Hi everyone, I'm Stephanie Munz and I am fortunate to work as a dentist in an academic hospital setting. The oral health professional has a vital role to play in the care of patients in a hospital. And hospitals are points of access to comprehensive health care that is vital for diagnosis, treatment, and survival for people with increasingly complex and interconnected conditions. The relevance of oral health to systemic health should really be emphasized, and the hospital dentist offers a unique perspective and contribution in this regard. The hospital-based dental practice is specific to certain populations with complex conditions. Dental care is performed in various settings including inpatient in the hospital care, which may be at the bedside, or in a specific procedural setting. Versus in an outpatient dentistry clinic adjacent to other hospital-based outpatient clinics. Hospital dentists also provide a unique expertise in the overall management of rehabilitation for patients with head and neck cancers, trauma and craniofacial anomalies. As well as provide comprehensive care for patients with disabilities in an operating room setting with general anesthesia, especially when it's not possible in a routine clinic setting. Hospital dentists assure that patients with medical complexity are free of risk infection from an oral or dental source. This is known as dental clearance, and I'll speak a lot more on this later. This is important before procedures such as organ transplantation, cardiac surgeries, and systemic cancer therapies. Depending on severity of medical conditions, dental treatment may be optimally performed in an operating room setting under general anesthesia. Resources in the hospital setting allow dentists to provide a sophisticated level of care, including access to the comprehensive health record, laboratory values, advanced imaging, and operating room settings. Management decisions are made collaboratively with colleagues when complex conditions require a team-based perspective. And our patients are certainly appreciative for our shared decisions and services. The collaborative support of our colleagues' expertise is invaluable in managing patient needs. Many types of other professional experts work with hospital dentists, this could include physicians, but also physician assistants, nurse practitioners and nurses. Social workers, physical and occupational therapists, psychologists, and others. As examples, I worked very closely with a speech and language pathologist, to evaluate the effectiveness of dental prosthetics that seal the separation between the nose and the mouth, after a cancer resection by a surgeon colleague in the mexilla or the upper jaw. This prostheses is generally called an uptrader, and improves the patient's ability to eat, drink, speak and swallow. With the focus on quality of life after surgical and artmum therapies such as radiation and or chemotherapy. I also worked in coordination with an endocrinologist, and that's a person who makes prostheses for using silicone, for replacing eyes, ears, or noses due to trauma or cancer or other conditions. There are certain requirements of a highly functional team in interprofessional care. Which includes a working knowledge, skills, attitudes, and behaviors that facilitate professionalism, and ethics, and teamwork, and communication. As well as an understanding of the roles and responsibilities, with patients' values and goals prioritized. IPC is defined as the provision of comprehensive health services to patients by multiple healthcare providers, in various fields working collaboratively to deliver quality care within and across settings. IPC has great potential to improve patient safety and quality of care. The benefits to patients, healthcare providers, peers and society are particularly noteworthy. I think everyone can appreciate and benefit from this kind of teamwork. Dental clearance is requested by professional colleagues for patients who are planned to have invasive medical procedures, for which oral health optimization is truly important. The priorities include treatment of oral disease before medical intervention, prevention, and/or treatment of complications during their intervention and prevention and/or treatment of additional oral disease or effects after their intervention. There are certainly nuances to providing this type of oral health service, and the hospital dentist is able to take part In many of the intricacy of patient care. In order to prevent and or treat dental decay and periodontal disease, as well as minimize the effects of dry mouth known as xerostomia, oral soreness or ulcerations known as mucositis. Any limitations in oral opening known as trismus, changes to taste, function, and compromise oral healing. Diagnosis and treatment recommendations are made with consideration, not only with what must be completed, but also how to accomplish the treatment in a safe and timely manner. As well as how the patient's current and future health status may impact their oral health related quality of life. People who require special care and a particular focus on alternative methods to accomplish treatment goals, are those with disabilities. People with disabilities represent a particular group of patients, and which strategies to complete recommended and necessary treatment, may not always be possible in a clinic setting. While these oral findings pictured here may seem extreme in the general population, these examples of disease are not rare in the populations we treat. You may consider the severity of the effects on quality of life for these patients including, all ready missing teeth. The fractured tooth that you see in the top left picture, the accumulation of calculus and plaque with associated soft tissue inflammation. And the wear of the occlusal or biting surfaces that potentially are result from bruxism or other neuromuscular conditions that cause that associated tooth attrition. Certain people really can't tolerate routine dental treatment in an outpatient clinic setting. And these people may be affected by some diagnosis related to cognitive impairment or movement disorders, dementia, schizophrenia. A traumatic brain injury, extreme anxiety about dental procedures, and trismus, which I already told you was a limited oral opening. Comprehensive dental care in an operating room setting under general anesthesia is certainly a last resort option, but an important strategy for many people to receive dental care. The operating room setting with general anesthesia may be the most appropriate setting for patients with special health care needs. And this is certainly possible in the hospital, this is a typical depiction of the operating room for dentistry. The circulating nurse is charged with supporting the overall care of the patient, while the anesthesiologist and or nurse anesthetist facilitate and monitor the general anesthesia. This allows the dentist and dental team to complete the theracare. The dental clean team, including the dentist an dental assistant, provide dental care once the patient is intubated stabilized, and prepared for treatment. This includes particular diligence in patient safety and preparation from a lengthy sequence of treatment, which may take even several hours depending on extensiveness of need. A dentist who provides care in this setting must have a good understanding of their patients potential medical risks, and then work effectively with physicians and others to optimize their conditions before the day of the procedure. We must also support nurses and physicians in the preparation, implementation, and recovery of our patients in this setting. The order of procedures is to first prepare the patient for transfer to the OR table and perform an initial time out. Then induction and intubation is completed by our anesthesia colleagues, and verification of general anesthesia initiation is also completed, this includes a final time out. Time-outs are completed to verify that the team is on the same page, and agrees with the plan as its' been stated. A throat pack is then placed to protect the airway, and the upper gastrointestinal tract. Then a cursory oral exam is performed, appropriate radiographs or x-rays are obtained, occlusion, or bite is verified. Then a debridement, prophylaxis, or a dental cleaning, and periodontal probing. As well as a definitive exam for dental caries, fractures, and tooth mobility is completed. Restoration are completed before extractions, then fluoride application is completed as indicated, followed by removal of the throat pack. Appropriate suctioning of the oral cavity and throat and a final exam before extravasation is critical to verify that all necessary procedures are completed. And then the patient is transferred to the bed for transport to recovery, and discharged to home after their proper recovery. In conclusion, the hospital dentistry scope of practice is broad and also deep. We provide a dental clearance prior to organ or bone marrow transplantation, cardiac surgery, head and neck radiation therapy, chemotherapy, anti-resorptive therapies. We rehabilitate oral and maxillofacial cancer resection and traumas, as well as craniofacial anomalies. We treat patients under general anesthesia as a last resort and complete all of their comphrehensive care there entirely, we also provide emergency services 24 hours a day. Especially to support our emergency physician and other healthcare provider colleagues, and we provide care on an inpatient and outpatient basis. In order to practice in a hospital setting, dentists are now expected to complete postdoctoral training in a hospital. Dental specialists in a hospital setting may also include oral and maxillofacial surgeons, dental anesthesiologists, oral pathologists, radiologists, oral medicine specialists, and maxillofacial prosthodontists. My favorite part of being a general dentist in a hospital is practicing aspects of all of these disciplines. Opportunity to articulate and execute an intricate expertise from prove oral health and systemic health and a team based context, is what makes me excited to be in dentistry.
