Oral Medicine and Medically Complex Patients

Oral Medicine and Medically Complex Patients

by Peter B. Lockhart

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Oral Medicine and Medically Complex Patients, Sixth Edition provides succinct, yet comprehensive information on in-hospital care and outpatient management of the medically complex dental patient, as well as the management of non-surgical problems of the maxillofacial region. Fully revised to include up-to-date information on procedures and medications, the Sixth Edition contains over 15 additional charts and tables for rapid reference and expanded coverage on maxillofacial prosthodontics and increasingly prevalent conditions, such as ONJ.

Oral Medicine and Medically Complex Patients follows a practical approach, organizing essential information into quickly referenced tables, easy-to-read diagrams and step-by-step procedures. Replete with examples of hospital charts, operative notes, and consultations, the book provides thorough coverage of the broad scope of clinical problems and patient populations encountered by dentists. A truly must-have resource Oral Medicine and Medically Complex Patients serves the needs of an increasing number of dental students, residents in general practice and specialty training, and practitioners engaged in the care of both hospitalized and ambulatory patients.

Product Details

ISBN-13: 9781118495834
Publisher: Wiley
Publication date: 11/26/2012
Sold by: Barnes & Noble
Format: NOOK Book
Pages: 512
Sales rank: 998,613
File size: 14 MB
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About the Author

Peter B. Lockhart, DDS, FDS RCSEd, FDS RCPS, is Professor and Chair of the Department of Oral Medicine and Director of the Institute for Oral Medicine at Carolinas Medical Center in Charlotte, North Carolina. He has over 35 years of experience in various aspects of hospital-based dentistry, teaching, and research in oral medicine.

