Descriptive Analysis of the Medical Consultations Conducted in the Dental School of Kerman University of Medical Sciences

ARTICLE INFO Article Type Original Article


Introduction:
Dental profession has dramatically changed over the past two decades, and it is no longer merely limited to practical techniques and approaches.As a result of medical advances and various available treatments, fewer patients lose their lives.(3) The statistics show that during the course of his/her professional career, a dentist visits at least 100 asthmatic patients. Medical consultation is scientifically and legally considered as an important step in planning dental treatment for patients with systemic problems. (1)Many systemic diseases or their treatments necessitate changes in dental treatment plans.11)(12) Due to the increasing number of dental patients who also suffer from chronic medical problems as well as the potential risks that dental treatments can cause, medical consultation seems necessary prior to dental treatment.Successful dental treatments require a strong cooperation between dentists and physicians, and consultation is of utmost importance in the establishment of this cooperation.Proper medical consultations are important in terms of offering suitable treatment services, as well as in terms of legal issues, and determining the pattern of current medical consultations would contribute to improving the aforementioned cooperation in the future.Therefore, the present study aimed to determine the specifications of the medical consultations performed in the department of oral medicine of the dental school of Kerman University of Medical Sciences.

Materials and methods:
In this descriptive study, sequential sampling method was used.The study population consisted of the patients attending the dental school of Kerman University of Medical Sciences from September 23, 2014 to September 23, 2015.In this dental school, all patients are initially examined and their specifications are filed and recorded.All the examinations are conducted under the supervision of oral medicine specialists, and when medical consultations are needed, they are conducted with the cooperation of the specialists using pre-prepared forms.The consultation meeting is transcribed by a dental student or an oral medicine resident and its contents are finally confirmed by the oral medicine specialist.The printed pre-prepared medical consultation forms were used as research instruments for data collection.Each form consisted of three sections: (1) Patient's demographic information (name, date of examination, age, sex, case number, marital status, and occupation); (2) Consultation reason, which is explained, stamped and signed by the dentist; (3) Specialists' comment, which is explained, stamped, and signed by the specialist. (13)After conducting the consultations, the forms completed by the physicians and the forms responded by the patients were transferred to the department of oral medicine, and copies of them were kept by a senior dental student in a separate file until the end of the study.All the medical consultations carried out during the study period were included in this research.Those patients who did not return or did not participate in medical consultations were excluded.The participants' personal information was confidential.The present study was approved by the department of science and technology of Kerman University of Medical Sciences with the ethics code number of ir.kmu.rec.1394.727.
The data were analyzed using SPSS software   Discussion: This descriptive study evaluated the medical consultations (2.77%) carried out for the patients attending the dental school of Kerman University of Medical Sciences.Due to involvement of various factors (including differences in the prevalence of systemic diseases, differences in the quality control of these diseases in different areas, as well as the differences across skills and knowledge of dentists who conduct the initial visits with the patients, and their disagreement on the necessity of medical consultations), no particular figure or range can be considered for medical consultations.Laurence  dentists' beliefs regarding the importance of regular screening for systemic diseases, and stated that the highest frequencies in terms of importance of screening were reported for hypertension (85.8%), cardiovascular diseases (76.8%) and diabetes mellitus (76.6%). (14)t seems that, regardless of the values related to the conducted consultations, dentists should be familiar with the important role of medical consultation in the detection of undiagnosed systemic diseases, and that they should not consult with physicians solely to obtain a license and to confirm the treatment for patients with systemic diseases.It seems that one of the reasons that general practitioners fail to conduct medical consultations is the referral of patients with systemic diseases to dental specialists.In a study by Cottrell et al, the majority of dental patients with systemic problems were referred to maxillofacial surgeons. (15)n the present study, the highest frequency of medical consultations was recorded for the age group 20-29 years; however, it is commonly expected that the elderly suffer more from chronic medical problems.Jainkittivong, et al. claimed that about 80% of the patients above 60 years of age who had requested dental treatments were suffering from systemic problems, and the continuous use of various drugs also increases with age. (16)It is likely that the higher frequency of consultations conducted for the age group 29-20 years in the current study is because of the greater concern of dentists about the symptoms expressed by the patients at the time of medical history recording.
In the present study, the majority of the patients were females (64.2%), consistent with the results of studies by Jainkittivong et al. and Hatipoglu et al. (16,17) Higher life expectancy and higher number of dental visits among women are the probable reasons for this finding.
In this study, most medical consultations were conducted for hypertension and heart diseases.This finding is consistent with those found by Jainkittivong et al. (16) Similarly, most dental consultations in the study by Hatipoglu et al were those between cardiologists and dentists. (16,17) his can be due to the high prevalence of hypertension and cardiovascular dis-eases, as well as the dentists' concerns about serious heart complications such as dangerous arrhythmias and syncope during dental treatment.
It is worth mentioning that in the present study, consultations for psychological problems were of relatively high frequency (12.7%), while only one consultation for infectious diseases was conducted.These may also originate from the dentists' concerns about the risk of seizures during dental treatment of patients with neurological disorders, dentists' adequate information about diseases such as hepatitis, as well as specified protocols used in the diagnosis and treatment of infectious diseases. (1,18)n the current research, 57.8% of the doctors recommended special considerations for patients.This value was equal to 1.32% and 55.3% in studies by Jainkittivong et al and Hatipoglu et al, respectively. (16,17) Te value obtained in the second study is close to the one in this study.In the current research, antibiotic prophylaxis was recommended in 7.5% of consultations, while 19.7% of the doctors also recommended the use of local anesthesia without epinephrine.These values were 32% and 20.4%, respectively for antibiotic prophylaxis and use of local anesthesia without epinephrine in the study by Jainkittivong et al. (16) Although Jainkittivong et al evaluated these two aspects from the perspective of the dentists' concerns, the results of the present study are associated with the physicians' emphasis on these two aspects. (16)ainkittvong et al and Hatipoglu et al stated that a new medical diagnosis and the initiation of treatment were considered for 8% and 16.35% of the patients after consultations. (16,17) n the present study, such values were not derived from the data.
In the present study, all the answers to the consultations were handwritten, and this can be considered as a limitation, since illegible handwritings cause probable confusions.Another non ideal observation was the overuse of abbreviated medical terminology by respondent physicians, as dentists may not be familiar with these abbreviations. (18)eist et al stated that the use of a standard and structured medical consultation form can improve the quality of the responses to dentists' medical consultations. (19)Ahsen et al. recommended the use of training video clips in order to improve the quality of medical consultation, which is considered as a type of skill. (20)he results of this study suggest that more efforts should be made to standardize medical consultation forms, and a more accurate program should be reinforced to teach the indications for medical consultation

Conclusion:
Dental management of medically-compromised patients may encompass different risks.The data from the present study reinforce the necessity of medical consultation for individuals with systemic diseases.The consultation process may affect the diagnosis and treatment plan.

Table 2 -Frequency distribution of medical con- sultations based on systemic diseasesTable 3 -Frequency distribution of the medical re- marks based on the physician's advice
evaluated the Downloaded from jrdms.dentaliau.ac.ir at 16:15 +0330 on Thursday November 2nd 2017 Downloaded from jrdms.dentaliau.ac.ir at 16:15 +0330 on Thursday November 2nd 2017 http://www.Jrdms.dentaliau.ac.irJournal of Research in Dental and Maxillofacial Sciences,Vol 2,No 1, Winter 2017 29 to dentists.Medical consultation forms should be standardized.The basics of medical consultation are usually communicated during general dentistry courses; however, lack of sufficient practice may decrease the quality of medical consultations conducted by dentists.