from the american heart association rheumatic fever, endocarditis, and kawasaki disease committee, council on cardiology, cardiovascular disease in the young, and the council on clinical care and council on cardiovascular surgery and anesthesia, and the quality of outcomes research interdisciplinary working group. Circulation. 2007; 116: 1736-1754
- Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis guidelines from the american heart association. A guideline from the american heart association rheumatic fever, endocarditis, and kawasaki disease committee, council on cardiology, cardiovascular disease in the young, and the council on clinical care and council on cardiovascular surgery and anesthesia, and the quality of outcomes research interdisciplinary working group. J Am Dent Assoc 2007;138(6):739-60.
- Baddour LM, Bettmann MA, Bolger AF, Epstein AE, Ferrieri P, et al. Nonvalvular cardiovascular device related infections. [AHA Advisory Committee] Circulation 2003; 108 (16):2015-31.
- Fiese R, Herzog S. Issues in dental and surgical management of the pregnant patient. Oral Surg Oral Med Oral Pathol 1988; 65(3):292-7.
- Lakshmanan S, Radfar L. Pregnancy and Lactation. Oral Surg Oral Med Oral Pathol 2004; 97(6):672-82.
- Michalowicz BS, DiAngelis AJ, Novak MJ, Buchanan W, Papapanou PN, Mitchell DA, Curran AE, Lupo VR, Ferguson JE, Bofill J, Matseoane S, Deinard AS, Rogers TB. Examining the safety of dental treatment in pregnant women. J Am Dent Assoc 2008; 139(6):685-95.
- Moore PA. Selecting drugs for the pregnant dental patient. J Am Dent Assoc 1998;129(9):1281-6.
- Antibiotic prophylaxis for bacteremia in patients with joint replacements. Information statement of the American Academy of Orthopaedic Surgeons. Http://www.aaos.org/about/papers/advistmt/1033.asp, February, 2009.
- Little JW, Jacobson JJ, Lockhart PB. The dental treatment of patients with joint replacements: a position paper from the American Academy of Oral Medicine. J Am Dent Assoc 2010; 141(6):667-71.
- American Dental Association; American Academy of Orthopaedic Surgeons, Antibiotic prophylaxis for dental patients with total joint replacements, J Am Dent Assoc 2003; 134(7): 895-99.
- Baddour LM, Betmann MA, Bolger AF, Epstein AE, Ferrieri P, Gerber MA, et al. Nonvalvular cardiovascular device-related infections. Circulation 2003; 108:2015-31.
- DeRossi S, Glick M: Dental considerations for the patient with renal disease receiving hemodialysis, J Am Dent Assoc 1996; 127:211-219.
- Kerr AR. Update on renal disease for the dental practitioner. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92(1):9-16.
- Shariff G, Brennan MT, Kent ML, Fox PC, Weinrib D, Burgess P, Lockhart PB. Relationship between oral bacteria and hemodialysis access infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 98(4):418-22.
- Tokars J, Miller ER, Alter MJ et al: National surveillance of dialysis-associated diseases in the United States, 1997, Semin Dial 2000; 13:75-85.
- Zachee P, Vermylen J, Boogaerts M: Hematologic aspects of end-stage renal failure, Ann Hematol 1994;69:33-40.
STEROID THERAPY AND SUPPLEMANTATION
- Miller C.S., Little JW, Falace DA. Supplemental corticosteroids for dental patients with adrenal insufficiency. J Am Dent Assoc 2001;132(11):1570-9.
- De Rossi SS, Glick M. Lupus erythematosus: considerations for dentistry. J Am Dent Assoc 1998;129(3): 330-9.
- Kohn WG, Collins AS, Cleveland, JL. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(RR17): 1-68.
- Eng H, Lu S, Yang C, et al. Oral tuberculosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81(4):415-20.
- Atkinson JC, Fox PC. Sjogren's syndrome: oral and dental considerations. J Am Dent Assoc 1993;124(3):74-86.
- von Bültzingslöwen I, Sollecito TP, Fox PC, Daniels T, Jonsson R, Lockhart PB, WDray, Brennan MT, Carrozzo M, Gandera B, Fujibayashi T, Navazesh M, Rhodus NL, Schiødt M. Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 103(Suppl):57-65.
- Dawes C. Salivary flow patterns and the health of hard and soft oral tissues. J Am Dent Assoc 2008; 139(Suppl):18-24.
- Navazesh M. How can oral health care providers determine if patients have dry mouth? J Am Dent Assoc 2003;134(5):613-20.
- Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97(1):28-46.
- Wiener RC, Wu B, Crout R, Wiener M, Plassman B, Kao E, McNeil D. Hyposalivation and xerostomia in dentate older adults. J Am Dent Assoc 2010;141(3):279-84.