Universitat Internacional de Catalunya
Dentistry for Special Patients
Other languages of instruction: Catalan, English
Teaching staff
Thursday at 3 p.m. By appointment via e-mail to the lecturer: b.olmo@uic.es
Introduction
The subject Dentistry for Special Patients deals with the field of dentistry that cares for patients with medical and pharmacological conditions and involves specific and differentiated treatment from the dentist to the treatment provided for other patients. The subject also covers scenarios resulting from caring for uncooperative patients, those with psychological or physical disorders that require intervention, and specific means and procedures.
Pre-course requirements
There are no prerequisites
Objectives
A. Provide the student with the knowledge, skills and abilities required for the prevention, diagnosis and treatment of abnormalities and diseases of patients with medical complications and complex physical and medical disorders.
B. Train the student in the scientific method applied to the study, evaluation and solution of dental health problems of patients with medical complications and complex physical and medical disorders.
C. Train the student towards eventual specialization, research or teaching.
Intermediate objectives
1. Acquire the skills and attitudes necessary for the clinical examination of patients with medical and pharmacological conditions and complex physical and medical disorders. Obtain and evaluate clinical, radiographic and complementary data of the aforementioned patient and carry out a diagnostic, prognostic and therapeutic approach to the patient's dental health status.
2. Distinguish the characteristics of the diagnosis and the therapeutic approach in personalized dental care for patients with disabilities and patients with complex medical conditions.
3. Identify and describe the etiological and risk agents of oral diseases in patients with medical complications and / or complex physical and medical disorders.
4. Train students to carry out the main methods and techniques of treatment, and in the control and prevention of oral diseases collectively for selected patients.
5. Master individual and community educational techniques for patients with disabilities or with a medical condition.
6. Train the student to describe the oral health condition and dental treatment needs of the different groups of patients mentioned above.
7. Know and describe the different groups of patients with disabilities according to their abilities, their degree of dependency, their social environment and their place of residence.
8. Know the different public health programs designed for dental care of this group.
9. Train the student to use conscious sedation techniques orally and by inhalation with nitrous oxide
Competences/Learning outcomes of the degree programme
- 15 - Being familiar with the general pathological characteristics of the illnesses and disorders that affect organic systems, specifically those which have dental repercussions.
- 21 - Knowing how to undertake a full dental exam, including the necessary X-ray and complementary exploratory tests, as well as obtaining suitable clinical references.
- 23 - Establishing a diagnosis, prognosis and suitable treatment planning for all the different clinical areas of Dentistry, being competent in terms of the diagnosis, prognosis and writing up the dental care plan for patients who require special care, including medically compromised patients (such as diabetics, those with hypertension, a depressed immune system or are anticoagulated, etc) and patients with disabilities.
- 31 - Knowing about the National Healthcare System, as well as the basic aspects of healthcare legislation, clinical management and the correct use of healthcare resources, and understanding the importance of the role of the dentist in the field of Primary Healthcare
- 51 - Knowing about the organisation and provision of oral healthcare in the community, both private and public, as well as general healthcare and the role of the dentist in these fields
- 54 - Knowing the role of the dentist within the healthcare professions and working with other healthcare professionals and other members of the dentistry team
- 58 - Knowing the general pathological characteristics of the illnesses and disorders that affect organic systems
- 59 - Knowing the oral manifestations of systemic diseases
- 60 - Knowing about general and clinical pharmacology for dental practice
- 61 - Knowing the pharmacological grounding for the various anaesthetic techniques, both local and general, as well as the role of sedation and general anaesthesia in terms of managing dental patients
- 62 - Conocer y manejar las emergencias y urgencias médicas más frecuentes en la práctica odontológica y en las técnicas de reanimación cardiorrespiratoria básica
- 69 - Identifying patients who require special care, recognising the characteristics and peculiarities of such cases
- 72 - Appropriate medical prescriptions, while being aware of their guidelines and warnings, systemic effects and repercussions on other organs
- 75 - Identifying, evaluating and attending to medical emergencies which may arise during clinical practice and apply cardiopulmonary recuscitation techniques; manage severe infections, including pharmaceutical prescriptions and simple surgical aspects
Learning outcomes of the subject
INTRODUCTION. GENERAL ASPECTS OF DENTAL CARE IN PATIENTS WITH MEDICAL PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the general or systemic diseases that affect dental activity. Assess preventive measures in dentistry to anticipate medical complications. Understand the increased risk and relative risk of oral diseases associated with each general disease. Know the prevalence of the most common general diseases that affect dental practice. Evaluate the expected frequency of patients presenting with certain pathologies. Understand some legal aspects of providing care to patients with physical or mental limitations or medical compromises. Know the most important diseases or syndromes that cause physical or mental limitations and their relationship with different areas of dentistry.
