The methamphetamine epidemic and dentistry

Methamphetamine is a potent central nervous system stimulant with limited therapeutic effects. This drug produces prolonged euphoria and is relatively inexpensive to purchase and easy to make and distribute. Methamphetamine changes normal physiologic processing of several centrally acting neurotransmitters and ultimately leads to neurotoxicity and neurodegeneration from chronic use. Chronic methamphetamine use has been associated with severe oral health effects; rampant caries is the most notable of these. Dental professionals must recognize patients who are involved with methamphetamine use and understand the risk factors associated with its deleterious oral effects so that preventive and treatment strategies may be implemented for patients who use this drug.     

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.     

The pregnant patient: considerations for dental management and drug use.

The pregnant woman who presents for dental care requires special consideration. This article reviews physiologic changes associated with pregnancy and current considerations for the dental treatment of pregnant dental patients, as well as for pregnant dental professionals. The limitations and safety of commonly used drugs and anesthetics are discussed. Recommendations for prenatal oral counseling are presented.     

Methamphetamine and its impact on dental care

Dental professionals should be aware that methamphetamine (MA) use is on the rise in North America. MA is a potent central nervous system stimulant with limited therapeutic effects. The allure of this drug is its availability in many different forms that are relatively easy to make and distribute and inexpensive to purchase and that produce prolonged euphoria for the user. This euphoria results from alteration of the normal physiologic processing of several centrally acting neurotransmitters, which also causes neurotoxicity and neurodegeneration with long-term use. Long-term use of MA has been associated with severe oral health effects, the most notable being a distinctive pattern of caries called methamphetamine-induced caries. Dental professionals need to recognize and understand patients who may be using MA and the risk factors associated with its deleterious oral effects. This knowledge will allow appropriate and effective preventive and treatment strategies for users of this drug.     

Dietary supplements: clinical implications for dentistry

BACKGROUND: Sales of dietary supplements in the United States continue to increase; patients who seek dental care more than likely are taking or contemplating taking dietary supplements. The author reviews the background of dietary supplements, highlights popular over-the-counter supplements available in the United States and addresses the issues of safety, efficacy and contraindications that merit consideration in clinical practice. METHODS: The author reviewed the literature regarding effectiveness of common dietary supplements and mechanisms of action with drug interactions. The author assessed properties of dietary supplements within the context of clinical implications for oral health care professionals. CONCLUSIONS: Dietary supplement use may be prevalent among patients seeking dental care. While some dietary supplements may be effective and safe, their biological activity may interfere with treatment or medications in oral health care. CLINICAL IMPLICATIONS: Oral health care professionals can ascertain patients' use of dietary supplements and evaluate them with respect to treatment. Resources for additional information are provided.     

Geriatric oral health issues in the United States

Of the more than 270 million people in the United States, about 13 per cent are aged 65 years or older. As in most other countries throughout the world, this proportion of the population is projected to increase in the coming years. To care for this ageing and racially/ethnically diverse population, health care professionals, especially dentists, must initiate changes in public policies, available resources and access to services. The dental profession especially must improve awareness among the general public and health care professionals of the link between oral health and general health. Immediate improvements should be made to increase the proportion of dentists who are willing and qualified to treat these patient groups. Increasing the reimbursement rates available through the Medicaid programme and expanding the types of services Medicaid recipients can seek are critical. Dental education programmes must continue to provide more training opportunities to prepare professionals to meet the needs of these patients.     

Diagnosis and treatment of salivary gland disorders.

The keystone of the architecture of the oral cavity is saliva; however, it is rarely acknowledged as a vital physiologic secretion. Saliva plays three major roles in oral and systemic health. It provides host protection, assists in the initiation of food and fluid intake, and enables communication through speech. Without adequate salivary output augmented by a rich assortment of salivary proteins and electrolytes, oral and pharyngeal health declines as well as a person's quality of life. This article will provide a brief summary of the function of saliva, oral and systemic etiologies of salivary dysfunction, and methods to treat and prevent salivary disorders. Oral health care professionals can play a vital role in identifying patients at risk for developing salivary dysfunction and should provide appropriate preventive and interventive techniques that will help preserve oral health and function.     

