1. Linking Medicine with Dental Professional Internal Medicine for Dentists

2. Dentist is no longer treating teeth in patients, but rather patients who have teeth.

3. Connecting Oral Health to Overall Health “You’re not healthy without good oral health.” Making the Link Dentistry – The Forefront of Overall Health Patients visit the dentist more frequently than their regular physician.

4. Goals Dentists don’t treat only healthy people Dentists don’t treat only healthy people Dental treatments can affect the patient health Dental treatments can affect the patient health Dentists can discover some signs of special diseases Dentists can discover some signs of special diseases Emergency treatments in internal medicine Emergency treatments in internal medicine Increase the communication skills Increase the communication skills Give a wider horizon to medicine Give a wider horizon to medicine Help to be more competitive Help to be more competitive

5. Dentistry - Internal Medicine I. Introduction. History taking. II. The principles of physical examination. III. Physical examination of the head and neck region. IV. Chest and lung diseases. (pneumonia, bronchial asthma, tumors). V. Cardiovascular diseases. Symptoms and signs of common cardiovascular diseases (IHD, valvular diseases, heart failure, Infective Endocarditis). VI. Hypertension & Hypertension Emergrncy

6. Dentistry - Internal Medicine I. Gastrointesinal and liver diseases. (oesophageal diseases, ulcers, gastrointestinal tumors, liver and biliary diseases, pancreatitis). II. Endocrine diseases, diabetes mellitus and metabolic disorders. III. Infectious diseases and blood borne pathogenes IV. Kidney and genitourinary system. (glomerulonephritis, nephrotic syndrome, urinary tract infections, nephrolithiasis, renal failure). V. Haematology disorders ( Anaemia, Haemato-oncology, Haemostasis m blood transfusion.

7. Terminology and Definitions Medical Diabetes Diabetes Hypertension Hypertension Ischemic Heart Disease Ischemic Heart Disease Heart Valve Replacement Heart Valve Replacement Infective Endocarditis Infective Endocarditis Pulmonary disease (aspiration pneumonia) Pulmonary disease (aspiration pneumonia) Auto-immune diseases & Sjogren’s syndrome Auto-immune diseases & Sjogren’s syndrome

8. Other Medical-Dental Disease Links Oral cancer Oral cancer Stroke Stroke Medications and xerostomia Medications and xerostomia Gingival infiltration Gingival infiltration Osteoporosis Osteoporosis Chronic kidney failure/renal insufficiency Chronic kidney failure/renal insufficiency

9. Making the Link Dentistry – The Forefront of Overall Health Dental exams and health questionnaire can help Dental exams and health questionnaire can help Assess overall health Assess overall health Uncover hypertension Uncover hypertension Uncover cardiovascular disease Uncover cardiovascular disease Detect oral cancer - accounts for 2% to 4% of cancers. Detect oral cancer - accounts for 2% to 4% of cancers. Diagnose and treat periodontal (gum) disease - 80 percent of adults will have some form of periodontal disease Diagnose and treat periodontal (gum) disease - 80 percent of adults will have some form of periodontal disease This leads to overall better health This leads to overall better health

10. Making the Link to Overall Health: Diabetes Periodontal disease worsens diabetes – Periodontal disease worsens diabetes – Diabetes worsens periodontal disease – Diabetes worsens periodontal disease –

11. Making the Link to Overall Health: Oral Cancer Oral and pharyngeal cancer account for 2% to 4% of cancers diagnosed. Oral and pharyngeal cancer account for 2% to 4% of cancers diagnosed. Oral cancer occurs twice as often in males as females Oral cancer occurs twice as often in males as females Tobacco users have a high incidence of oral cancer Early detection of oral cancer enables less invasive treatment, higher survival rate Tobacco users have a high incidence of oral cancer Early detection of oral cancer enables less invasive treatment, higher survival rate Early stage survival rate is 80% Early stage survival rate is 80% Late stage five-year survival rate is 20% Late stage five-year survival rate is 20%

12. Roles and Responsibilities Be aware of link between oral disease and systemic diseases Be aware of link between oral disease and systemic diseases Ask patients if they are seeing a dentist regularly Ask patients if they are seeing a dentist regularly Observe oral soft and hard tissues Observe oral soft and hard tissues Work with physician to manage co-morbidity associated with systemic inflammation and oral periodontal disease Work with physician to manage co-morbidity associated with systemic inflammation and oral periodontal disease Make appropriate referrals Make appropriate referrals

13. Roles and Responsibilities: Dentist can detect 120 disease symptoms in the mouth Early detection of systemic diseases and recognition of oral manifestations Early detection of systemic diseases and recognition of oral manifestations Often first to identify a systemic health problem based on what they see in the patient’s mouth Often first to identify a systemic health problem based on what they see in the patient’s mouth Oral evaluation and diagnosis Oral evaluation and diagnosis

14. The main parts of the diagnosis Pathological Pathological Etiological Etiological Anatomical Anatomical Prognostic Prognostic

15. Medical Examination Patient history Patient history Physical examination Physical examination Laboratory and instrumental examination Laboratory and instrumental examination

16. Patient history 0.Introduction 1. Chief complaint(s) 2. Present illness 3. Past history 4. Current health status 5. Family history 6. Review of organ systems

17. Present illness Location Location Quality Quality Quantity or severity Quantity or severity Timing (onset, duration, frequency) Timing (onset, duration, frequency) Setting in which it developed Setting in which it developed Factors that aggravated or relieved Factors that aggravated or relieved Associated manifestations Associated manifestations Treatments Treatments

18. Past history Most important diseases in chronological order (hospitalisations) Most important diseases in chronological order (hospitalisations) Operations, injuries, accidents Operations, injuries, accidents Allergies (drug, food, pollens etc.) Allergies (drug, food, pollens etc.) Transfusion(s) Transfusion(s) Screening tests Screening tests

19. Current health status Social circumstances Social circumstances Occupation (recent and past) Occupation (recent and past) Enviromental hazards (home, school, workplace) Enviromental hazards (home, school, workplace) Diet (incl. beverages) Diet (incl. beverages) Alcohol and illicit drugs (type, amount, frequency, duration of use) Alcohol and illicit drugs (type, amount, frequency, duration of use) Tobacco (type, amount, duration) Tobacco (type, amount, duration) Current medication Current medication Exercise and leisure activities Exercise and leisure activities Sleep patterns Sleep patterns Sexual history Sexual history

20. Family history Parents, siblings, spouse, children, other relatives Parents, siblings, spouse, children, other relatives age; age and cause of death; health status; important age; age and cause of death; health status; important diseases diseases Occurence of Occurence of Diabetes Diabetes Hypertension, heart diseases, stroke Hypertension, heart diseases, stroke Infective diseases Infective diseases Malignant diseases Malignant diseases Coagulation disorders Coagulation disorders Psychiatric diseases, alcoholism, drug addiction Psychiatric diseases, alcoholism, drug addiction Symptoms like those the patient Symptoms like those the patient

21. Review of organ systems General General General status General status Usual weight, weight change Usual weight, weight change Fatigue Fatigue Fever Fever According to organs According to organs Skin, Head, Eyes, Ears, Nose, Mouth, Neck, Breasts, Respiratory, Cardiac, Gastrointestinal, Urinary, Genital etc. Skin, Head, Eyes, Ears, Nose, Mouth, Neck, Breasts, Respiratory, Cardiac, Gastrointestinal, Urinary, Genital etc.