PATIENTS WITH CARDIORESPIRATORY PATHOLOGY
PATIENTS WITH CARDIAC PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the cardiac pathophysiology and the functioning of cardiac valves. Understand the aspects of valvular cardiopathies that condition dental care. Understand the concept and consequences of myocardiopathies in dental assistance. Distinguish between types of ischemic heart disease. Understand the concept of coronary insufficiency and the peculiarities of dental care for these patients. Understand the concept of heart failure and the peculiarities of dental care for these patients. Understand the concept of arrhythmia, its pathophysiology, classification, and considerations when treating a patient with arrhythmia. Understand the peculiarities of dental care for hypertensive patients. Understand the etiopathogenesis of bacterial endocarditis. Know the risk of suffering bacterial endocarditis according to previous cardiac pathology. Evaluate the need for preventive treatment of bacterial endocarditis based on the type of dental intervention. Distinguish situations in which endocarditis prophylaxis is not necessary. Know how to minimize the occurrence of resistant strains in endocarditis prophylaxis. Know the antibiotic guidelines for endocarditis prophylaxis. Understand the management of endocarditis prophylaxis in patients with joint prostheses.
PATIENTS WITH RESPIRATORY PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the attitude to maintain in patients with influenza who require dental treatment. Understand the attitude to maintain in patients with rhinitis who require dental treatment. Understand the attitude to maintain in patients with pharyngotonsillitis who require dental treatment. Understand the attitude to maintain in patients with laryngitis who require dental treatment. Understand the attitude to maintain in patients with sinusitis who require dental treatment. Understand the attitude to maintain in patients with pneumonia who require dental treatment. Understand the attitude to maintain in patients with pulmonary tuberculosis who require dental treatment. Understand the attitude to maintain in patients with chronic obstructive pulmonary disease (COPD) who require dental treatment. Understand the attitude to maintain in patients with asthma who require dental treatment.
PATIENTS WITH HEMATOLOGICAL PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the oral repercussions of Plummer-Vinson syndrome and its treatment. Understand the oral repercussions of iron-deficiency or megaloblastic anemia and its treatment. Understand the clinical features and dental treatment of myelodysplastic syndromes. Understand the oral repercussions of agranulocytosis and its dental treatment. Understand the oral repercussions of thrombocytopenic purpura and its treatment. Understand the oral repercussions of neoplasms of the hematopoietic and lymphatic system and their dental implications. Know the antagonists of vitamin K and their management. Understand the drug interactions of coumarins and the safest drugs for anticoagulated patients. Know the concept of INR. Understand the objective of using anticoagulants and antiplatelet drugs and when to use them. Evaluate the risk of bleeding and thromboembolism according to the type of activity or previous patient pathology. Understand the protocols for managing anticoagulated and antiplatelet patients. Evaluate the management in patients diagnosed with blood dyscrasias. Understand the approach in patients with coronary stents.
PATIENTS WITH HEPATIC PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the concept of hepatic cirrhosis and the general aspects of its pathophysiology that influence dental activity. Understand the types of hemochromatosis and the signs and symptoms related to dentistry. Evaluate the influence of dental drugs on hepatic pathology. Understand the concept of hepatic insufficiency and the general aspects of its pathophysiology that influence dental activity. Evaluate the relationship between coagulation disorders and hepatic activity. Understand the mechanism of coagulation: extrinsic and intrinsic. Understand the concept of portal hypertension and the general aspects of its pathophysiology that influence dental activity. Describe the gastrointestinal alterations related to dental activity.
PATIENTS WITH ENDOCRINE-METABOLIC PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Know what to do and what not to do from a dental point of view in patients with adrenal disorders (Addison's syndrome, Cushing's syndrome, pheochromocytoma), thyroid disorders (Graves' disease, Hashimoto's thyroiditis, congenital hypothyroidism), parathyroid disorders (hypo or hyperparathyroidism), and pancreatic disorders such as diabetes. Understand the pathophysiology of adrenal hormone production. Understand the pathophysiology of adrenal corticoid inhibition. Understand the corticosteroid treatment regimen for a patient.
