T h e
r o le
o f
e d ic in e
m
a n d
r e s p o n s ib ilit ie s
in
a
s c h o o l
o f
o f
a
d e p a r tm
e n t
d e n tis tr y
James V. Woodworth, M D
1
he
d e n ta l
e d u c a tio n
th a t
s tu d e n ts
re c e iv e
s h o u ld n o t be lim it e d to o ra l h e a lth care b u t s h o u ld b e c o n c e rn e d w it h th e o v e r a ll h e a lth o f th e p a tie n t. O ra l h e a lth a n d s y s te m ic h e a lth are re la te d a n d th e p re s e n c e o f p ro b le m s in o n e area m a y a ffe c t th e p r o v is io n o f care in th e o th e r. M e d ic o d e n ta l e d u c a tio n o fte n is p re s e n te d in th e c o u rs e o f o ra l m e d ic in e a n d in o th e r c o u rs e s s u c h as o ra l d ia g n o s is , o ra l p a th o lo g y , a n d o ra l b io lo g y . O ra l m e d ic in e fo r th e d e n ta l c u r r ic u lu m has b e e n d e fin e d as “ th a t area o f s p e c ia l c o m p e te n c e in th e p ra c tic e o f d e n tis tr y , r e la tin g to th e m a n a g e m e n t o f th e to ta l h e a lth o f th e p a tie n t, w h ic h is c o n c e rn e d w it h th e d ia g n o s is a n d n o n - s u r g ic a l tre a tm e n t o f p r im a r y a n d s e c o n d a ry d ise a ses in v o lv in g th e o ra l a n d p a ra -o ra l s tr u c tu re s .” 1 O ra l m e d ic in e is a n e d u c a tio n a l d is c ip lin e , r e a lly a m u l t i p l i c i t y o f d is c ip lin e s , th a t in v o lv e s o ra l p a th o lo g y , o ra l s u rg e ry , o ra l d ia g n o s is , p h a rm a c o lo g y , a n d o ra l r a d io lo g y . M a n y s c h o o ls h a v e a d e p a rtm e n t o f o ra l m e d ic in e , b u t n o t a ll in c lu d e th e d e p th o f s tu d y in th e fie ld o f m e d ic in e n o w th o u g h t to b e b e n e fic ia l i n th e s tu d y o f d e n tis tr y . A d d in g to th e c o m p le x it y is th e a m b ig u o u s te r m “ o ra l m e d ic in e .” I t c a n be a llin c lu s iv e in v o lv in g m a n y d is c ip lin e s o r e x te n s iv e s tu d y o f s y s te m ic disease, o r b o th , o r i t m a y c h ie fly in v o lv e o ra l diseases w it h o u t in - d e p th c o n s id e ra t io n o f s y s te m ic diseases a n d th e ir in flu e n c e o n th e p r o v is io n o f o ra l h e a lth care. A n a lte rn a te a p p ro a c h fo r a s c h o o l is to d e v e lo p a
d e p a rtm e n t o f m e d ic in e th a t is s u p p o r tiv e o f a n d h a s c o n jo in t te a c h in g w it h s u c h d e p a rtm e n ts as o ra l d ia g n o s is , o ra l p a th o lo g y , o ra l b io lo g y , p h a r m a c o lo g y , o ra l s u rg e ry , a n d o ra l r a d io lo g y . I o r i g i n a lly d is c u s s e d th is in 1 9 7 0 in th e a rtic le , “ M e d ic in e a n d th e d e n ta l s tu d e n t.” 2 I p ro p o s e d th a t a d e p a rtm e n t o f m e d ic in e be d ire c te d b y a p h y s ic ia n w h o w o u ld h a v e th e r e s p o n s ib ilit ie s o f c o o r d in a tin g th e c o u rs e c o n te n t th a t re la te s to th e te a c h in g o f m e d ic in e th r o u g h o u t th e s c h o o l, a n d w h o w o u ld b e re s p o n s ib le to m a k e c e rta in th a t th e p r in c ip le s o f m e d ic in e w e re a p p lie d a p p r o p r ia te ly in th e d e n ta l c lin ic s . T h e m a te r ia l to be p re s e n te d c a n n o t be g iv e n s o le ly b y a d e p a rtm e n t o f m e d ic in e , b y le c tu re s , o r in c lin ic s , b u t n e e d s to be in te g ra te d in t o th e to ta l te a c h in g p ro g ra m . A d e p a rtm e n t o f m e d ic in e c h a ire d b y an in te r n is t o ffe rs s o m e th in g u n iq u e to a s c h o o l o f d e n tis tr y . It p u ts i n th e d e n ta l c o m m u n it y a s c ie n t if ic a lly o rie n te d p h y s ic ia n , a n e x p e rie n c e d d ia g n o s tic ia n , w h o ca n c o o rd in a te th e c o m p r e h e n s iv e m e d ic a l a n d d e n ta l ca re o f p a tie n ts . In th e p r o v is io n o f h e a lth ca re , a d e p a rtm e n t o f m e d ic in e is c o n c e rn e d n o t o n ly w it h o ra l diseases th a t a ffe c t th e w h o le p a tie n t, b u t a ls o w it h s y s te m ic diseases th a t a ffe c t a n d a lte r o ra l ca re . I t stresses th e n e e d fo r a d d itio n a l a w a re n e s s in d e n ta l tre a tm e n t fo r th e p a tie n t w h o m a y h a v e le ss th a n p e rfe c t s y s te m ic h e a lth . K n o w le d g e d e riv e d fr o m b a s ic s c i ence, a p p lie d s c ie n c e , la b o ra to ry p ro c e d u re s , a n d
JADA, Vol. 98, June 1979 ■903
P E R S P E C T IV E
