Impact of drug abuse/dependence on dentists

Drug abuse and dependence are important and complex health problems, and understanding these issues is important for dental patient management. At the same time, dentists, like their patients, could abuse alcohol and other illicit drugs, which would jeopardize their ability to provide optimum dental care. This article reviews important aspects of drug abuse and dependence, risk factors for dentists, the impact of drug abuse on the dental profession, and various treatment options.     

Dental treatment for deaf patients

The deaf population requires special treatment in the dental office. Virtually all published articles in the literature about dental treatment for these persons are reviewed. This population is one of several populations having limited access to care as identified by the ADA. A course developed to address the special needs of persons who are hearing impaired is described. Definitions of persons who are hearing impaired, education of deaf persons, psychosocial aspects of deafness, aids to communication, the deaf community, sign language, and interpreting and interpreters are topics discussed here that will improve dentists' service to deaf persons. The dental professional has the privilege of providing care to all Americans and the hearing-impaired population has been identified as one having special treatment needs. After exposure to this information, dental students and dentists should become more aware of, and seek more information pertaining to the special needs of deaf persons. It is further hoped that they will make the modifications necessary to accommodate deaf persons as patients.     

Education of dentists in the treatment of patients with special needs

The dental education system has been suggested as the vital link in providing a workforce capable of improving oral health for people with special needs. Dental education institutions not only train dental professionals for their role in providing oral health services for people with special needs, they also provide a significant amount of services to this population in their clinical environments. However, there is no consensus about whether to concentrate the educational efforts on the preor postdoctoral level, or both. Furthermore, it is not clear if educational initiatives in the care of patients with special needs will translate into a larger oral health workforce willing to treat these patients. However, for the purposes of this paper, it will be assumed that more education and training in special care dentistry will lead to better-educated dentists and the desired result of better access to care for special needs patients. The authors will define special needs patients as those who have a chronic physical, developmental, behavioral, or emotional condition, and who also require health and related services of a type or amount beyond that the general population requires. This paper will describe accreditation issues and discuss the advantages and disadvantages of special care education in pre- and postdoctoral training and beyond.     

General dentists and special needs patients: does dental education matter?

Special needs patients are one of the underserved dental patient groups in the United States. This study investigates whether undergraduate dental education about special needs patients affects general dentists' a) professional behavior, b) practice characteristics, and c) attitudes concerning special needs patients. Data were collected from 208 general dentists (178 male/30 female; average age: 49.85 years) who were members of the Michigan Dental Association. The more the respondents agreed that dental education had prepared them well, the more likely they were to treat various types of special needs patients and to set up their practices so they could treat them and the more they liked treating these patients. In conclusion, most general dentists did not think their undergraduate dental education had prepared them well to treat special needs patients. However, the better they reported to have been educated, the more likely they were to treat special needs patients. Given the access to care problems for many special needs patients, it seems crucial to revise dental curricula and provide more didactic and clinical education concerning the treatment of special needs patients.     

Patients with special needs: dental students' educational experiences, attitudes, and behavior

Accreditation standards require U.S. dental schools to prepare their graduates for the diagnosis of treatment needs of patients with special health care needs (SHCN). The objective of this study was to explore dental students' perceptions of their education about these issues, their satisfaction with this education, and their professional attitudes and behavioral intentions concerning treating patients with SHCN in the future. Web-based survey data were collected from forty-nine dental student leaders in thirteen U.S. dental schools and paper-and-pencil survey data from 397 dental students at a Midwestern dental school. Most respondents agreed that it is important to be educated about providing care for patients with SHCN and that they will provide care for these patients in the future. However, their satisfaction with their education was not equally positive. Their perceived quality of their dental education was correlated with their confidence concerning treating SHCN patients; their confidence was in turn correlated with their intentions to include these patients in their patient families in their future professional lives. In conclusion, dental students are strongly motivated to learn about providing care for patients with SHCN. The better their dental education prepares them for this task, the more confident they will be when treating these patients and the more likely they will be to provide care for these patients.     

