ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00759.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00760.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00761.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A volunteer patient was examined by five dentists experienced in caring for geriatric patients. The patient and dentist interaction was videotaped and reviewed to evaluate a previously generated hypothesis regarding the diagnosis process. This descriptive study suggests that dentists experienced in geriatric care did assess and evaluate a wide range of patient characteristics. However, they did not follow the previously hypothesized process in arriving at an appropriate treatment plan. Instead, they relied heavily on past experiences with similar situations. The possible implications of this process for treatment planning and teaching of geriatric dentistry are discussed.

ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00762.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Although various studies have attempted to evaluate the success of general practice residency (GPR) programs in providing postdoctoral training, little work has investigated the motivation for senior dental students opting for such training compared with entering directly into private practice. Questionnaires were administered to 58 seniors at the State University of New York at Buffalo School of Dental Medicine 1 month before graduation to determine possible differences between those entering GPR programs and those planning to enter private practice. The survey also examined the goals of dentists about to enter GPR programs and compared them with the training goals determined by the Commission on Dental Accreditation.Although 75% of those entering GPR programs cited additional clinical experience as the reason for choosing this step in their careers, the most frequent response from those entering directly into private practice concerned the financial benefits. Also, of the respondents about to enter GPR programs, only one student indicated a desire for training in hospital dentistry.Although this survey was relatively limited in size, it appears that advanced instruction in the management of patients with complex health care problems is not one of the primary motivating factors for students considering residencies. This may indicate a need at the pre doctoral level for greater instruction in changing health care demographics and in the training goals of general practice residencies, to continue to attract qualified dental graduates with goals compatible with those of GPR programs.

ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00763.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Factitious illness can be a problem for disabled patients who experience recurrent trauma or irritation to a particular part of the body. In this case, the patient's recurring lip trauma combined with his overlying physical disability presented a problem not easily solved with prior methods of treating lip trauma. Modifying the standard orthodontic appliance solved the problem; after a short period of use, the patient dropped the harmful habit that caused the lip trauma. The appliance was no longer needed.

ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00764.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Foods or medicines can be pouched or held in the mouth to prolong taste, enjoyment, or effect. This article describes a patient who pouches medications. The oral injury that occurred from this behavior is reported.SummaryIn this report, an institutionalized 44‐year‐old female who was developmentally disabled with sloughing of oral tissue and ulcer formation in the mandibular buccal vestibules visited the dental clinic. Toothbrush trauma to the oral tissues was suspected initially and was ruled out. On the empirical recommendations of an oral pathologist who examined the patient, ketoconazole was prescribed by the patient's physician. This treatment was not effective. After medication pouching was suspected, simethicone was changed from chewable tablets to a liquid. The patient's caretakers and nurses observed the patient after medications were administered to be sure that the patient was not holding medication in her mouth.Although tissue sloughing was resolved, ulcerations of the tissue persisted in the mandibular mucobuccal fold. A biopsy of these ulcerated areas was not diagnostic for any suspected pathosis. Five months after her initial visit, the patient showed no signs of ulceration or desquamation of her oral tissues. Thus, changing simethicone chew‐able tablets to a liquid, the increased efforts of the direct care staff members and nurses to prevent the patient from holding medications in her mouth, and the gradual improvement of the patient's oral condition confirmed the provisional diagnosis of pouching medications.Medication pouching may not be a unique habit limited to patients in institutions for the mentally handicapped. It is a problem observed in some geriatric patients in long‐term facilities or nursing homes, as well (J. Thomas, director of geriatric dentistry, Veterans Administration Medical Center, personal communication, 1990). Several recommendations should be followed to prevent this habit and the injury that may occur:1. Patients who have difficulty swallowing tablets or capsules may be given liquid medications.2. Medications that can be crushed without adversely affecting the drug's absorption in the gastrointestinal tract can be administered in applesauce or another pleasant tasting food. Mitchell22has reported on several medications that should not be crushed.3. Fluids should be given to facilitate swallowing.4. After medications are given, inspect the mouth for any remaining portions.One problem dental professionals may encounter when treating patients with mental retardation or impairment is the difficulty in determining the causes that would be helpful in correctly diagnosing certain oral problems. This difficulty results from the reduced capability for communication between the doctor and patient and from the doctor's lack of awareness of unique habits found among these patients. When examining patients of this type, medication pouching should be included as a possible causative factor in the differential diagnosis of oral ulcerative

ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00765.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0275-1879    

DOI:10.1111/j.1754-4505.1990.tb00766.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY