The Management of Dental Problems Presenting to an Accident and Emergency Department

Oral cancer teaching of medical students in the UK: time for a new approach?

Many patients with oral lesions present to general medical practitioners (GMPs). GMPs are also more likely to see patients with higher oral cancer risk. Therefore, GMPs play an important role in the early detection and prevention of oral cancer but is this reflected in undergraduate medical teaching. A questionnaire regarding oral cancer teaching was delivered to the curriculum directors of all UK medical schools. A response rate of 66% was achieved. There was wide variation in teaching time, teaching methods employed, and specialties involved. Sixty percent of schools provided clinical examination of patients with oral lesions. Up to 55% of medical schools included oral cancer in student assessment. There is wide variation in oral cancer teaching in UK medical schools. There is a need to develop a curriculum that addresses the important aspects of oral cancer from an evidence-based consensus approach.

The role of non-dental health professionals in providing access to dental care for low-income and minority patients

The disadvantaged suffer disproportionately from dental problems. These persons are more likely to have untreated oral health problems and associated pain, and also are more likely to forego dental treatment even when in pain. There has been increased emphasis on the potential role of physicians in alleviating oral health disparities, especially among children. In addition, many adults lacking access to traditional dental services seek care and consultation from hospital emergency departments, physicians, and pharmacists. The delivery of oral health care services by non-dental health professionals may assume increasing importance as the population continues to age and becomes more diverse. This is because, in general, the elderly and ethnic and racial minorities face significant economic barriers to accessing private dental services.

Low-income and minority patient satisfaction with visits to emergency departments and physician offices for dental problems

OBJECTIVES

Individuals lacking access to dentists may use hospital emergency departments (EDs) or physicians (MDs) for the management of their dental problems. This study examined visits by minority and low-income individuals to physicians and hospital emergency departments for the treatment of dental problems with the goal of exploring the nature of treatment provided and patient satisfaction with the care received.

METHODS

Eight focus group sessions were conducted with 53 participants drawn from low-income White, Black, and Hispanic adults who had experienced a dental problem and who had sought MD/ED care at least once during the previous 12 months.

RESULTS

Toothache pain or more generalized jaw/face pain was the most frequent oral problem resulting in MD/ED visits. Pain severity was the principle reason for seeking care from MDs/EDs, with financial barriers most often mentioned as the reason for not seeking care from dentists. Expectations of MD/ED visits were generally consistent with care received; most participants limited their expectations to the provision of antibiotics or pain medication. Nearly all of the participants thought they would eventually need to see a dentist for resolution of their dental problem.

CONCLUSIONS

Poor/minority individuals seek relief from oral pain through MDs/ EDs while recognizing that such care is not definitive.

Dental knowledge of accident and emergency senior house officers

OBJECTIVES

To determine the dental knowledge of accident and emergency (A&E) senior house officers (SHOs).

METHOD

A telephone survey of A&E departments in England with more than 30 000 new attendances per year was conducted between November 1998 and July 1999. The questionnaire covered basic dental knowledge as well as scenarios of some common dental problems encountered in the A&E department.

RESULTS

Most SHOs in this study saw between one and five dental problems each week. Of the 102 SHOs in this survey, 52% had no previous training in examination of the mouth. Only 52% knew the approximate date of eruption of a permanent upper central incisor. In the treatment of post-extraction bleeding, 36% knew the first line of treatment. When presented with a scenario of a patient with a dental infection, only 29% gave the optimal empirical treatment.

CONCLUSIONS

There is a need for better dental education among medical personnel. Guidelines or algorithms for the management of some common dental problems would also be useful as well as standard written advice sheets for patients with dental problems.