Oral kinesiology. A new postgraduate programme in the Netherlands

As one of the dental differentiations in The Netherlands, temporomandibular disorders (TMD) focuses on the diagnosis and treatment of pain and dysfunction of the masticatory system. Bruxism (i.e. tooth clenching and/or grinding) is thought to play an important aetiological role in TMD. Among others, bruxism may result in TMD pain and dental attrition. The close relationship between TMD, bruxism, and attrition necessitates an integrated approach to these clinical problems. This could be achieved through the multidisciplinary differentiation 'oral kinesiology', that covers not only the diagnosis and treatment of TMD and bruxism but also the restoration of worn dentitions. This article focuses on the background of oral kinesiology, as well as on the rationale to develop a curriculum for the postgraduate training of dentist-kinesiologists in the Netherlands. Further, the oral kinesiology curriculum of the Academic Centre for Dentistry Amsterdam will be introduced. This curriculum will ensure that specialized professionals, who are able to approach the different aspects of oral kinesiology in an integrated manner, are available not only for general dental practice but also for centres for special dental care and university departments. This will lead to improved care for patients, whose management is until now dispersed between various dental specialists.     

Drug abuse identification and pain management in dental patients: a case study and literature review

Properly identifying patients with a history of drug abuse is the first step in providing effective dental care. Dental professionals need to be fully aware of the challenges associated with treating this population. In the current study, the authors analyzed the physical and oral manifestations of illicit drug abuse to aid in the identification of patients who abuse drugs and the pain management strategies needed to treat them. The authors also present a clinical case of a patient with unique skin lesions and discuss the typical clinical findings of drug abuse based on a literature review.     

Special considerations for treating dental patients exhibiting the "Post-polio Syndrome"

A condition called "Post-polio Syndrome" (PPS) is a special type of neuromuscular disturbance that affects some elderly patients who had polio myelitis either as children or as young adults. It has been reported that approximately 1,600,000 polio survivors are alive today. Most will seek dental care, and up to half of the survivors will present with some form of PPS. This paper describes polio, its characteristics, and the long-term consideration of PPS, and discusses the special clinical implications related to this condition. Special emphasis is placed on physical impairments, breathing problems, and difficulty swallowing. Also included are sections discussing such topics as patient scheduling, office design and housekeeping, patient management, oral hygiene, diagnostic procedures, drug and pain management, and general health considerations.     

Outreach dental service for persons with special needs in Hong Kong

The authors describe the acceptance and efficiency of an outreach dental service, which provided oral health care to persons with special needs in Hong Kong. Portable dental equipment was transported to various institutions. Basic dental care including prevention, scaling, restoration, extraction, and denture repair was provided free of charge. Elderly adults living in institutions were the main service recipients, but other people with special needs, including physically disabled and persons with mental retardation were also reached. One-third of the patients had dental pain or sensitivity, and 70% had not visited a dentist for more than three years. Dental care was provided to 6,867 patients over four years. Feedback from the patients showed that more than 90% of them were satisfied with the service. These findings indicate that patients with special needs in Hong Kong are in great need of dental care. An outreach dental service appears to be both appropriate and efficient in providing care to these persons.     

Accuracy of estimation of dental treatment need in special care patients

OBJECTIVES: To assess the ability of carers and dental professionals to estimate treatment need in a group of children and adults with special needs. METHOD: A retrospective study of a series of 103 special needs patients who had received restorative dental treatment under general anaesthetic was undertaken. The initial reason for attendance and the time lapse between first symptoms and decision to consult were established. The parent or carer was asked to estimate treatment need and to assess the degree of discomfort suffered by the patient. The dentist evaluated treatment need by means of a pre-operative treatment plan. These results were compared to actual treatment performed. RESULTS: Treatment need was severely underestimated by both carer and dentist. The degree of advanced pathology found in the population would suggest that pain suffered was also underestimated. CONCLUSIONS: Access of patients with special needs to dental care may be limited by the ability of their carers to evaluate their oral condition and/or by the persons inability to express their pain or discomfort.     

Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant. Part 2

Aimed at the practitioner in Special Care Dentistry, this is the second article in a two-part series providing guidelines on the dental management of renal patients. Dentists working in Special Care Dentistry will frequently be called upon to manage dialysis patients, whether pre- or post-transplant. The following paper deals with guidance as to the assessment, work-up and management of such patients when undergoing specialist dental treatment. The key to safe treatment is careful assessment, discussion and planning with the relevant team members. Clinical Relevance: This paper provides guidance to the special care dentist for the dental management of patients with renal disease, and highlights issues in patients who are either on dialysis or have a kidney transplant.     

