Dental Secrets

1. Establishing a Therapeutic Dentist-Patient Relationship

To establish a therapeutic dentist-patient relationship in which accurate data are collected, presenting problems are assessed, and effective treatment is suggested.

Building Trust and Rapport. The initial patient interview is crucial for establishing a strong dentist-patient relationship. This involves active listening, empathy, and respect. Understanding the patient's perspective and acknowledging their feelings, especially anxieties related to past dental experiences, can significantly enhance communication and compliance.

Effective Communication Techniques. Open-ended questions, facilitation by reflection, and positive phrasing are essential tools. These techniques encourage patients to express themselves fully, clarify their concerns, and feel more comfortable. Avoiding negative commands and using indirect suggestions can also reduce resistance and improve patient cooperation.

Addressing Patient Insecurities. Patients often harbor insecurities related to dental care, such as fear of criticism or humiliation. By conveying attentiveness, acceptance, and support, dentists can alleviate these fears and build trust. Recognizing and addressing these emotional barriers is key to a successful treatment outcome.

2. Essential Elements of Patient History and Physical Examination

The chief complaint is the reason that the patient seeks care, as described in the patient’s own words.

Comprehensive Data Collection. A thorough patient history is vital for accurate diagnosis and treatment planning. This includes the chief complaint, history of present illness (HPI), past medical history, social history, and family history. The HPI should detail the duration, location, character, and previous treatments related to the patient's symptoms.

Physical Examination Techniques. Physical examination involves inspection, palpation, percussion, and auscultation. In dentistry, inspection and palpation are most commonly used to evaluate the oral cavity and neck. Auscultation, often with a stethoscope, is used to assess the temporomandibular joint (TMJ) and blood pressure.

Importance of Vital Signs. Monitoring vital signs—blood pressure, pulse, respiratory rate, and temperature—is essential for assessing the patient's overall health. Abnormal vital signs may indicate underlying medical conditions that could affect dental treatment. Normal values are:

• Blood pressure: 120/80 mmHg
• Respiratory rate: 16-20 breaths per minute
• Pulse: 72 beats per minute
• Temperature: 98.6°F or 37°C

3. The Importance of Laboratory Tests in Oral Diagnosis

With few exceptions, biopsy is the diagnostic technique of choice for virtually all soft-tissue lesions of the mouth.

Diagnostic Blood Tests. A complete blood count (CBC) provides valuable information about a patient's overall health, including hemoglobin, hematocrit, white blood cell count, and differential white blood cell count. Fasting blood sugar is the most effective screen for diabetes mellitus.

Biopsy and Cytology. Biopsy is the preferred diagnostic technique for soft-tissue lesions in the mouth. Exfoliative cytology may be used as a screening technique but has a high rate of false negatives. Immunofluorescence is valuable in diagnosing autoimmune diseases affecting the mouth.

Microbiologic Culturing. Microbiologic culturing is indicated for bacterial, viral, and fungal infections, especially in immunocompromised patients or when infections are refractory to initial antibiotic treatment.

4. Antibiotic Prophylaxis: When and Why

The patient’s well-being is the dentist’s responsibility.

Cardiac Conditions Requiring Prophylaxis. Antibiotic prophylaxis is recommended for patients with specific cardiac conditions, including prosthetic cardiac valves, previous bacterial endocarditis, complex cyanotic congenital heart disease, and surgically constructed systemic pulmonary shunts or conduits.

Dental Procedures Requiring Prophylaxis. Prophylaxis is recommended for dental extractions, periodontal procedures, dental implant placement, endodontic instrumentation beyond the apex, subgingival placement of antibiotic fibers, initial placement of orthodontic bands, intraligamentary local anesthetic injections, and prophylactic cleaning of teeth or implants if bleeding is anticipated.

Antibiotic Regimens. Standard regimens include amoxicillin or clindamycin for patients allergic to penicillin. Specific dosages and alternative antibiotics are outlined by the American Heart Association (AHA) and should be consulted regularly.

5. Managing Medically Compromised Patients

Prevention is the most important strategy.

