Dentists are obligated to document and report suspected cases of abuse in all states, and dental hygienists are similarly obligated in some, but not all, states. The obligation is not to prove abuse or neglect, just to report what is suspected. Each state has different regulations on mandatory reporting for healthcare and other professionals, as well as specific reporting requirements for private citizens. It is essential that dental professionals know the potential signs and symptoms of the various types of abuse, are able to identify these, and understand the mandatory requirements for reporting in the state(s) in which they live and practice. It is by identifying, documenting and reporting abuse that victims can be protected and perpetrators prevented from continuing abusive practices and patterns.

Upon completion of this course, the clinician will be able to do the following: Define cardiovascular disease and understand its occurrence in various demographic groups, understand the need for an updated medical history and risk factors to consider when screening and counseling each patient, understand procedural precautions that need to be taken in the dental office due to a patient’s medical history, and understand the current drug therapies for cardiovascular treatment and the implications of these medications for dental office treatment - including potential side effects, drug interactions, and adverse oral drug reactions

Methamphetamines were originally derived from amphetamine. Meth can be illegally and easily synthesized, and is known by many names, including speed, crystal meth and ice. In the United States, more than 10 million people report having tried meth. Its use results in immediate effects that can be pleasurable but medically dangerous. Longer-term use results in serious and devastating medical, psychological and oral conditions, and in extreme cases can result in death. Dental professionals are in a position to help with the early identification of meth abuse and to refer patients to medical professionals for counseling and treatment. Palliative and preventive oral care and treatment, as well as counseling, should be provided, along with monitoring of the patient, and definitive care should be provided when appropriate for the individual patient.

Parafunctional activities associated with the stomatagnathic system include lip and cheek chewing, fingernail biting, and teeth clenching. Bruxism can be classified as awake or sleep bruxism. Patients with sleep bruxism are three to four times more likely to experience jaw pain and limitation of movement than people who do not experience sleep bruxism. Signs and symptoms of bruxism and parafunctional activity include hypertrophied masseter and temporalis muscles, myocitis of these same muscles, morning jaw stiffness, and sensitivity in a tooth or teeth. Additionally, migraine is associated with parafunctional activity. Dental professionals are responsible for diagnosing and managing parafunction. Patients can be managed with oral appliances of various designs.

Inflammation represents the body’s protective response to injury and tissue destruction. Its purpose is to destroy, dilute, or sequester the injurious agent and the injured tissues in order to permit healing. Inflammation can also be potentially harmful. Clinical signs of inflammation are redness due to open blood vessels, heat due to warmth of blood, swelling due to edema, pain due to stimulation of pain receptors, and loss of function due to edema. Periodontitis is the result of inflammation to the periodontium, and cytokines, or chemical mediators, are the result of inflammatory cells fighting against bacterial plaque. High amounts of these mediators can affect the body’s systems, especially the arteries and can potentially cause more harm in a patient with compromised cardiovascular health. Dental professionals should assess risk for patients with diagnosed (or undiagnosed) diseases such as diabetes, respiratory diseases, and osteoporosis and refer patients to a physician or periodontist as necessary. It is very important to evaluate and monitor oral hygiene in at risk patients. The inclusion of antimicrobials as a part of patient home care to enhance plaque control should be considered.

Dental procedures are conducted in an intraoral environment that harbors a substantial bacterial load. During procedures, in particular ultrasonic scaling and those using a high-speed handpiece, a bacterial aerosol is created that is hazardous to dental healthcare professionals and patients. Intraoral bacteria are also associated with both systemic and local infections. The use of pre-procedural mouthrinses to reduce bacterial aersols, as well as to reduce post-operative and nosocomial infections, has been widely investigated.

Upon completion of this course, the clinician will be able to do the following: Understand the range of diseases for which stem cell therapies are being investigated, be knowledgeable about the various sources of stem cells and the advantages and disadvantages of each source, understand the fundamental reasons for the effectiveness of stem cells and the meaning of tissue differentiation, and understand the basics of cryopreservation and the banking of stem cells.

Twenty-six million people in the United States are living with chronic kidney disease (CKD). As the baby boomer generation continues to mature, medical procedures extending life improve,and with pharmacology advances, this number will increase. With an increased number of patients living with CKD seeking dental treatment, will the dental healthcare provider be prepared to provide treatment to patients living with renal disease-induced anemia, and with secondary hyperparathyroidism and its effects on bone metabolism and the cardiovascular system? Many providers are familiar with providing palliative treatment for xerostomia, but how do you recommend palliative treatment for someone who is on strict fluid and dietary restrictions, such as patients living with end stage renal disease? Diabetes and hypertension are the two greatest causes of kidney disease. Dental providers should be knowledgeable about the different stages of renal disease and different treatments associated with this condition, and be prepared to address oral complications of renal disease. The dental healthcare provider must become more familiar with the impact of periodontal disease on renal disease, specific medical challenges and become proficient in collaborating with medical healthcare providers to provide dental treatment to these patients.

Dental professionals commonly review health histories listing medications that identify patients with a diagnosis of acid reflux. Most often, a specialized physician known as a gastroenterologist treats this condition. However, there are dental manifestations, so it is important that dental professionals identify these patients and recommend appropriate dental therapies to protect the long-term health of the dentition. Furthermore, dental professionals have the opportunity to recognize this condition in untreated patients and may need to refer those patients to a physician for further evaluation.