PATIENTS WITH RENAL PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the functions of the kidney and the nephron. Understand the concept of glomerular filtration, tubular reabsorption, and secretion. Understand the prevalence of chronic kidney disease, the causes, and the clinical presentation. Evaluate the stages of renal function based on glomerular filtration. Know the meaning of creatinine and creatinine clearance. Evaluate the differences between types of dialysis and their implications in dental activity. Understand the relationship between immunosuppressants and their side effects in dental care of transplant patients. Understand the dental problems presented by kidney disease patients. Understand the associations of kidney disease with other diseases of interest to the dentist. Properly handle medications and doses in patients with renal insufficiency. Evaluate the approach to treating dialyzed and renal transplant patients.
PATIENTS WITH AUTOIMMUNE PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the main autoimmune diseases with general involvement and especially those with oral repercussions. Know the common general concepts of autoimmune diseases. Understand the clinical features of erythema multiforme, its association with triggering external agents. Know other forms of autoimmune diseases triggered by external agents: Stevens-Johnson syndrome, Behçet's syndrome, Lyell syndrome. Understand the autoimmune diseases characterized by blisters or vesicles: Pemphigus, mucous membrane pemphigoid. Understand the autoimmune diseases characterized by ulcers: Aphthous stomatitis, Lupus, Scleroderma, Dermatomyositis, Rheumatoid arthritis. Understand the clinical features, evolution, and treatment of Sjögren's syndrome.
PATIENTS WITH NEURODEGENERATIVE AND PSYCHIATRIC PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the main neurological diseases and their implications in dental care: Parkinson's disease, Alzheimer's disease, Epilepsy. Understand the most frequent symptoms of neurological diseases. Evaluate the stages of neurodegenerative diseases. Evaluate the dental management index. Concept and application. Develop appropriate treatment plans based on clinical situations and patient cooperation or management. Understand and manage the indices that allow assessing the patient's cognitive level, independence, and cooperation: ICO, Katz, Mini-Mental Test, McLeran. Understand the criteria for treating patients with neurological disorders. Evaluate the generalities of the clinical interview with neurological patients or their family members. Understand the issues related to carrying out prosthetic restorations in elderly patients with neurological compromise.
PATIENTS WITH PSYCHIATRIC PATHOLOGY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the most relevant psychiatric diseases and their general clinical features: Psychotic disorders (schizophrenia), mood disorders (depression, bipolar disorders), anxiety disorders (anxiety, phobias, obsessive-compulsive disorder), personality disorders. Understand the attitudes, prevention, and treatment to follow in these pathologies.
PATIENTS IN PREGNANCY AND LACTATION
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the systemic changes in pregnant women during pregnancy. Understand the oral changes in pregnant women. Understand the oral diseases related to pregnancy. Know the dental management of pregnant women. Evaluate the timing of pregnancy to carry out dental treatments.
TREATMENTS UNDER SEDATION. GENERAL ANESTHESIA
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand drugs and techniques for general anesthesia. Understand drugs and techniques for conscious sedation, both intravenous and nitrous oxide. Understand the indications and limitations of these techniques. Understand the risks and precautions.
PATIENTS WITH PSYCHIC DISABILITIES
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the management of patients with mental disabilities. Understand the psychiatric disorders and their dental repercussions. Understand the preventive activities to implement.
DENTAL OFFICE EMERGENCIES
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the ASA evaluation system of vital signs. Understand the management of variables such as heart rate, rhythm, and quality of pulse in emergency situations. Understand the management of variables such as respiratory rate and blood pressure in emergency situations. Evaluate the correct drafting of communication reports with other professionals. Understand the guidelines for basic life support and the management of venipuncture techniques. Handle syncope, convulsions, chest pain, arrhythmias, hypertensive crises, emotional disorders, foreign body aspiration, and respiratory disorders correctly. Understand the allergic reactions to anesthetics and other products and their treatment and attitude in these situations. Know the minimum equipment for emergency kits.
DRUG INTERACTIONS
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the pharmacokinetics of bisphosphonates. Know the management regimen for patients taking or to take oral or intravenous bisphosphonates. Know the treatment regimen for patients affected by bisphosphonate-related osteonecrosis. Understand the mechanisms of drug interactions. Know the peculiarities of drug use in dentistry. Classify pharmacological interactions based on severity and existing documentation. Understand the pharmacokinetics of local anesthetics and their interactions with other drugs. Understand the pharmacokinetics of vasoconstrictors and their interactions with other drugs. Understand the pharmacokinetics of antibiotics and their interactions with other drugs. Understand the pharmacokinetics of antifungals and their interactions with other drugs. Understand the pharmacokinetics of hypoglycemic agents and their interactions with other drugs. Understand the pharmacokinetics of NSAIDs and their interactions with other drugs.
