Management of the Orally Compromised Medical Patient
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Medicine today is different from what was practiced a decade ago, not only in procedures and technology but also in the types of patients seen. As a result of extraordinary advances in medicine, people are living longer and are receiving treatment for diseases that were fatal only a few years ago. By the end of 1990’s, an influx of literature connecting the oral cavity with the systemic health came to the bookshelves of dentist and researchers. Initially, the association between gum disease and cardiovascular disorders was at the first order in several publications. Then, researchers explore more potential associations between the mouth and the systemic health opening a door to a new world. To address this new field, dental schools quickly developed courses in the dental management of medically compromised patients as well as in the systemic component of oral health. However, few medical schools offered courses in oral health for the students; the door was opened only to one-side: dentistry to medicine. This course is designed using the framework developed at the University of Kentucky. The intent is to bring patients orally compromised to medicine, a twist of the traditional course of dental management of the medically compromised patient. Cases of patients orally compromised (with gingivitis, caries, migratory glossitis, candidiasis, etc.) will be presented to medical students and physicians. Each case will have a history, pictures, implications for the systemic health, and treatment. The key to successful medical management of orally compromised patients is thorough evaluation and assessment of the oral condition to determine the future treatment. Using real cases with patients orally compromised, medical students and physicians will see and evaluate the consequences of the oral health in the systemic health from a different optic. This course is designed to provide medical students and physicians with a basic understanding of how various oral disorders can affect systemic health and delivery of medical care. This course is different from most other courses in that it requires the participant to assess each patient individually and determine the severity of their oral condition, the level of control and risk for care and need for treatment modifications. The student will learn the process of dental risk assessment and treatment planning for patients with various oral disorders (including caries and gingivitis for example). Emphasis will be placed upon evidence-based recommendations, researching and using various information resources and participating in case discussions.
- This work is the end result of more than 15 years of teaching medically compromised patients to dental students. I used different methodologies to capture the attention of the dental students and to show the importance of adequate evaluation of patients with different medical problems.
- However, only in the last couple of years, I found that the "case-base approach" is the best strategy to integrate medicine to dentistry and dentistry to medicine.
- Each case will bring a particular REAL clinical scenario that will place a medically compromised patient in the dental chair or a orally compormised patient in the medical evaluation bed.
- After the case is presented, a series of questions are presented to the student about the case. Then, and probably the most important component, my proposal brings a summary of the most important points and the relation of the particular disease with dentistry.
Yepes J. Management of the orally compromised medical patient. MedEdPORTAL Publications. 2012;8:9291. http://dx.doi.org/10.15766/mep_2374-8265.9291
- To understand the implications in the general health of orally compromised patients.
- To critically evaluate published clinical and basic science literature and apply the information to manage patients with oral health compromise.
- To collect information in a sequential and logical manner to develop a treatment plan to manage and promote oral and overall health, and to minimize the health hazards in medical practice.
- To assess the need for clinical laboratory and other diagnostic procedures and tests and assess how test results may affect oral health treatment.
- To assess the influence of oral diseases and disorders health management. Be able to plan general medical care for most orally compromised patient in an outpatient setting selecting the appropriate referral.
- Periodontal Diseases, Gingivitis, Building Oral Health Capacity (BOHC) Collection, Medically Compromised, Plaque
This information is made available under the Creative Commons license.
Authors & Co-Authors
Juan Yepes, DDS, MD
University of Kentucky
Sponsorship or Funding Source
This project is also sponsored in part by funding from the Health Resources and Services Administration/Maternal Child Health Bureau grant #U44MC20223.