For several reasons, a dentist may choose to hospitalize a patient with severe medical problems. Important considerations are the availability of emergency resuscitation supplies; nursing care before and after the dental procedure; consultations with other medical disciplines; clinical laboratory facilities before and after the dental procedure; and operating rooms and anesthesiologists. Several medical insurance plans now cover hospitalization for patients with severe medical problems who are admitted for dental treatment.
Once the dentist decides that a patient should be treated in a hospital, the dentist should consider whether the dental procedure should be done on an inpatient or outpatient basis. The reason for using the hospital determines this choice. For example, if the hospital is being used for a patient with severe heart disease because of the resuscitation equipment available, hospitalization before and after the procedure may be unnecessary, and outpatient hospital management will accomplish the objectives. Conversely, a patient with hemophilia may require factor concentrates to elevate factor VIII levels prior to oral surgery. In this case, the hospital setting becomes more important for preoperative management and postoperative observation than for the procedure.
The dentist may choose to hospitalize patients for dental treatment of the following disorders:
1. Bleeding disorders due to hereditary disease, bone marrow suppression or extensive liver disease
2. Susceptibility to shock due to adrenocortical insufficiency or uncontrolled diabetes
3. Severe cardiovascular disease
4. Susceptibility to infection due to primary or secondary
immunodeficiency
immunodeficiency
5. Need of heavy sedation or general anesthesia
6. Neuromuscular or other physical disability requiring
special dental equipment for proper management Most hospitals allow single-day admissions and have day
surgery or short procedure units. Such a schedule is convenient for patients who require heavy sedation or general anesthesia but who do not require extensive pre- or postoperative care.
Dental patients who are admitted to the hospital should have a complete medical history and a head and neck examination noted on the chart by a member of the dental staff. Most hospitals require a physical examination by a physician or an oral surgeon, but this does not excuse the hospital dentist from writing a history and regional examination findings on the chart. There are many 2-year general-practice residencies and some oral medicine specialty programs that train dentists to perform competent screening and complete physical examinations.
Dentists who admit patients to a hospital may not be able to perform a complete physical examination, but they must be capable of understanding the implications of the physician’s examination and its relationship to the dental procedure to be performed. If the physician writes “PMI 6th ICS AAL gr iv/vi systolic in mitral region radiating to axilla” under “heart examination,” the dentist should understand that the heart is enlarged and that a probable organic murmur is present. In this case, further evaluation such as a cardiology consultation may be necessary before dental surgery is performed.
The hospital dentist should write the necessary orders for patients he or she admits, including orders regarding diet, frequency of vital signs, bed rest, medications, and laboratory tests. The dentist should be able to interpret the results of the tests he or she orders.
In summary, the hospital dentist is responsible for the total welfare of the hospitalized patients he or she admits. The dentist may be unable to treat all problems that arise, but he or she must know whom to consult to treat these problems. The dentist must also be trained to answer complex consultations regarding oral disease that are requested from other departments.
Hospital general-practice residency programs in dentistry train residents in physical diagnosis, laboratory diagnosis, and advanced oral medicine, to help them manage dental patients with severe medical problems. Residencies in oral medicine train dentists to provide oral health and dental care for patients with complex medical disorders as well as difficult diagnostic problems of the mouth and jaws. The future of dentistry and oral medicine in the hospital rests with the men and women being trained in these programs. Their training not only will benefit the dental profession but (more important) will also raise the level of oral health care available to patients with compromised health.
special dental equipment for proper management Most hospitals allow single-day admissions and have day
surgery or short procedure units. Such a schedule is convenient for patients who require heavy sedation or general anesthesia but who do not require extensive pre- or postoperative care.
Dental patients who are admitted to the hospital should have a complete medical history and a head and neck examination noted on the chart by a member of the dental staff. Most hospitals require a physical examination by a physician or an oral surgeon, but this does not excuse the hospital dentist from writing a history and regional examination findings on the chart. There are many 2-year general-practice residencies and some oral medicine specialty programs that train dentists to perform competent screening and complete physical examinations.
Dentists who admit patients to a hospital may not be able to perform a complete physical examination, but they must be capable of understanding the implications of the physician’s examination and its relationship to the dental procedure to be performed. If the physician writes “PMI 6th ICS AAL gr iv/vi systolic in mitral region radiating to axilla” under “heart examination,” the dentist should understand that the heart is enlarged and that a probable organic murmur is present. In this case, further evaluation such as a cardiology consultation may be necessary before dental surgery is performed.
The hospital dentist should write the necessary orders for patients he or she admits, including orders regarding diet, frequency of vital signs, bed rest, medications, and laboratory tests. The dentist should be able to interpret the results of the tests he or she orders.
In summary, the hospital dentist is responsible for the total welfare of the hospitalized patients he or she admits. The dentist may be unable to treat all problems that arise, but he or she must know whom to consult to treat these problems. The dentist must also be trained to answer complex consultations regarding oral disease that are requested from other departments.
Hospital general-practice residency programs in dentistry train residents in physical diagnosis, laboratory diagnosis, and advanced oral medicine, to help them manage dental patients with severe medical problems. Residencies in oral medicine train dentists to provide oral health and dental care for patients with complex medical disorders as well as difficult diagnostic problems of the mouth and jaws. The future of dentistry and oral medicine in the hospital rests with the men and women being trained in these programs. Their training not only will benefit the dental profession but (more important) will also raise the level of oral health care available to patients with compromised health.