PATIENTS WITH INFECTIOUS PATHOLOGY. HEPATITIS. HIV
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the body's defense mechanisms. Distinguish between different viruses causing hepatitis and their characteristics. Understand the actions to be taken in patients with acute and chronic hepatitis. Refer to contraindicated and recommended drugs for patients with hepatitis. Understand the attitude towards patients with HIV. Understand the pathophysiology and evolution of HIV. Understand the concepts of HIV epidemiology. Understand the diseases associated with HIV. Evaluate the risk when attending an HIV-positive patient. Understand how to act with a patient affected by HIV. Understand the concepts of viral load. Understand how to deal with HIV treatment.
PATIENTS WITH ONCOLOGICAL PATHOLOGY. CHEMOTHERAPY AND RADIOTHERAPY
PATIENTS WITH ONCOLOGICAL PATHOLOGY. NEOPLASMS OF THE HEMATOPOIETIC AND LYMPHATIC SYSTEM
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand neoplasms of the hematopoietic and lymphatic system. Describe the different types of leukemia, their dental implications, and their differential diagnosis. Describe the medical diagnostic means for leukemias. Understand the dental professional's attitude towards patients with neoplasms of the hematopoietic and lymphatic system. Describe the mechanism of coagulation and complementary tests to assess it. Describe the characteristics, clinical features, and differential diagnoses of Hodgkin's disease. Describe the characteristics, clinical features, and differential diagnoses of non-Hodgkin lymphomas. Describe the characteristics, clinical features, and differential diagnoses of Polycythemia Vera. Describe the characteristics, clinical features, and differential diagnoses of Mycosis Fungoides. Describe the characteristics, clinical features, and differential diagnoses of Macroglobulinemia. Describe the characteristics, clinical features, and differential diagnoses of Solitary Oral Plasmacytoma. Describe the characteristics, clinical features, and differential diagnoses of Multiple Myeloma.
PATIENTS UNDERGOING CHEMOTHERAPY AND RADIOTHERAPY
- LEARNING OUTCOMES At the end of this unit, the student will be able to:
Understand the consequences of mucositis, its classification, and spontaneous clinical evolution. Describe the risk factors for radiation-induced mucositis. Describe the effects of chemotherapy and the most commonly used drugs. Describe the guidelines for preventing radiation-induced mucositis. Understand the methods of mucositis treatment. Describe the guidelines for preventing xerostomia in oncology patients.
Please note that this is a summary of the learning outcomes for each section of the course. The actual content and details of each unit may vary depending on the specific course or program.
Syllabus
THEORETICAL PROGRAM:
GENERAL ASPECTS OF THE DENTAL ASSISTANCE IN PATIENTS WITH MEDICAL PATHOLOGY.
PATIENT WITH HEPATIC AND DIGESTIVE PATHOLOGY.
PATIENT WITH CARDIORESPIRATORY PATHOLOGY.
PATIENT WITH METABOLIC ENDOCRINE PATHOLOGY.
PATIENT WITH HEMATOLOGICAL PATHOLOGY.
PATIENT WITH RENAL PATHOLOGY.
PATIENT WITH AUTOIMMUNE PATHOLOGY.
EMERGENCIES IN THE DENTAL CABINET.
PATIENT WITH PSYCHIC DISABILITIES.
DRUG INTERACTIONS.
NEURODEGENERATIVE AND PSYCHIATRIC PATHOLOGY.
PATIENTS IN STATE OF PREGNANCY AND BREASTFEEDING.
TREATMENTS UNDER SEDATION OR GENERAL ANESTHESIA.
PATIENT WITH INFECTIOUS PATHOLOGY. HEPATITIS. HIV.
ONCOLOGICAL PATIENT. NEOPLASMS OF THE HEMATOPOIETIC SYSTEM.
PRACTICAL PROGRAM:
It will be carried out in practical activity in the Primary Care Centers and in the Catalonia Foundation for Psychically Handicapped and other external institutions
Teaching and learning activities
In person
Masterclasses: Topics will be presented with computer support.
Practical seminars: Attendance is compulsory. Roll call. You can only have a maximum of 2 EXCUSED absences (the documented justification will be provided at most during the week after the seminar). Clinical cases will be discussed in a participatory way Either venipuncture seminars will be held, nitros oxide management, according to the program. and then a continuous evaluation will be carried out through a computer platform in which the student needs to obtain 50% of the grade for each of the seminars in order to be able to take the practical part of the final exam. The seminar will be attended with a laptop, tablet or mobile.
