I had the craziest call yesterday. The caller was angry that we would require a treatment consultation for a patient's gastric reflux disease and nutritional habits. "He's not a real doctor," she said. "Is he a nutritionist and a physician?" Yeah, yeah, I've seen "The Hangover." Don't worry. I'm sleeping at night.
The caller claims she filed a complaint with the Washington Dental Service, accusing me of violating privacy and treatment guidelines because I was practicing outside of my scope of dentistry and practicing medicine without a license. For a moment, let's forget about how this caller is a grandmother of 2 pediatric patients I saw for comprehensive examinations. And let's also forget about the fact that this caller was asking us to violate HIPAA regulations and disclosure laws. Let's stay focused on the issues of the kids for a moment, and what I feel must be clearly understood by patients and parents alike.
I sat with the mother of these kids prior to exam and talked about the reasons they were here. Mom was loking for a dentist who could perform sedation procedures for her anxious daughter. Mom was also concerned about visible cavities. So I led Mom through the decay risk assessment form that we issue to every patient who is at moderate or high risk for tooth decay. We discussed medical histories, nutirional habits, the scope and level of supervision for the dietary and oral hygiene habits of her teen and preteen kids. I heard what I think is pretty typical for a family: a little hands-on supervision with nutrition at home, kids are mostly self-managed away from the house at school. Hygiene supervision is self-directed. I also discovered some crucial information about the teenager--a history of mild to moderate episodic gastric reflux. So now it's time for the clinical exam.
I sit with the teenager and diagnose 16 teeth with first stage tooth decay or greater. This means there is likely a medical component to the cause of her decay. I also learn that there is a history of hay fever and the occasional need to medicate for it, along with the history of medicating the reflux. I drill down with the patient about her current symptoms of reflux, discovering some tipoffs to continued reflux. She has a few--occasional epigastric pain, morning cough and morning need to clear her throat with mucous discharge occasionally, a mild reddening of the upper airway tissues, routine late night eating. She also has a significant potential to improve her hygiene habits, and could reduce how much soda she consumes regularly.
Not only is it my obligation to treat tooth decay, it's also my duty to inform the parents of minors about the influence of medical conditions on their children's mouths. So Mom and I agree to schedule a consultation for executing a treatment plan to address GERD and tooth decay treatments for their teenager.
Let's understand why I am discussing any medical issues or nutritional issues. There are so many medical conditions that affect the mouth. Acid erosion and tooth decay are a real side effect of gastric reflux disease (also known as GERD). I have to be well informed about the clinical signs, symptoms, diagnosis, testing, and therapies, because GERD puts teeth directly in danger. I refer all my patients with this clinical presentation if they are not under the care of a physician for the conditions.
In my practice, we are experts in everything we become responsible for treating. We are one of the first healthcare facilities a patient will visit for a diagnosis of cardiovascular disease, sleep breathing disorders, diabetes, oral cancer, migraine headaches, the list goes on. I routinely train and acquire continuing education for these medical issues. We also team up with surgeons, gasteroenterologists, ENT, cardiologists, sleep medicine, internal medicine, and family physicians on a regular basis. I visit medical clinics and provide no-cost educational sessions for physicians to become better acquainted with the strong connections between medicine and dental health.
So, yeah, I know medicine. It's called oral medicine. And I've been practicing it since I became a dentist. Medical dentistry is now the recognized standard of care.
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