The hospital is frequently the setting for the most complex cases in oral medicine. Hospitalized patients are most likely to have oral or dental complications of bone marrow transplantation, hematologic malignancies, poorly controlled diabetes, major bleeding disorders, and advanced heart disease. The hospital that wishes to provide the highest level of care for its patients must have a dental department.
The hospital dental department should serve as a community referral center by providing the highest level of dental treatment for patients with severe systemic disease and management of the most medically complex patients is best performed in the hospital because of the availability of sophisticated diagnostic and life-sustaining equipment and the proximity of expert consultants in all areas of health care.
Hospital patients with oral medical problems may be seen by the dentist in three ways:
1. The patient may be admitted as an inpatient to the dental service. This is done most frequently for patients who require dental care and who also have severe medical problems.
2. The patient may be seen as a hospital outpatient. This is the common procedure for the majority of patients with diagnostic problems of the oral mucosa, jaws, and salivary glands.
3. The patient may be seen by consultation at the request of another department of the hospital. Some of the most difficult and unusual problems evaluated by the hospital dentist are seen as consultations.
Examples of problems or needs that are rarely seen in outpatient practice but are commonly seen in hospitalized patients are oral ulcers, oral bleeding, and oral infection secondary to blood dyscrasias or chemotherapy; acute parotitis in debilitated patients; dental care to prevent osteoradionecrosis prior to radiotherapy; and dental care to prevent infection prior to organ transplantation or open heart surgery.
To handle consultations properly, the dentist must be familiar with the proper method of requesting and answering consultations. Hospitals may differ in the form used, but there is a universally accepted method that should be followed.