other diagnostic techniques is used to manage an outpatient or a hospitalized patient. The depart ment can teach the dentist how to obtain, interpret, and evaluate reports from physicians about sys temic health that influence the provision of dental care. In training, medical students are taught basic health care of the whole body, and then later may specialize. Only dental students start to specialize the moment they enter school. Currently, there has been more emphasis on the study of medical prob lems that affect the provision of oral health care. Because of recent medical advances, there is a new group of patients who need dental care, includ ing those receiving dialysis, those receiving chemotherapeutic agents, and all those who are terminally ill. Currently, these patients and their physicians are expecting the dentist to provide oral health care. The physician is not likely to have been trained to handle the problems developing in the mouth as a result of systemic disease. Thus it is the responsibility of dental schools to educate dentists to provide comprehensive oral medical care. As stated by the Council on Dental Education, “the primary focus in dental education should be to prepare students to provide compre hensive patient care to all population age groups including the handicapped and medically com promised patient.”3 In 1976, a department of medicine was estab lished at the University of Oregon Health Sciences Center’s School of Dentistry. The responsibilities of the department were developed to include lectures; hospital rounds; involvement in multiple areas of education, consultation, and emergency care; and to provide liason with the medical community. This article will describe the specific goals devel oped by the department during its organization and will summarize the topics presented in lectures and hospital rounds.
O rganization o f the departm ent o f m edicin e The department has been under the direction of a physician who has considerable clinical experience and a broad knowledge of the problems faced by the dental practitioner. Ideally, the chairman should be an internist and should devote full time to the needs of the department. There should be at least a part-time associate or paid consultants, or both, who can augment the teaching program. Space should be provided for an examining room, and for consultation with faculty and students. 904 ■ JA D A , V o l. 98, June 1979
R ole o f the departm ent
E d u c a tio n The responsibilities of the department are to edu cate dental students in medical subjects, so they will be able to understand the interrelationship of medicine and dentistry; to take and evaluate a med ical history, to perform a physical examination ap propriate for the dental office, and to organize and evaluate laboratory data; to recognize and evaluate existing medical problems and to determine their influence on the provision of dental care; and to know when and how to obtain medical consulta tion and advice. Dental students should also be taught to evaluate the systemic effect of drug reactions and interac tions as they affect dental care and the production of oral lesions; to anticipate and prevent most med ical emergencies and, if one arises, be able to pro vide appropriate treatment, including cardio pulmonary resuscitation (CPRj, and know where and how to seek medical assistance; and to admit a patient to a hospital and be able to use its facilities to the greatest advantage in providing dental care. Other responsibilities of the department are to edu cate the dental hygienist to handle medical emergencies and perform CPR; to develop courses for the department of continuing education; and to develop seminars for the faculty on medical sub jects. The department should also keep the student and the graduate alert to advances in medical practice that affect dental care. These include hemodialysis, kidney transplants, or renal insufficiency; preg nancy; cancer chemotherapy; oral cancer chemo therapy; oral cancer, including recent changes in radiotherapy, chemotherapy, and preservation of teeth; drug reactions and interactions, including oral manifestations thereof, and hazards of adverse drug reactions secondary to medications of dental origin interacting with medications prescribed by the physician, such as crystalline sodium warfarin and aspirin. Recent developments in the use and misuse of antibiotics, both in the healthy and in the immunosuppressed patient should be made known to graduates and students by the department. The de partment should monitor curriculum content in terms of applicability to medical problems as they appear in the dental office and it should educate students and faculty to minimize malpractice lia bility.