Patients’ and health professionals’ experience of the Danish fast track treatment pathway for head and neck cancer patients receiving oral rehabilitation

Abstract

Objective: This study aims to investigate the responsiveness of the Danish treatment pathway for head-and-neck-cancer (HNC) patients receiving oral rehabilitation.

Material and Methods: Eighteen HNC-patients who had received oral rehabilitation as well as five medical and four oral health care professionals involved in the treatment of HNC-patients filled in a questionnaire on responsiveness. The responsiveness was further described in individual interviews in the HNC-patients and focus group interviews in the health care professionals. All interviews were semi-structured and analysed using the grounded theory.

Results: Patients and health care professionals overall reported good responsiveness of the pathway. Prompt attention was in both groups considered the most important aspect, although the patients found it difficult to cope mentally with the fast-track and the health care professionals reported insufficiencies giving prompt attention. The patients in general described a good relationship with their health care professionals, but along with the health care professionals also reported some problems regarding communication. Further, the health care professionals reported a gap between medical treatment and oral rehabilitation.

Conclusions: The Danish treatment pathway for HNC-patients was, in general, evaluated positively. Communication and relationship between patient and health care professional can affect the responsiveness of the pathway.     

Oral health care for the pregnant patient

Pregnancy is a unique time in a woman's life, accompanied by a variety of physiologic, anatomic, and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnancy, general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.     

Oral health care for the pregnant patient

Pregnancy is a unique time in a women's life, accompanied by a variety of physiologic, anatomic and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnant general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.     

Oral health care for the pregnant patient

Pregnancy is a unique time in a woman's life, accompanied by a variety of physiologic, anatomic and hormonal changes that can affect how oral health care is provided. However, these patients are not medically compromised and should not be denied dental treatment simply because they are pregnant. This article discusses the normal changes associated with pregnancy, general considerations in the care of pregnant patients, and possible dental complications of pregnancy and their management.     

The Central Massachusetts Oral Health Initiative (CMOHI): a successful public–private community health collaboration

Objectives: The Central Massachusetts Oral Health Initiative (CMOHI) aimed to improve access to quality oral health care in central Massachusetts. Methods: A broad‐based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school‐based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health. Results: A state legislative Oral Health Caucus helped secure sought‐after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school‐based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established. Conclusions: Significant sustainable gains in oral health care access were created through our multifaceted approach, ongoing evaluation and communication, coordination of CMOHI partner resources, and collaboration with other involved parties.     

Treatment modalities and medication recommended by health care professionals for treating recurrent herpes labialis

BACKGROUND: The authors conducted a survey to determine how health care professionals respond to patients' inquiries about cold sores, also known as recurrent herpes labialis, and their choices of treatment modalities and medications. METHODS: The authors mailed a one-page, pretested survey to a random sample of dentists, pharmacists and family physicians in Alberta, Canada. After receiving ethics approval from the University of Alberta, Edmonton, the authors mailed 998 surveys. The response rate was 51 percent. RESULTS: Topical antiviral medication was the most common treatment recommended (63 percent). Over-the-counter medication was the first choice for pharmacists (83 percent) as compared with dentists (15 percent) and physicians (16 percent). Emotional stress (60 percent) was reported by patients to be the most common trigger, and pain or discomfort (81 percent) was their primary concern. Acyclovir ointment was the most common antiviral drug recommended or prescribed by health care professionals (60 percent), and cost was the major reason they gave for not recommending or prescribing antiviral drugs (73 percent). CONCLUSIONS: The authors found variation in treatment modalities and recommendations by each health profession, despite the fact that patients reported similar triggers and concerns. This may be due to individual patient need and the health care professional's lack of knowledge. PRACTICE IMPLICATIONS: Survey results may serve as a reference for health care professionals to use to determine how their choices of medications and treatment modalities compare with those of other practitioners. Professionals should know the benefits and limitations of all therapies, discuss them with the patients and select a treatment.     

