Prescription opioid abuse: dental perspectives

Drug abuse and diversion of controlled substances prescribed by dentists will continue to be an important issue in the overall management of dental pain, and must be recognized by the dentist. If suggested guidelines, regulations, and laws are observed, the associated problems for the dentist and the entire dental team and their patients can be minimized. Pain control is an essential service and duty for dentists, and the appropriate selection and use of analgesics affords this service with the best safety and efficacy.     

Knowledge, attitudes, practices, and training needs of Kentucky dentists regarding violence against women

Dentists may be the first (and perhaps the only) health care professionals to treat patients who have experienced oral facial trauma resulting from domestic violence. Dentists are likely to see the signs of abuse while performing an oral examination and they often develop relationships with patients that could allow them to detect subtle changes in patients that may indicate signs of domestic violence. This study sought to assess the knowledge, attitudes, practices, and training needs of Kentucky dentists regarding domestic violence against women (VAW). A written survey was sent to a population of 1,892 eligible licensed dentists in Kentucky; 790 (42%) were returned. Ninety percent of the respondents were general dentists and the distribution by practice location was almost equal among urban, suburban, and rural dentists. Only 7.0% of respondents reported having any training in the prevention of VAW. When asked "... are you legally required to report suspected cases of VAW to the appropriate authorities, regardless of the patient's wishes?", 42% answered "no." An overwhelming majority (82%) indicated that they would like more training and information regarding VAW identification and management. Based on analysis of the data, Kentucky dentists would benefit from and be interested in additional education opportunities concerning recognizing, referring, and managing patients who may be the victim of domestic violence.     

Practices and opinions of Connecticut general dentists regarding dental treatment during pregnancy

This study aimed to evaluate the opinions and practices of general dentists in Connecticut regarding dental care during pregnancy. A survey was mailed to Connecticut general dentists to acquire data regarding age, gender, training, type of practice, years in practice, payment types accepted, procedures provided for pregnant women according to trimester, provider comfort level with treating pregnant patients, reasons for not treating pregnant patients, and provider opinions about dental care during pregnancy. The response rate was 42%, yielding a sample of 116 dentists. The majority of respondents (97%) reported treating pregnant patients; however, only 45% felt "very comfortable" treating these patients. All dentists in the sample agreed that physicians need to include an oral health evaluation and appropriate referral for patients' prenatal care. However, 70% of respondents had never received a dental referral for a pregnant patient. The majority of dentists favored providing dental treatment during the second trimester of pregnancy. Most dentists (77%) would take a radiograph for a patient 10 weeks into the pregnancy seeking treatment for dental pain, but only 2% would take routine radiographs regardless of the pregnancy trimester. There was a lack of consensus about medications dentists reported acceptable to prescribe for pregnant patients, and female dentists were significantly less likely than males to prescribe ibuprofen (P < 0.05). At least half of the respondents reported not being completely comfortable treating pregnant patients. Further, many dentists appear to not follow medication prescribing guidelines for this population. While additional research is needed, these initial results indicate that additional education regarding the treatment of pregnant patients would be a beneficial addition to dental school and continued education course curricula.     

Elder abuse update

The following article offers an update on the topic of elder abuse. As the baby boomer generation ages, the number of elderly patients seeking all forms of dentistry will increase. This article is designed to inform dentists of their responsibility to the entire health of their patients. Guidelines and suggestions are made to ensure that dentists are able to diagnose and manage patients that may be in an abusive relationship.     

Dentists' attitudes and behaviors regarding domestic violence. The need for an effective response