P E R S P E C T IV E
C o n s u lta tio n The responsibilities of the department are to pro vide consultative services in terms of care of pa tients; to exchange information with the faculty concerning the effect of medical problems on the provision of dental care; to serve as a representative for the physician in the dental community; and to speak for the dentist in the medical community. The department should provide input by physi cians through their participation on committees, especially in fields such as infectious disease and biohazard control, management of stress, and cur riculum.
E m erg en cy care The responsibilities of the department are to de velop a comprehensive program for providing emergency care throughout the school that in cludes location of equipment and maintenance of drugs in key areas; training of students, faculty, and other personnel in basic life support and the ap propriate use of medications when emergencies arise; and training of key personnel in advanced life support. The department should coordinate what is taught to students, faculty, and community dentists with what is included in the emergency kits and with the equipment distributed throughout the school and should provide consultative services in a med ical emergency.
Courses offered by the departm ent o f m edicine Principles of medicine should be required for all dental students, starting the last term of the junior year and the first two terms of the senior year. It can be presented as a one-hour weekly lecture that would be given by the chairman and occasional guest lecturers. Hospital clinics should be required for all dental students during their senior year. Groups of five to six students would visit the hospital on four occa sions with a physician and would attend a tumor board twice. Medical emergency procedures should be re quired for one term for all dental students and den tal hygienists. This would be presented, with an emphasis on CPR, in eight one-hour lectures and two two-hour laboratory sessions for students in groups of eight. Conjoint teaching should include lectures and
conferences in the departments of oral pathology, oral surgery, dental hygiene, and pedodontics.
Sum m ary o f course content Some of the major subjects that should be offered to dental students, so that the educational goals of the department of medicine are achieved, include sys temic diseases that modify the provision of dental care, and diseases of the cardiovascular system, particularly acute coronary insufficiency, valvular and congenital heart disease with or without prosthetic valves, hypertensive cardiovascular dis ease, and congestive heart failure. Other topics that should be offered concern dis eases involving the endocrine system, particularly diabetes mellitus, thyroid disorders, adrenal disor ders, (cushingoid disorder, adrenal insufficiency), parathyroid disorders, and pituitary disorders. Topics should also be offered that familiarize students with diseases involving the central ner vous system, particularly pain syndromes of the head and neck, strokes, multiple sclerosis, myas thenia gravis, convulsive seizures, Bell palsy, and Parkinson disease. The student should be taught about care of the debilitated patient. Lectures that give information on diseases of the gastrointestinal tract, particularly functional and organic diseases, and hepatocellular disease should be included in the curriculum. Other lectures should cover dis eases of the respiratory tract, particularly sinusitis, allergic disorders, aspirated foreign bodies, asthma, respiratory infections, allergic rhinitis, atelectasis, tuberculosis, and acute and chronic pulmonary in sufficiency. Also included should be information on diseases of the genitourinary tract, particularly renal dys function and dialysis. The causes and treatment of hypertension should be a part of the curriculum. Diseases involving hematology, and the use of routine laboratory pro cedures and their interpretation should also be sub ject matter for discussion, particularly coagulation disorders, leukemia, lymphomas, and anemia. Lec tures should include instruction on diseases of connective tissue and arthritic disorders, particu larly systemic lupus erythematosus, rheumatoid ar thritis, vasculitis, osteoarthritis, other collagen vas cular disorders, and gout. Other courses should teach care of the hospitalized patient and the stu dents should be familiar with the hospital setting and routine and be able to give advice on oral health care for hospitalized patients. The program should familiarize students with
W oodworth : R O L E O F D E P A R T M E N T O F M E D IC IN E IN D E N T A L SC H O O L ■ 905
P E R S P E C T IV E
the role of the dentist as a member of the health care team through early recognition by the dentist of treatable systemic disease, such as hypertension and cardiovascular disorders; malignancies of the head and neck; endocrine disorders, with special attention to diabetes mellitus; and anemias, leukemias, and coagulation disorders. A course in medical emergencies for both dental students and dental hygienists should include the recognition and management of emergencies that may occur in the dental office, including acute myocardial infarction with the attendant risk of cardiorespiratory arrest, CPR, treatment of acute respiratory obstruction, acute drug reactions, syn cope and other causes of loss of consciousness in cluding strokes and seizure disorders, reactions to insulin and diabetic coma, and adrenal insuffi ciency.