Diabetes Management. In patients with insulin-dependent diabetes mellitus (IDDM), the primary concern is hypoglycemia. Dentists should inquire about changes in insulin dosage, diet, and exercise routines. Symptoms of hypoglycemia include tachycardia, palpitations, sweating, and nausea.

Corticosteroid Therapy. Patients on long-term corticosteroid therapy may require adjustments in their medication dosage before dental procedures. Antibiotic therapy is often indicated to minimize the risk of infection.

Renal Dialysis. Patients on renal dialysis with arteriovenous (AV) shunts should be premedicated before any dental treatment that has the potential of producing a transient bacteremia. Dental treatment should be done on the day between dialysis appointments to avoid bleeding difficulties.

6. Understanding and Addressing Patient Fears and Anxieties

Fear dissolves in a trusting relationship.

Common Dental Fears. Patients often experience fears related to pain, drills, needles, loss of teeth, and surgery. These fears stem from the unknown, loss of control, physical harm, and helplessness.

Addressing Fears Through Communication. Establishing good rapport and providing preparatory explanations can alleviate fears. Allowing patients to signal when they need a pause can restore a sense of control.

Behavioral Methods. Relaxation techniques, hypnosis, and distraction methods can help patients cope with dental anxiety. Informing patients about what to expect during procedures can also reduce fear of the unknown.

7. Oral Manifestations of Systemic Diseases

The mandible is not an infrequent site for metastatic breast cancer.

Leukemia. Spontaneous gingival bleeding is a common presenting sign of acute leukemia. A complete blood count and platelet count should be ordered to help establish a preliminary diagnosis.

Diabetes Mellitus. Polyuria, polyphagia, polydipsia, and suppurative periodontal disease should raise a strong suspicion of diabetes mellitus. A fasting blood glucose test is the most efficacious screen.

Metastatic Breast Cancer. Numbness of the mandible may suggest metastatic breast cancer. Radiographic evaluation of the jaw is a reasonable first step to make a diagnosis.

8. Diagnostic Techniques for Oral Lesions

With few exceptions, biopsy is the diagnostic technique of choice for virtually all soft-tissue lesions of the mouth.

Biopsy. Biopsy is the diagnostic technique of choice for soft-tissue lesions in the mouth. Any ulcer that is present for 2 weeks or more should be biopsied.

Exfoliative Cytology. Exfoliative cytology may be used as a screening technique for oral lesions but has a high rate of false negatives. It has value mainly in the diagnosis of certain viral, fungal, and vesiculobullous diseases.

Immunofluorescence. Immunofluorescent techniques are of value in the diagnosis of autoimmune diseases that affect the mouth, including pemphigus vulgaris and mucous membrane pemphigoid.

9. Treatment Planning for Oral Cancer

Tobacco and alcohol use are the major risk factors for the development of oral cancer.

Risk Factors. Tobacco and alcohol use are the major risk factors for the development of oral cancer.

Clinical Presentations. The two most common clinical presentations for oral cancer are a nonhealing ulcer or an area of leukoplakia, often accompanied by erythema.

Staging. Staging is a method of defining the clinical status of a lesion and is closely related to its future clinical behavior. The staging system used for oral cancers is called the TNM system.

10. Infection Control and Exposure Prevention

Infection control encompasses all policies and procedures to prevent the spread of infection and/or the potential transmission of disease.

Standard Precautions. Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection. They apply to blood, all bodily fluids, nonintact skin, and mucous membranes.

Engineering Controls. Engineering controls are technologically derived devices that isolate or remove hazards from the work environment. Examples include needle-recapping devices and sharps containers.

Work Practice Controls. Work practice controls are determined by behavior rather than technology. An example is the proper technique for handwashing.

11. The Role of Computers in Modern Dentistry

This book was written by people who like to teach for people who like to learn.

Dental Management Information Systems (DMIS). DMIS are essential for office management and are becoming more common in clinical dentistry. They offer benefits such as improved efficiency, accuracy, and data analysis.

Hardware and Software Considerations. The choice of DMIS often determines the hardware configuration required. Factors to consider include practice size, type, model, and desired features.

Clinical Applications. Computers can be used chairside for clinical charting, image capturing, digital x-rays, and clinical consulting. They also play a role in diagnosis and treatment planning.

Last updated: April 3, 2025