A survey of UK dental health professionals using a medicines information service: what questions do they ask and do they get useful answers?

Dentists prescribe a limited range of medicines but it is important that they consider the effects of all medicines their patients are taking when providing dental care. In the UK, a national medicines information (UKMi) service funded by the National Health Service is available to advise health professionals on prescribing and to support evidence-based practice. This paper presents the results of a survey of 151 dental health professionals who contacted the UKMi service for advice. Enquiries most commonly involved antibiotics (32%), but dental health professionals also asked for advice on legal issues relating to medicines (10%), and on managing patients receiving bisphosphonates (9%), local anaesthetics (6%) and antiplatelet drugs (5%). One hundred and forty-six (97%) enquirers used the advice provided: for managing current patients, planning the care of future patients, for continuing professional development and teaching others. Two thirds of enquirers used the information provided to check if current or proposed management was appropriate, one half to change therapy and over one quarter to identify, manage or avoid adverse effects or drug interactions.     

The pregnant and breast-feeding patient.

The pregnant or breast-feeding patient presents a number of unique management problems for oral health care providers. Clinicians are responsible for providing safe and effective care for the mother, while also considering the safety of the fetus or newborn. They must consider the effects of medications, which may be distributed from the maternal plasma through the placenta to the fetus, or to breast milk, exposing the nursing infant to potentially dangerous concentrations. In addition, a number of maternal oral changes, requiring the attention of oral health care providers, may be observed as a consequence of the multiple physiologic changes associated with pregnancy. In view of the dual responsibility that oral health care providers face in treating the pregnant or breast-feeding patient, understanding the physiology of pregnancy, fetal development, potential oral complications of pregnancy, and the effects that dental intervention may have on the woman, her fetus, or her neonate are imperative.     

Infectious disease control and the dental office: AIDS and other transmissible diseases

In spite of attempts to modify homosexual behaviour and the sharing of contaminated needles by drug abusers, AIDS virus infections continue to spread throughout the world. The potential for transmission, the lack of a vaccine and effective treatment, and the lethal nature of the disease cause great alarm and influence health care delivery. Dentistry is involved because oral health care is being given knowingly or unknowingly to high-risk individuals. These high-risk individuals are the sources for many other infections with viral, bacterial, fungal and protozoal organisms. In spite of the fact that spread does not occur through casual contact, concern is justified since many questions involving transmissibility and susceptibility have not been completely resolved. Therefore, dental professionals must follow infectious disease control guidelines to protect themselves as well as other patients. Because oral manifestations of those infected by the AIDS virus are common, dental professionals also play a role in recognition, counselling and referral.     

Oral health status of drug addicts in the Czech Republic

Over the last decade, illicit drug use has become a very pronounced problem in the Czech Republic. Some branches of medicine such as psychiatry, internal medicine and neurology have tried to confront the situation by joint treatment of addicted patients. Dentistry has so far remained outside this multi-disciplinary care despite the fact that the status of dental and other tissues in the oral cavity influences general health and vice versa. The aim of the survey on the oral health of drug addicts that was conducted in the Czech Republic from 2000 to 2002 was to collect data to help dental professionals contribute to the complex care of drug addicts. The number of addicted persons examined was 400 and the subgroup of drug addicts consisted of 217 subjects (mean age 23.87 yrs, SD 6.70), all being treated in long term hospitals. Among other oral health features observed, the DMFT and CPITN indices are presented in this paper. The results show severe dental and periodontal tissue destruction in young addicts and two case reports are included. The above survey indicates that dental treatment should become a part of standard care for addicted patients in long-term hospitals. Furthermore, if severe oral tissue impairment in young persons whether in dental practice or during autopsy is encountered a drug addiction should be suspected. If so, the treatment of the person or examination of the dead body should accordingly be adjusted.