Comm ents The dental profession needs to solve, with input from the medical profession, the following prob lems: —Evaluation, determining the extent of history and physical examination that a dentist should do; —Professional interchange, developing the ca pacity to exchange information and to work to gether to solve mutual problems such as those of the medically compromised patient, or of who will pay for health care. — Humanism, developing the capacity of the dentist, who, in the provision of dental care, con
906 « JA D A , V o l. 98» June 1979
siders the interests, values, and dignity of the pa tient as he deals with patients who are emotionally disturbed, medically compromised, or terminally ill. — Curriculum, determining how extensively den tists should be trained in medical subjects.
Sum m ary In each school of dentistry there is a place for a department of medicine that can help prepare the dentist to provide dental care for the increasing number of patients with organic disease. The de partment of medicine can provide consultative ser vices to the medical profession in the dentist’s area of specialization.
Dr. W oodworth is an associate professor of m edicine and chairm an, departm ent of m edicine, University of Oregon H ealth Sciences Center, School of Dentistry. Send requests for reprints to Dr. W oodworth, 999 NE 169th Dr, Portland, Ore 97230. 1. Mazzeo, V.A. G uidelines for advanced education in oral m edicine. Advanced education in oral m edicine, a hospital based dental residency. J Oral Med 30(l):17-20, 1975. 2. W oodworth, J.V. M edicine and the dental student. J Dent Educ 34(2):168-170, 1970. 3. Dental education in the United States, 1976. Council on Dental Edu cation, Am erican Dental Association and Am erican A ssociation of Dental Schools. Chicago, A m erican Dental Association, 1977, p 150.
Essays of opinion on current issues in dentistry are published in this section of The Journal. The opinions expressed or im plied are strictly those of the authors and do not necessarily reflect the opinion or official policies or position of the Am erican Dental Association.
r o le
o f
e d ic in e
m
a n d
r e s p o n s ib ilit ie s
in
a
s c h o o l
o f
o f
a
d e p a r tm
e n t
d e n tis tr y
James V. Woodworth, M D
1
he
d e n ta l
e d u c a tio n
th a t
s tu d e n ts
re c e iv e
s h o u ld n o t be lim it e d to o ra l h e a lth care b u t s h o u ld b e c o n c e rn e d w it h th e o v e r a ll h e a lth o f th e p a tie n t. O ra l h e a lth a n d s y s te m ic h e a lth are re la te d a n d th e p re s e n c e o f p ro b le m s in o n e area m a y a ffe c t th e p r o v is io n o f care in th e o th e r. M e d ic o d e n ta l e d u c a tio n o fte n is p re s e n te d in th e c o u rs e o f o ra l m e d ic in e a n d in o th e r c o u rs e s s u c h as o ra l d ia g n o s is , o ra l p a th o lo g y , a n d o ra l b io lo g y . O ra l m e d ic in e fo r th e d e n ta l c u r r ic u lu m has b e e n d e fin e d as “ th a t area o f s p e c ia l c o m p e te n c e in th e p ra c tic e o f d e n tis tr y , r e la tin g to th e m a n a g e m e n t o f th e to ta l h e a lth o f th e p a tie n t, w h ic h is c o n c e rn e d w it h th e d ia g n o s is a n d n o n - s u r g ic a l tre a tm e n t o f p r im a r y a n d s e c o n d a ry d ise a ses in v o lv in g th e o ra l a n d p a ra -o ra l s tr u c tu re s .” 1 O ra l m e d ic in e is a n e d u c a tio n a l d is c ip lin e , r e a lly a m u l t i p l i c i t y o f d is c ip lin e s , th a t in v o lv e s o ra l p a th o lo g y , o ra l s u rg e ry , o ra l d ia g n o s is , p h a rm a c o lo g y , a n d o ra l r a d io lo g y . M a n y s c h o o ls h a v e a d e p a rtm e n t o f o ra l m e d ic in e , b u t n o t a ll in c lu d e th e d e p th o f s tu d y in th e fie ld o f m e d ic in e n o w th o u g h t to b e b e n e fic ia l i n th e s tu d y o f d e n tis tr y . A d d in g to th e c o m p le x it y is th e a m b ig u o u s te r m “ o ra l m e d ic in e .” I t c a n be a llin c lu s iv e in v o lv in g m a n y d is c ip lin e s o r e x te n s iv e s tu d y o f s y s te m ic disease, o r b o th , o r i t m a y c h ie fly in v o lv e o ra l diseases w it h o u t in - d e p th c o n s id e ra t io n o f s y s te m ic diseases a n d th e ir in flu e n c e o n th e p r o v is io n o f o ra l h e a lth care. A n a lte rn a te a p p ro a c h fo r a s c h o o l is to d e v e lo p a
