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Oral Medicine and Medically Complex Patients


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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 Sjoegren'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

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.


I would recommend this book as a quick reference guidefor dental profes-sionals practising oral and maxillofacialsurgery and/or oral medicine, and clini-cians involved in thedaily management of hospital in-patients. (BritishDental Journal, 23 November 2013)

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