EXPANDING THE SCOPE OF DENIAL PRACTICE As the sole purveyors of dental care, dentistry has the obligation to continually seek new knowledge that will enhance its mission.
Ig lh o u ld dentists conduct screening tests in their dental offices for diseases such as diabetes? How about routine adm inistration of electrocardiograms? Two recent dental publications say yes. One report cited evidence th a t 4 percent of patients screened in a dental setting had arrhythm ias of sufficient m agnitude to w arrant furth er medical evaluation. Based on this finding, it was suggested th a t all patients be tested before invasive dental procedures are performed. To support their conclusions, the authors indicated th a t tested patients viewed the EKG as a valuable service and were not concerned w ith the dental setting for th e procedure. Sim ilar conclusions were noted by a group of investigators who evaluated the use of the fasting capillary blood glucose test for patients who had “no consultative relationship w ith a physician.” Does the appearance of these reports signify a new effort to incorporate previous “physician only” tests into routine dental procedure? Why not? Supporters of additional in-office testing would argue, suggesting th a t skeptics look a t the list of “medical” tests already incorporated into routine dental practice. For example, blood pressure cuffs, rare a decade ago, now are standard equipm ent in m any dental offices. While I’m personally unaw are of general dental practitioners offering WBC, hemoglobin, clotting time and other blood tests to
E
L A W R E N C E H. M E S K IN , D .D .S E D IT O R
8
JADA, Vol. 123, March 1992
D
I
T
O
R
I
A
L
their patients—surely some oral and maxillofacial surgeons and periodontists must. In fact, considering the invasiveness of m any surgical dental procedures, would physicians perform this type of surgery without these basic tests? Is there any reason to question the actions of those dentists who wish to expand the scope of dental practice by including additional medical procedures in their everyday practice regime? D entistry’s m andate as a health profession is to advance the public’s oral health status. As the sole purveyors of dental care, dentistry has the obligation to continually seek new knowledge th a t
will enhance its mission. If offering medical tests, pre viously in the domain of other h ealth professionals, assists in accomplishing this goal, then argum ents against such procedures are spurious. If, however, the evidence for inclusion of such testing indicates potential harm —even to a few patients—the legitim acy of the procedure(s) m u st be questioned. For example, in the instance of fasting capillary blood glucose test, is the dental office the appropriate site for such testing? How m any dental patients would be willing to fast for 10 hours before their dental appointm ent? Compliance issues aside, for elderly patients heavily involved in a regime of polypharm acy, how safe is it for them to refrain from following
their norm al prescription schedule prior to invasive dental procedures? Can the dentist perform the procedure at a level of competency consistent with other medical settings? W hat about false positives and negatives? Do they occur a t a greater rate in the dental office? O ther questions m ust be addressed. Is the dentist trained in the interpretation of these tests? W hat will the dentist do with the te st results? How will these procedures be paid for? Medical insurance? Highly unlikely. Dental insurance? Even less so. If paym ent for testing is out of pocket, will dental patients be willing to obligate them selves for the additional costs? Will this affect their use of dental services? Each dental practitioner m ust
answ er these questions satisfactorily before accepting new medical procedures as “standard of care” in his or her dental office. There will be no universal answer. Many dentists will reject increased activity, others will participate a t different levels. As dentists assess their personal interest and competence, the precept “do no harm ” should be the basis for the judgm ent process. ■
LETTER S ADA welcomes letters from m em ber dentists on topics of
The proven superior adhesive.
Testing m ethodology (gnathodynamometry) was recommended and recognized by the FDA Over-theCounter Panel on the Review of Dentifrice and Dental Care Agents. Data on file.
Ig lh o u ld dentists conduct screening tests in their dental offices for diseases such as diabetes? How about routine adm inistration of electrocardiograms? Two recent dental publications say yes. One report cited evidence th a t 4 percent of patients screened in a dental setting had arrhythm ias of sufficient m agnitude to w arrant furth er medical evaluation. Based on this finding, it was suggested th a t all patients be tested before invasive dental procedures are performed. To support their conclusions, the authors indicated th a t tested patients viewed the EKG as a valuable service and were not concerned w ith the dental setting for th e procedure. Sim ilar conclusions were noted by a group of investigators who evaluated the use of the fasting capillary blood glucose test for patients who had “no consultative relationship w ith a physician.” Does the appearance of these reports signify a new effort to incorporate previous “physician only” tests into routine dental procedure? Why not? Supporters of additional in-office testing would argue, suggesting th a t skeptics look a t the list of “medical” tests already incorporated into routine dental practice. For example, blood pressure cuffs, rare a decade ago, now are standard equipm ent in m any dental offices. While I’m personally unaw are of general dental practitioners offering WBC, hemoglobin, clotting time and other blood tests to
E
L A W R E N C E H. M E S K IN , D .D .S E D IT O R
8
JADA, Vol. 123, March 1992
D
I
T
O
R
I
A
L
their patients—surely some oral and maxillofacial surgeons and periodontists must. In fact, considering the invasiveness of m any surgical dental procedures, would physicians perform this type of surgery without these basic tests? Is there any reason to question the actions of those dentists who wish to expand the scope of dental practice by including additional medical procedures in their everyday practice regime? D entistry’s m andate as a health profession is to advance the public’s oral health status. As the sole purveyors of dental care, dentistry has the obligation to continually seek new knowledge th a t
will enhance its mission. If offering medical tests, pre viously in the domain of other h ealth professionals, assists in accomplishing this goal, then argum ents against such procedures are spurious. If, however, the evidence for inclusion of such testing indicates potential harm —even to a few patients—the legitim acy of the procedure(s) m u st be questioned. For example, in the instance of fasting capillary blood glucose test, is the dental office the appropriate site for such testing? How m any dental patients would be willing to fast for 10 hours before their dental appointm ent? Compliance issues aside, for elderly patients heavily involved in a regime of polypharm acy, how safe is it for them to refrain from following
their norm al prescription schedule prior to invasive dental procedures? Can the dentist perform the procedure at a level of competency consistent with other medical settings? W hat about false positives and negatives? Do they occur a t a greater rate in the dental office? O ther questions m ust be addressed. Is the dentist trained in the interpretation of these tests? W hat will the dentist do with the te st results? How will these procedures be paid for? Medical insurance? Highly unlikely. Dental insurance? Even less so. If paym ent for testing is out of pocket, will dental patients be willing to obligate them selves for the additional costs? Will this affect their use of dental services? Each dental practitioner m ust
answ er these questions satisfactorily before accepting new medical procedures as “standard of care” in his or her dental office. There will be no universal answer. Many dentists will reject increased activity, others will participate a t different levels. As dentists assess their personal interest and competence, the precept “do no harm ” should be the basis for the judgm ent process. ■
LETTER S ADA welcomes letters from m em ber dentists on topics of
The proven superior adhesive.
Testing m ethodology (gnathodynamometry) was recommended and recognized by the FDA Over-theCounter Panel on the Review of Dentifrice and Dental Care Agents. Data on file.