d e p a rtm e n t o f m e d ic in e th a t is s u p p o r tiv e o f a n d h a s c o n jo in t te a c h in g w it h s u c h d e p a rtm e n ts as o ra l d ia g n o s is , o ra l p a th o lo g y , o ra l b io lo g y , p h a r m a c o lo g y , o ra l s u rg e ry , a n d o ra l r a d io lo g y . I o r i g i n a lly d is c u s s e d th is in 1 9 7 0 in th e a rtic le , “ M e d ic in e a n d th e d e n ta l s tu d e n t.” 2 I p ro p o s e d th a t a d e p a rtm e n t o f m e d ic in e be d ire c te d b y a p h y s ic ia n w h o w o u ld h a v e th e r e s p o n s ib ilit ie s o f c o o r d in a tin g th e c o u rs e c o n te n t th a t re la te s to th e te a c h in g o f m e d ic in e th r o u g h o u t th e s c h o o l, a n d w h o w o u ld b e re s p o n s ib le to m a k e c e rta in th a t th e p r in c ip le s o f m e d ic in e w e re a p p lie d a p p r o p r ia te ly in th e d e n ta l c lin ic s . T h e m a te r ia l to be p re s e n te d c a n n o t be g iv e n s o le ly b y a d e p a rtm e n t o f m e d ic in e , b y le c tu re s , o r in c lin ic s , b u t n e e d s to be in te g ra te d in t o th e to ta l te a c h in g p ro g ra m . A d e p a rtm e n t o f m e d ic in e c h a ire d b y an in te r n is t o ffe rs s o m e th in g u n iq u e to a s c h o o l o f d e n tis tr y . It p u ts i n th e d e n ta l c o m m u n it y a s c ie n t if ic a lly o rie n te d p h y s ic ia n , a n e x p e rie n c e d d ia g n o s tic ia n , w h o ca n c o o rd in a te th e c o m p r e h e n s iv e m e d ic a l a n d d e n ta l ca re o f p a tie n ts . In th e p r o v is io n o f h e a lth ca re , a d e p a rtm e n t o f m e d ic in e is c o n c e rn e d n o t o n ly w it h o ra l diseases th a t a ffe c t th e w h o le p a tie n t, b u t a ls o w it h s y s te m ic diseases th a t a ffe c t a n d a lte r o ra l ca re . I t stresses th e n e e d fo r a d d itio n a l a w a re n e s s in d e n ta l tre a tm e n t fo r th e p a tie n t w h o m a y h a v e le ss th a n p e rfe c t s y s te m ic h e a lth . K n o w le d g e d e riv e d fr o m b a s ic s c i ence, a p p lie d s c ie n c e , la b o ra to ry p ro c e d u re s , a n d
JADA, Vol. 98, June 1979 ■903
P E R S P E C T IV E
other diagnostic techniques is used to manage an outpatient or a hospitalized patient. The depart ment can teach the dentist how to obtain, interpret, and evaluate reports from physicians about sys temic health that influence the provision of dental care. In training, medical students are taught basic health care of the whole body, and then later may specialize. Only dental students start to specialize the moment they enter school. Currently, there has been more emphasis on the study of medical prob lems that affect the provision of oral health care. Because of recent medical advances, there is a new group of patients who need dental care, includ ing those receiving dialysis, those receiving chemotherapeutic agents, and all those who are terminally ill. Currently, these patients and their physicians are expecting the dentist to provide oral health care. The physician is not likely to have been trained to handle the problems developing in the mouth as a result of systemic disease. Thus it is the responsibility of dental schools to educate dentists to provide comprehensive oral medical care. As stated by the Council on Dental Education, “the primary focus in dental education should be to prepare students to provide compre hensive patient care to all population age groups including the handicapped and medically com promised patient.”3 In 1976, a department of medicine was estab lished at the University of Oregon Health Sciences Center’s School of Dentistry. The responsibilities of the department were developed to include lectures; hospital rounds; involvement in multiple areas of education, consultation, and emergency care; and to provide liason with the medical community. This article will describe the specific goals devel oped by the department during its organization and will summarize the topics presented in lectures and hospital rounds.