Presentations:
The students, in groups, will make some presentations / communications / works that they will expose according to days and hours that will be previously specified
1. The names of the components of the groups are established in alphabetical order.
2. The groups are of 5 components.
3. Erasmus students can work in team communications without the need for all members to be physically present.
4. The presentation of class work is done by one of the group members. Individual questions from the presentation will be asked to all the members of the group.
5. Obviously the Erasmus students are exempt from attending the presentation in class but at least one of the group must be able to take charge of the presentation.
6. The best communications presented may be registered at the annual SEGER congress with the tutelage of the professor.
7. Communications must be accompanied by a previous word and power point that includes the work carried out following the established rules. The criteria for its elaboration are explained in class.
8. Teachers are available to students to answer any questions that may arise in their preparation.
9. The themes will be assigned to each group and the list with the components of the groups and the theme will be published.
10. During the last days of seminars, the papers will be presented and presented orally.
External Practices
Students will attend for 24 hours distributed between CAPs, Catalonia Foundation for the mentally handicapped and / or other EXTERNAL institutions or in the master of special patientsthroughout the academic year to complete their training, doing external internships supervised by practicing dentists in primary school or by a teacher, following an organization to be published in Moodle at the beginning of the course.
Evaluation systems and criteria
In person
MASTER CLASSES: The Exam will consist of 40 test questions with 5 answers and only one correct one. 0.20 points are subtracted for each incorrect answer.
PRACTICAL SEMINARS: The exam will consist of 10 test questions with 5 answers and only one correct one. 0.20 points are subtracted for each incorrect answer. Only those who have attended seminars that have been taught with a maximum of 2 EXCUSED absences may be examined from this part. The justification is delivered no later than the week following the absence.
The EXAM is 60% of the grade.
The grade of the communications is 10% of the grade.
The evaluation of the practical activity in the Primary Care Centers, in the Catalonia Foundation for Psychic Disabilities and other external entities is 30% of the mark.
All components (examination, communications, and external practical activities) must be passed separately to calculate the final grade for the course.
The grade for any of the course components will not be carried over to subsequent examination periods. Therefore, if a student fails any of these components and, consequently, the course as a whole, they will need to retake each and every one of the components in subsequent examination periods.
Bibliography and resources
1. Tratamiento odontológico del paciente bajo tratamiento médico.Little JW, Falace DA Medici. Barcelona, 1998. 5ª edición.
2. Medicina interna en odontología- Tomos I y II. Rose LF, Kaye D. Salvat. Barcelona, 1992.
3. La atención odontológica en pacientes médicamente comprometidos.Bullón P, Machuca G. Laboratorios Normon, S.A. Departamento de publicaciones científicas,1996.
4. Complicaciones médicas en la consulta dental.Urraco A, Díaz MT. Litofinter impresores, 1995.
5. Urgencias médicas en la consulta de odontoestomatologíaBugarín Gonzalez R. , Galego Feal P. Lab. Menarini.
6. Emergencia Médicas en Odontología Eduardo Dias de Andrade ,Ranali José .Ed.Artes Médicas .2004
7. Hernández M, Boj JR, Casas JI. Guía rápida del tratamiento de lasurgencias médicas en la consulta dental. Barcelona: Publicación delColegio Oficial de Odontólogos y Estomatólogos de Cataluña, 2000.
8. Myers A. Medicine 2nd edition; Harwal Publishing, 1994.
9. Tratamiento del paciente odontológica con hemopatias
Lucas Bermudo ., Palma Gomez A. Lab.Glaxo SmithKline
10 Medicina Interna . Farreras Rozman
11. Elias R. Odontología para pacientes con necesidades especiales.Madrid: Ripano EM.2008.
12.Fiske J, Dickinson C, Boyle C, Rafique S, Burke M. Special Care Dentistry. London: Quintessence Publishing Co. 2007.
13. Pinto da Silva LC, de Almeida Cruz R. Odontología para pacientes com necesidades especiais. Protocolos para o atendimento clínico. Saö-Paulo: Livraria Santos Editora.2009.
14. Scully C, Diz-Dios P, Kumar N. Special Care Dentistry. London: Churchill Livingstone-Elsevier. 2007.
15. Silvestre FJ, Plaza A. Odontología en pacientes especiales.Valencia: Publicaciones Universidad de Valencia (PUV). 2007
16. Odontología de alto riesgo: pacientes clínicamente comprometidos. Roberto Elías. Nº Edición: 1ª/ 2022
Evaluation period
- E1 23/05/2024 A02 16:00h
- E1 23/05/2024 A01 16:00h
- E1 23/05/2024 A03 16:00h
- R1 06/06/2024 A01 14:00h
- E2 13/06/2024 A01 15:00h