BACKGROUND: The authors examined the attitudes and behaviors of a national sample of dentists regarding domestic violence and the barriers dentists face in intervening to help victims. METHODS: The authors surveyed a national random sample of 321 dentists by mail from November 1997 to March 1998 about their attitudes and clinical practice behaviors related to domestic violence. Survey items were developed based on the domestic violence and health care literature. The authors used the Total Design Method to maximize the response rate and analyzed data to determine differences between dentists who had received domestic violence education and those who had not. RESULTS: Eighty-seven percent of responding dentists never screened for domestic violence; 18 percent never screened even when patients had visible signs of trauma on their heads or necks. Overall, respondents intervened only minimally to help patients whom they had identified as victims. Respondents reported that the major barriers to screening were the presence of a partner or children (77 percent), lack of training (68 percent), concern about offending patients (66 percent) and their own embarrassment about bringing up the topic of abuse (51 percent). Respondents who had received domestic violence education were significantly more likely to screen for domestic violence and to intervene. CONCLUSIONS: Dentists face many barriers to identifying and helping patients who are abuse victims, yet these data suggest that education about domestic violence could help them overcome some of these barriers. CLINICAL IMPLICATIONS: We suggest that dentists follow the AVDR model when approaching abused patients in their practice: Ask about abuse, provide Validating messages, Document presenting signs and Refer victims to domestic violence specialists.     

A preferred future through informed choice

The premise of this article is that discriminating patients will seek optimal dental health from dentists who understand and accommodate their expectations, whereas those patients with low expectations will have their requirements satisfied by providers equipped to process large numbers of people. Dentists who intend to remain "captains of their fate" must understand the sociologic evolution occurring in the provision of health care to the masses if they are to chart an appropriate course for their professional contribution. By accepting that change is occurring, they can prepare themselves and their practices for the segment of the population they choose to serve.     

TMD: it's our responsibility! Part Two

Dentists modify and construct occlusions. This occurs on a daily basis in the disciplines of restorative, fixed and removable prosthetics and orthodontics. These procedures influence the TMJ, the muscles of mastication, the supporting structure of the teeth and the teeth as well. Dentists have an opportunity to not only objectively analyze how they all interrelate, but to create a physiological harmonious relationship. This will reduce a traumatic occlusion to one that is within the histological adaptive range for the tissue to accommodate. This knowledge can be applied to not only help patientsí pain and dysfunction, but to ensure confidence that dentists are not going to be responsible for iatrogenic results. The future of dentistry is not only being able to effectively deal with TMD but to prevent the problems. Management of mandibular whiplash and migraine headaches are also becoming our responsibility. Dentists are the specialists of occlusion. With the technology available to render this quality of care, they must fulfill their obligation to the public, take responsibility and continue to increase their capability. This approach to dentistry provides a new "window of opportunity" as its many applications have yet to be explored.     

Feature Article: Emtala: Impact on hospital dentistry emergency services

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital-based dental residency programs and hospital dentists to meet Federal standards when patients come to a hospital emergency department and need emergency dental services. EMTALA (42 U.S.C. 1395dd) has three key provisions which must be understood because of Its impact on hospital emergency dental services:
Medical Screening Requirements,
Necessary Stabilizing Treatment for Emergency Medical Conditions, and
Restricting Transfers Until the Individual is Stabilized.
This article reviews the relevant Federal statutes, codes of Federal regulation, and published court cases to help practitioners understand the Issues. An understanding of the informed consent process, including the "informed refusal" doctrine, as well as the dentist's obligation when patients refuse recommended diagnostic tests, treatment, or transfer, is Important. Immunity for failure to obtain informed consent is sometimes appropriate under state law. Under EMTALA, the term "physician" applies to dentists. Recent changes clarify distinctions between the terms "on campus" and "off campus" related to hospital property emanating from the "Ravenswood" tragedy. Hospital dentists must be familiar with these requirements when caring for patients seeking emergency services     

Substance abuse issues in oral and maxillofacial practice

Substance abuse has far-reaching consequences for individuals, their families, and the community. Medications with abuse potential play an important role in the management of pain and are widely prescribed by the oral and maxillofacial surgeon. Reducing the likelihood of abuse and providing appropriate pain management for the known abuser are critical aspects of perioperative patient management. Health care providers are not immune to substance abuse and may, in fact, be at an elevated risk. Identification of impaired providers is essential to help them find the appropriate treatment and counseling and to prevent harm to their patients, family, friends, or associates.     