O rganization o f the departm ent o f m edicin e The department has been under the direction of a physician who has considerable clinical experience and a broad knowledge of the problems faced by the dental practitioner. Ideally, the chairman should be an internist and should devote full time to the needs of the department. There should be at least a part-time associate or paid consultants, or both, who can augment the teaching program. Space should be provided for an examining room, and for consultation with faculty and students. 904 ■ JA D A , V o l. 98, June 1979
R ole o f the departm ent
E d u c a tio n The responsibilities of the department are to edu cate dental students in medical subjects, so they will be able to understand the interrelationship of medicine and dentistry; to take and evaluate a med ical history, to perform a physical examination ap propriate for the dental office, and to organize and evaluate laboratory data; to recognize and evaluate existing medical problems and to determine their influence on the provision of dental care; and to know when and how to obtain medical consulta tion and advice. Dental students should also be taught to evaluate the systemic effect of drug reactions and interac tions as they affect dental care and the production of oral lesions; to anticipate and prevent most med ical emergencies and, if one arises, be able to pro vide appropriate treatment, including cardio pulmonary resuscitation (CPRj, and know where and how to seek medical assistance; and to admit a patient to a hospital and be able to use its facilities to the greatest advantage in providing dental care. Other responsibilities of the department are to edu cate the dental hygienist to handle medical emergencies and perform CPR; to develop courses for the department of continuing education; and to develop seminars for the faculty on medical sub jects. The department should also keep the student and the graduate alert to advances in medical practice that affect dental care. These include hemodialysis, kidney transplants, or renal insufficiency; preg nancy; cancer chemotherapy; oral cancer chemo therapy; oral cancer, including recent changes in radiotherapy, chemotherapy, and preservation of teeth; drug reactions and interactions, including oral manifestations thereof, and hazards of adverse drug reactions secondary to medications of dental origin interacting with medications prescribed by the physician, such as crystalline sodium warfarin and aspirin. Recent developments in the use and misuse of antibiotics, both in the healthy and in the immunosuppressed patient should be made known to graduates and students by the department. The de partment should monitor curriculum content in terms of applicability to medical problems as they appear in the dental office and it should educate students and faculty to minimize malpractice lia bility.
P E R S P E C T IV E
C o n s u lta tio n The responsibilities of the department are to pro vide consultative services in terms of care of pa tients; to exchange information with the faculty concerning the effect of medical problems on the provision of dental care; to serve as a representative for the physician in the dental community; and to speak for the dentist in the medical community. The department should provide input by physi cians through their participation on committees, especially in fields such as infectious disease and biohazard control, management of stress, and cur riculum.
E m erg en cy care The responsibilities of the department are to de velop a comprehensive program for providing emergency care throughout the school that in cludes location of equipment and maintenance of drugs in key areas; training of students, faculty, and other personnel in basic life support and the ap propriate use of medications when emergencies arise; and training of key personnel in advanced life support. The department should coordinate what is taught to students, faculty, and community dentists with what is included in the emergency kits and with the equipment distributed throughout the school and should provide consultative services in a med ical emergency.
Courses offered by the departm ent o f m edicine Principles of medicine should be required for all dental students, starting the last term of the junior year and the first two terms of the senior year. It can be presented as a one-hour weekly lecture that would be given by the chairman and occasional guest lecturers. Hospital clinics should be required for all dental students during their senior year. Groups of five to six students would visit the hospital on four occa sions with a physician and would attend a tumor board twice. Medical emergency procedures should be re quired for one term for all dental students and den tal hygienists. This would be presented, with an emphasis on CPR, in eight one-hour lectures and two two-hour laboratory sessions for students in groups of eight. Conjoint teaching should include lectures and
conferences in the departments of oral pathology, oral surgery, dental hygiene, and pedodontics.