Dental lesions: Diagnosis and treatment

Oral health care has been an integral part of the care of patients with HIV infection and AIDS since the disease was first identified in the early eighties. The spectrum of HIV-associated opportunistic diseases occurring in the oral cavity propelled dental health care providers to the forefront of patient care. Infection control issues soon became important in oral health care for patients infected with HIV, and for the first decade these two issues overshadowed the concerns about appropriate management of the dental needs of HIV-infected patients. Several concerns need to be considered in the management of dental care for patients infected with HIV. These include decreased salivary flow and increased sugar intake, prevention and management of routine inflammatory gingival and periodontal disease as well as the atypical forms of gingival and periodontal disease associated with HIV infection (linear gingival erythema [LGE], necrotizing ulcerative gingivitis [NUG] and necrotizing ulcerative periodontitis [NUP]). Finally, although reports of complications secondary to dental treatment of HIV-infected individuals are rare, it is important to consider those factors related to the medical status of HIV-infected patients which may interfere with oral health care These include potential bleeding problems related to thrombocytopenia and disease or medication related liver abnormalities, increased risk of local infection particularly in patients with severe neutropenia and adverse effects of multiple medications taken by HIV patients. Prevention and management of dental and periodontal disease in HIV-infected individuals is important to self esteem, quality of life and maintenance of adequate nutritional intake. Oral health care continues to be an important component of overall health care for HIV-infected patients.     

Dental needs assessment and access to care for adolescents

For many, the adolescent years can be a difficult emotional period and a time when dental and medical needs may be neglected. Oral health needs are critical factors in the maturation of the adolescent,whether they involve the relief of pain, improved nutrition, an in-crease in self-esteem with orthodontic treatment, or "just" saving the dentition from the ravages of the early stages of periodontal disease. This article reviews demographic characteristics of adolescents in the United States with regard to oral health status, use of dental services, barriers to dental care, and children who have special health needs.     

Access to special care dentistry, part 6. Special care dentistry services for young people

This article brings together some of the 'hidden disabilities' common amongst adolescents and young adults. Many of these conditions carry a social stigma and some are associated with secretive behaviour and even denial. The article will describe the features, management and oral implications of five eating disorders (Prader-Willi syndrome, anorexia nervosa, bulimia nervosa, binge eating disorder and pica) and three types of mental health problems (schizophrenia, obsessive-compulsive disorder and bipolar disorder). Without the input of the dental profession, and in the main the primary dental care service, all these conditions can have a detrimental effect on the dentition at a relatively early stage in life. Mental health problems are more common in adolescents and young adults than most people realise and this article will also consider the impact on oral health and delivery of dental care to young people who have experienced childhood sexual abuse.     

General dentists' perceptions of educational and treatment issues affecting access to care for children with special health care needs

This study analyzed a data subset of a national survey of general dentists conducted in 2001 to determine their overall care of children with special health care needs (CSHCN). In the survey, dentists were asked to respond to questions in the following areas: did they provide care for CSHCN (children with cerebral palsy, mental retardation, and those who are medically compromised); what were their perceptions of the training they received in dental school related to CSHCN; what was their interest in additional training for CSHCN; and what factors influenced their willingness to provide care for CSHCN? Only about 10 percent see CSHCN often or very often, and only one in four respondents had hands-on experience with these patients in dental school. Postgraduate education in general practice or advanced general dentistry residency had no effect on willingness to care for CSHCN. Older dentists, those accepting Medicaid for all children, and those practicing in small communities were more likely to see CSHCN. Dentists willing to see CSHCN also were more likely to perform procedures associated with special needs and underserved child populations including pharmacologic management and stainless steel crowns. Dentists with hands-on educational experiences in dental schools with CSHCN were less likely to consider such factors as level of disability and patient behavior as obstacles to care and were more likely to desire additional education in care of CSHCN.     

The face of a child: children's oral health and dental education

Dental care is the most common unmet health care need of children. Those at increased risk for problems with oral health and access to care are from poor or minority families, lack health insurance, or have special health care needs. These factors place more than 52 percent of children at risk for untreated oral disease. Measures of access and parental report indicate unmet oral health needs, but do not provide guidance as to the nature of children's oral health needs. Children's oral health needs can be predicted from their developmental changes and position in the life span. their dependency and environmental context, and current demographic changes. Specific gaps in education include training of general dentists to care for infants and young children and those with special health care needs, as well as training of pediatric providers and other professionals caring for children in oral health promotion and disease prevention. Educational focus on the technical aspects of dentistry leaves little time for important interdisciplinary health and/or social issues. It will not be possible to address these training gaps without further integration of dentistry with medicine and other health professions. Children's oral health care is the shared moral responsibility of dental and other professionals working with children, parents, and society. Academic dental centers hold in trust the training of oral health professionals for society and have a special responsibility to train future professionals to meet children's needs. Leadership in this area is urgently needed.