|Year : 2012 | Volume
| Issue : 4 | Page : 225-226
Emerging from an undergraduate dental degree program
Dean, School of Medicine and Dentistry, Director of Dental Research and Knowledge Transfer, UCLAN, Preston, Professor of Medicine in Dentistry Greenbank 303, University of Central Lancashire Preston, PR1 2HE, United Kingdom
|Date of Web Publication||12-Jul-2013|
Dean, School of Medicine and Dentistry, Director of Dental Research and Knowledge Transfer, UCLAN, Preston, Professor of Medicine in Dentistry Greenbank 303, University of Central Lancashire Preston, PR1 2HE
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Crean J. Emerging from an undergraduate dental degree program. SRM J Res Dent Sci 2012;3:225-6
Emerging from an undergraduate dental degree program, new graduates arrive expectantly, albeit somewhat hesitantly, into the professional dental surgery ranks. Their heads full of facts and figures, signs and symptoms, techniques and advancements, their journey begins with all the excitement of a child leaving the home nest for the first time, having been schooled in the skills their parents think they need to survive in the uncertain world ahead. And what sort of world do they encounter? Subjects delivered within the overly theoretical world of undergraduate dental programs suddenly explode into real-life problems and challenges, demanding not only-exam based knowledge but also the rarest of the commodities, "experience."
Thus, challenges emerge at every corner - changes in disease prevalence, emerging epidemiological trends, patient expectations, advances in technology, financial pressures, and regulatory demands for further training to permit more advanced care to be provided. The explosion in post graduate programs (MSc/MClin Dent), both full and part time, in the United Kingdom gives credence to the increasing realization that the new graduate is only part way along their training pathway to operate effectively and competitively in the professional arena.
One of those challenges emerging over the past two decades is the increasing medicalization of the dental patient cohort. Advances in medical diagnostics, management plans, and preventative programs have resulted in changes to life expectancy figures. In the UK, it is predicted that males and females will have an average life expectancy of 80 and 85 years by 2020. This reflects a potential challenge to the dental practitioner as the recent Adult Dental Health Survey (2009) in the UK has shown that the number of edentulous patients has fallen to 6% from 28% in 1978, with over 50% of 85-year olds having retained some natural teeth. Alongside these figures emerges the fact that these remaining teeth are likely to present complex treatment and even diagnostic challenges.
Patients who live longer are likely to bring with them increasing medical challenges. Research from our own group has shown that from a sample of 2000 patients attending primary dental care, over 65% reported a medical diagnosis and 70% relied upon some form of prescribed medication. Clearly the population attending for their dental care is and will pose a significant challenge to the knowledge base that dental practitioners require to provide their care on a professional and safe footing.
Those challenges can be viewed on a number of different levels. Firstly , with a population increasingly reliant upon medical intervention for survival, every member of the dental team should be capable of managing medical emergencies in the dental surgery. In the UK, the General Dental Council (GDC) through the UK Resuscitation Council expects that dental professionals will be able to manage a range of emergencies including fainting, hypoglycemia, angina, epileptic fitting, choking, asthma, anaphylaxis, myocardial infarction, bleeding, hyperventilation, and the collapsed patient. In addition, the team should be proficient in managing the patient who has suffered a cardiac arrest, with access to all the modern equipments such as automated electronic defibrillators. This has resulted in a large number of post graduate and continuing professional development (CPD) courses which are mandatory for continued registration with the GDC.
Secondly, the dental practitioner needs to be able to recognize in the dental patient those medical conditions already diagnosed and those that are as yet undiagnosed. This demands abilities in recognizing medical conditions in the fully clothed patient, a not inconsequential skill. These can include the bilateral swollen ankles and distended jugular veins of congestive cardiac failure, the malar flush of mitral stenosis, the plethora of signs indicating anemia, the bruising and bleeding suggesting disturbances in hemostasis or abnormal medication control such as warfarin, the characteristics of individuals challenged by respiratory disorders, the endocrine under- or overactive individual, and the degeneration associated with a number of neurological disorders. The range is enormous but vital to ensuring the dental appointment is delivered in the knowledge that a risk assessment has been performed and has reduced the likelihood of an untoward event.
Thirdly, the dental patient increasingly brings with them a dependence on prescribed and non-prescribed medication. The elderly based population accounts for up to 50% of all medications taken. In the UK, the average number of drugs taken by the >65 year olds is two, whereas on the European continent it is up to four. The syndrome of polypharmacy (taking five drugs or more) is also on the increase, accounting for 40% of the >65 year olds in the USA. Many new drugs appear on the market weekly, but the commonly prescribed range includes examples such as anti-thrombotic, sex hormones, angiotensin-converting enzyme inhibitors, acid suppressants, antidepressants, and lipid-lowering agents. As advances continue in medicine, this number will continue to increase. Thus, the dental practitioner will need to recognize what these drugs are and how they work so as to assess the likelihood that any interactions may occur which may impact on treatment provision or indeed on symptom presentation.
Fourthly, recognizing the co-morbidity of drugs will become increasingly important for dentists prescribing additional medication. These include examples such as nonsteroidal anti-inflammatory drugs (NSAIDs) and asthma, epilepsy and tricyclic antidepressants, antibiotics and anticoagulants, high blood pressure and NSAIDs. Recognizing that oral side effects such as angioedema, oral dysesthesia, gingival hyperplasia, glossitis, lichenoid reaction, salivary gland swelling, disturbed taste, and dry mouth may all herald from prescribed medication places an increasing demand upon the skills of the attending dental professional and indeed the expectations of their patients.
Fifthly , the pressure of migrational movements across the world demands that practitioners are perhaps increasingly familiar with the less indigenous diseases that migrants can bring with them. In the UK, for example, the need to recognize the presentation of diseases such as tuberculosis, dengue fever, Ebola virus, malaria, filariasis, Lyme disease, and sexually transmitted disorders highlights the need for practitioners to widen their diagnostic skills.
Finally, with all this knowledge, there also remains the need to examine the role that dental practitioners can play in providing support for the general health of the population. A recent study by Ireland et al. indicated that in a group of 789 primary dental care attendees who visited their dental practitioner on a yearly basis, only 21% regularly visited their general medical practitioner and over 40% of these were practising at-risk lifestyle behaviors such as smoking, drinking, being overweight, and reduced physical activity. Surely, as has been demonstrated in studies from Scandinavia, the dental practice could prove to be a valuable tool in the early diagnostic and even primary prevention against diseases outside the oro-facial region.
Dentistry continues to evolve its techniques and range of treatments, but the changing face of the patient profile demands an in-depth understanding of the medical challenges the patient population brings and will increasingly bring, which if ignored could result in events that could bring the profession into the spotlight for all the wrong reasons. The role the dental team can play in providing support of oral and general health issues is one of the next biggest strategic directions the profession needs to pursue. Get ready to study!
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