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Table of Contents

Contributors xi

Contributors to the Previous Edition xii

Acknowledgments xiv

Introduction xv

1. In-Hospital Care of the Dental Patient 1

Dental Admissions 1

The Patient’s Medical History 2

The Admission Note 2

Physical Examination 8

Admission Orders 12

Overview of Patient Admission Procedures 14

Preoperative Considerations 14

Preoperative Note 18

Preoperative Orders 18

Intraoperative Considerations 19

Operative Notes 22

Brief Operative Note 23

Postoperative Orders 23

The Postoperative Note 29

Follow-Up Notes 30

Discharge Notes and Requests 30

Discharge Summary 30

Examples of Hospital Charts 31

Examples of Emergency Room Admissions 32

Suggested Reading 32

2. Outpatient Management of the Medically Compromised Patient 33

Medical History 33

Allergy to Drugs 34

Bleeding Disorders 36

Specific Coagulopathies 37

Medications that Predispose to Bleeding 39

Cancer 41

Radiation Therapy to the Head and Neck Region 41

Cardiovascular Disorders 50

Diabetes Mellitus 58

Drug Abuse 62

Prescription and Non-Prescription Drugs 62

Alcohol 64

Fever of Unknown Origin 65

Human Immunodeficiency Virus Infection 65

Intellectual Disability 67

Down Syndrome (Trisomy 21) 67

Fragile X Syndrome 69

Autistic Spectrum Disorders (ASD) 69

Attention Deficit Hyperactivity Disorder 70

Liver and Spleen 71

Hepatitis 71

Liver Failure and Transplantation 73

Glycogen Storage Diseases 74

Asplenia 74

Neurologic Disorders 75

Cerebral Palsy 75

Dementia 76

Degenerative Neuromuscular Disorders 78

Myasthenia Gravis 78

Motor Neuron Disease 80

Multiple Sclerosis 80

Neural Tube Defects 81

Parkinson’s Disease 83

Seizures and Epilepsy 83

Orthopedic and Bone Disorders 85

Arthritis 85

Prosthetic Joint Replacement 86

Osteogenesis Imperfecta 88

Paget Disease (Osteitis Deformans) 88

Osteomalacia 89

Osteopetrosis 90

Osteoporosis 90

Pregnancy 91

Psychiatric Disorders 91

Renal/Adrenal Disorders 92

Adrenal Disorders 92

Renal Disorders 94

Respiratory Disease 95

Cystic Fibrosis 95

Asthma 96

Chronic Obstructive Pulmonary Disease 97

Tuberculosis 98

Sickle-Cell Anemia 98

Disorders of the Thyroid Gland 100

Hyperthyroidism 100

Hypothyroidism 100

Suggested Reading 101

3. Oral Medicine: A Problem-Oriented Approach 150

Altered Mucosa 151

White Lesions (or Lesions with a Predominantly White Component) 152

Red Lesions 157

Ulcerative Lesions 161

Exophytic Lesions 165

Pigmented Lesions 168

Pain and Altered Sensation 171

Orofacial Pain 171

Changes in Taste and Olfaction 181

Dry Mouth/Xerostomia 184

Malodor/Halitosis 186

Slow Healing 187

Swelling 188

Bleeding 188

Altered Oral Function 191

Problems with Teeth 191

Suggested Reading 193

4. Consultations 195

Requesting and Answering Consultations 195

Requesting Consults from Other Services 196

Answering Consult Requests from Other Services 197

Consult Format 198

Examples of Consultation Requests from Other Clinical Services 200

5. Dental, Oral, and Maxillofacial Emergencies 220

Medicolegal Aspects of Emergency Care 221

Emergency Department Medical Records 222

Intra-Oral Urgencies 226

Odontogenic Pain 226

Soft Tissue Lesions 229

Postoperative Emergencies 233

Bleeding 233

Postextraction Pain 235

Nausea and Vomiting 236

Odontogenic Infections 237

General Concepts 237

Diagnosis of Infection 237

Medical Management of Odontogenic Infections 239

Surgical Management of Odontogenic Infections 242

Most Common Reasons for Infection Management Failure 245

Salivary Gland Emergencies 246

Acute Parotid Infections 246

Obstructive Sialadenitis 247

Maxillofacial Trauma 248

General Principles of Care 248

Diagnosis of Facial Trauma 250

Dental and Dentoalveolar Trauma 256

Midface Trauma 264

Soft Tissue Wounds 266

Temporomandibular Joint (TMJ) Emergencies 278

Acute Condylar Dislocation 278

Acute Myofascial Pain 279

Traumatic Hemarthrosis or Joint Effusion 280

Suggested Reading 281

6. Medical Emergencies 283

Syncope 284

Respiratory Difficulty 286

Cardiac and Vascular Emergencies 292

Epilepsy: Seizures 301

Diabetic Emergencies 303

Allergic Reactions 306

Miscellaneous 308

Foreign Bodies or Instruments Swallowed or Aspirated 308

Emesis and Aspiration 309

Bleeding 310

Shock 311

Drug Overdose and Toxicity 313

Malignant Hyperthermia 316

Venipuncture Complications 317

Suggested Reading 318

7. Maxillofacial Prosthetics 319

Obturator Prosthesis: Types 319

The Maxillary Resection Patient 321

Rationale for Immediate Obturation 321

Presurgical Treatment Planning 322

Immediate Surgical Obturator 324

Extraoral Prostheses 328

Suggested Reading 332

Appendices 333

1. Abbreviations 335

2. Acid–Base Balance 357

3. Allergy: Common Examples of Pseudoallergic Drug Reactions 358

4. Biopsy 360

5. Cincinnati Prehospital Stroke Scale (CPSS) 362

6. Classifications 363

ASA Physical Status Classification System (Table A6-1) 363

Immunologic Reactions (Gell and Coombs) (Table A6-2) 363

New York Heart Association Functional Classification System (Table A6-3) 364

Classification and Management of Blood Pressure for Adults Aged 18 Years or Older (Table A6-4) 365

Sjögren’s Syndrome: Proposed International Classification Criteria (Table A6-5) 366

7. Coagulation and Hemostasis 367

Coagulation Cascade (Table A7-1) 367

Hemostasis (Table A7-2) 368

Procedures to Ensure Hemostasis (Table A7-3) 368

8. Conversion Tables 369

Centigrade to Fahrenheit (Table A8-1) 369

Kilograms to Pounds (Table A8-2) 370

Metric Equivalents (Table A8-3) 371

Corticosteroids—Systemic Equivalents (Table A8-4) 371

9. Cranial Nerves 372

10. Decimal Factors: Prefixes 373

11. Diets 374

12. Drugs and Medications 377

Asthma Medications (Table A12-1) 377

Bisphosphonates (Table A12-2) 378

Chemotherapy Drugs Associated with Mucositis (Table A12-3) 379

Common Medications Used in Dental Practice (Table A12-4) 380

Dilutions for Parenteral Drugs (Table A12-5) 411

Drugs and Medications of Concern in Dental Practice (Table A12-6) 412

Drugs Used in Dental Practice with Significant Allergic Potential and Alternative Medication(s) (Table A12-7) 413

Drug Interactions (Table A12-8) 413

Drugs with Fetal Effects from Maternal Exposure (Table A12-9) 417

Drugs for Use During Pregnancy (Table A12-10) 418

Drugs Used in Dentistry Considered Safe While Breastfeeding (Table A12-11) 419

Emergency Medications and Equipment (Table A12-12) 419

Federally Controlled Drugs (Table A12-13) 421

Renal Function: Adjustment of Dosage (Table A12-14) 422

Renal Drugs with Major Excretion Route via Kidneys (Table A12-15) 426

13. Emergency Room Kit 427

14. Facial Pain: Diagnostic Features 429

15. Fluid Management 432

Fluid Deficits (Table A15-1) 432

Types of Intravenous Fluid (Milliequivalents/L) (Table A15-2) 433

16. Glasgow Coma Scale 434

17. Hepatitis B Virus Infection 436

18. HIV Test Technologies 438

19. Hospital Charting 441

Examples of Hospital Charts (Table A19-1) 441

Examples of Emergency Room Admissions (Table A19-2) 446

20. Operating Room 453

Dress Code (Table A20-1) 453

Scrub Technique (Table A20-2) 454

21. Patient Transfer 455

22. Primary Dentition: Chronology 458

23. Prophylaxis 459

American Heart Association (Table A23-1) 460

American Dental Association and American Academy of Orthopedic Surgeons (Table A23-2) 461

Steroid Prophylaxis for Adrenal Insufficiency (Table A23-3) 462

24. Splint and Tray Construction 463

Anesthesia Splint (Table A24-1) 463

Medication Tray Construction (Table A24-2) 464

25. Staging 465

Staging and Management of BRONJ (Table A25-1) 465

TNM Staging for Tumors of the Lip and Oral Cavity (Table A25-2) 466

26. Trauma: Head Injury Sheet 468

27. Venipuncture 469

Index 471

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