Sum m ary o f course content Some of the major subjects that should be offered to dental students, so that the educational goals of the department of medicine are achieved, include sys temic diseases that modify the provision of dental care, and diseases of the cardiovascular system, particularly acute coronary insufficiency, valvular and congenital heart disease with or without prosthetic valves, hypertensive cardiovascular dis ease, and congestive heart failure. Other topics that should be offered concern dis eases involving the endocrine system, particularly diabetes mellitus, thyroid disorders, adrenal disor ders, (cushingoid disorder, adrenal insufficiency), parathyroid disorders, and pituitary disorders. Topics should also be offered that familiarize students with diseases involving the central ner vous system, particularly pain syndromes of the head and neck, strokes, multiple sclerosis, myas thenia gravis, convulsive seizures, Bell palsy, and Parkinson disease. The student should be taught about care of the debilitated patient. Lectures that give information on diseases of the gastrointestinal tract, particularly functional and organic diseases, and hepatocellular disease should be included in the curriculum. Other lectures should cover dis eases of the respiratory tract, particularly sinusitis, allergic disorders, aspirated foreign bodies, asthma, respiratory infections, allergic rhinitis, atelectasis, tuberculosis, and acute and chronic pulmonary in sufficiency. Also included should be information on diseases of the genitourinary tract, particularly renal dys function and dialysis. The causes and treatment of hypertension should be a part of the curriculum. Diseases involving hematology, and the use of routine laboratory pro cedures and their interpretation should also be sub ject matter for discussion, particularly coagulation disorders, leukemia, lymphomas, and anemia. Lec tures should include instruction on diseases of connective tissue and arthritic disorders, particu larly systemic lupus erythematosus, rheumatoid ar thritis, vasculitis, osteoarthritis, other collagen vas cular disorders, and gout. Other courses should teach care of the hospitalized patient and the stu dents should be familiar with the hospital setting and routine and be able to give advice on oral health care for hospitalized patients. The program should familiarize students with
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the role of the dentist as a member of the health care team through early recognition by the dentist of treatable systemic disease, such as hypertension and cardiovascular disorders; malignancies of the head and neck; endocrine disorders, with special attention to diabetes mellitus; and anemias, leukemias, and coagulation disorders. A course in medical emergencies for both dental students and dental hygienists should include the recognition and management of emergencies that may occur in the dental office, including acute myocardial infarction with the attendant risk of cardiorespiratory arrest, CPR, treatment of acute respiratory obstruction, acute drug reactions, syn cope and other causes of loss of consciousness in cluding strokes and seizure disorders, reactions to insulin and diabetic coma, and adrenal insuffi ciency.
Comm ents The dental profession needs to solve, with input from the medical profession, the following prob lems: —Evaluation, determining the extent of history and physical examination that a dentist should do; —Professional interchange, developing the ca pacity to exchange information and to work to gether to solve mutual problems such as those of the medically compromised patient, or of who will pay for health care. — Humanism, developing the capacity of the dentist, who, in the provision of dental care, con
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siders the interests, values, and dignity of the pa tient as he deals with patients who are emotionally disturbed, medically compromised, or terminally ill. — Curriculum, determining how extensively den tists should be trained in medical subjects.
Sum m ary In each school of dentistry there is a place for a department of medicine that can help prepare the dentist to provide dental care for the increasing number of patients with organic disease. The de partment of medicine can provide consultative ser vices to the medical profession in the dentist’s area of specialization.
Dr. W oodworth is an associate professor of m edicine and chairm an, departm ent of m edicine, University of Oregon H ealth Sciences Center, School of Dentistry. Send requests for reprints to Dr. W oodworth, 999 NE 169th Dr, Portland, Ore 97230. 1. Mazzeo, V.A. G uidelines for advanced education in oral m edicine. Advanced education in oral m edicine, a hospital based dental residency. J Oral Med 30(l):17-20, 1975. 2. W oodworth, J.V. M edicine and the dental student. J Dent Educ 34(2):168-170, 1970. 3. Dental education in the United States, 1976. Council on Dental Edu cation, Am erican Dental Association and Am erican A ssociation of Dental Schools. Chicago, A m erican Dental Association, 1977, p 150.
Essays of opinion on current issues in dentistry are published in this section of The Journal. The opinions expressed or im plied are strictly those of the authors and do not necessarily reflect the opinion or official policies or position of the Am erican Dental Association.