Educational needs in the field of detection of domestic violence and neglect: the opinion of a population of French dentists

Objectives: The attitude of French dentists concerning domestic abuse has hardly ever been documented upon so far. The purpose of this study is to investigate the attitudes, knowledge and practices of a population of French general dental practitioners towards the prevention and detection of signs of neglect and abuse in order to determine the educational needs both during undergraduate curriculum and continuing education sessions. Methods: A total of 418 general dental practitioners all practising in the French area of Puy de Dôme were invited to participate in the study. The survey was conducted with questionnaires including multiple‐choice or open questions and VAS scales. Results: The response rate was 54% (228/418). Only 5.7% of the practitioners systematically look for signs of neglect or abuse when treating their patients. 36% declare having already come across one or several cases of abuse and 48% having suspected at least one. The patients concerned were mainly women (54%). Only 28% would adopt an attitude in compliance with the French legislation if confronted with a case of abuse or domestic violence. 75.9% of the practitioners would like more training and assistance in the detection and care of abused patients and particularly as regards signs of abuse and the legal framework. Conclusions: More information and training concerning abuse and domestic violence is required in the French undergraduate dental curriculum in order to help practitioners deal with such patients.     

长期用药患者拔牙的风险及防治

长期使用药物的患者伴有不同严重程度的、不同于其他疾病特有的临床症状和体征,可干扰拔牙操作的正常进行。此外,拔牙过程也可能会加重患者因长期使用药物而出现的严重并发症,且围手术期用药亦可能对患者长期使用药物的药效造成影响。文章针对长期使用抗凝血药物、双膦酸盐类药物、免疫抑制剂的患者以及长期酗酒和吸毒、接受放疗的患者拔牙可能出现的风险及其预防和处理进行阐述,以期为口腔医生在临床工作中能够对此类患者安全、顺利地实施牙拔除术提供参考。     

Avoiding malpractice for nondental conditions. The example of human immunodeficiency virus

BACKGROUND: Dentists are legally liable for failing to recognize medical conditions that they identify while providing dental care and for failing to refer patients for follow-up care and testing. This article suggests ways to avoid liability using human immunodeficiency virus, or HIV, infection as an example. TYPES OF LITERATURE REVIEWED: The authors conducted a review of the legal literature to determine circumstances that would cause dentists to have legal liability for failing to recognize a medical problem. The authors also conducted a review of the dental literature to identify the most common signs of HIV infection that dentists might see in practice. RESULTS: The legal literature indicates that dentists can be held liable for failing to recognize medical problems, including HIV and acquired immunodeficiency syndrome. The dental literature shows that there are multiple signs and symptoms that indicate the potential for HIV infection to be the underlying cause of many oral diseases. PRACTICE IMPLICATIONS: Dentists should be familiar with the most common oral manifestations of medical conditions that are likely to be identified in the dental office, including those associated with HIV infection. They must recognize medical conditions and arrange for appropriate referral to avoid liability.     

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??Patients with long-term medications have different degrees of special clinical signs and symptoms??which can disturb the operating procedure of the tooth extraction.The process of tooth extraction can also make the signs and clinical symptoms more severe.The medications used during tooth extraction may have side-effect on the patients with long-term medications. Thus??the aim of this paper is to review the risks of tooth extraction in the patients with long-term use of anticoagulants??bisphosphonates??immunosuppressants??alcohol abuse??drug abuse??and radiotherapy. Meanwhile??how to prevent the potential risks once happening and the treatment are also reviewed in this paper??aiming to provide reference for dentists to perform the extraction safely and smoothly.     

Human trafficking and the dental professional

Background“Human trafficking” is a term for a modern form of slavery. It is a criminal human rights violation and a significant health issue. Dental professionals can assist in recognizing victims of trafficking.MethodsThe author conducted a PubMed search of the English-language literature through May 2011, which yielded no articles meeting the search criteria “dentistry” and “human trafficking prostitution.” Given these results, the author reviewed articles published in medical journals, reports from both governmental and nongovernmental agencies and lay literature.ResultsThe author examines the present state of human trafficking and provides information—including specific questions to ask—to help dentists identify victims. In addition, the author suggests means of notifying authorities and assisting trafficking victims. He also examines the health care needs of these patients.ConclusionHuman trafficking is a global problem, with thousands of victims in the United States, including many women and children. Dentists have a responsibility to act for the benefit of others, which includes detecting signs of abuse and neglect.Clinical ImplicationsDental professionals are on the front lines with respect to encountering and identifying potential victims who seek dental treatment. Dentists can combat human trafficking by becoming informed and by maintaining vigilance in their practices.     

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.