Introduction
General Dental Practice in the Hospital
Stanley R. Surabian, DDS, JD
Copyright 2001 Journal of the California Dental Association.
This edition of the Journal of the California Dental Association
focuses on the dentist’s role in hospital practice. The four articles
reveal the complexities in managing the diagnostic and treatment considerations
of patients with special care requirements. I am pleased to have participated
as contributing editor and as a contributing author to this edition.
In 1925, the American Dental Association published the first standards for hospital dental practice. For many years, ADA accredited the Hospital Dental Services as well as individual hospital residency programs.1 General practice residency accreditation standards were instituted in 1972. In 1979, ADA became one of five corporate members of what is now called the Joint Commission on the Accreditation of Hospital Organizations. An ADA moratorium on accreditation of hospital services began on Jan. 1, 1982.2 The ADA Commission on Dental Accreditation accredits dental schools and advanced education in general dentistry, GPR, and recognized dental specialty programs.
Several dental schools provide undergraduate dental student exposure to patients requiring special care; yet, a curriculum that includes special care dentistry is normally reserved for advanced postgraduate education programs including the GPR, which must be hospital-based, and the AEGD, which is most frequently based in a dental school. While most AEGD programs have a special care component, some also offer a hospital operating room experience. The number of programs available is deficient. From 1972 to 1990, the number of programs increased by 57 percent (118 programs), and the number of positions increased by 131 percent (1,367 positions). The unmet demand for these graduate general dental programs was estimated to be approximately 300 positions.3 As of Jan. 1, 2000, GPR and AEGD programs incorporate concepts of competency-based education to stress the outcomes of education rather than the process.4
The American Association of Hospital Dentists, one of three organizations making up the Federation of Special Care Organizations in Dentistry, is the only organization of hospital dentists representing general dentists and specialists under one umbrella. The Federation, also sponsored by the Academy of Dentistry for Persons with Disabilities and the American Society for Geriatric Dentistry, publishes an excellent bimonthly journal titled Special Care in Dentistry. Raymond F. Zambito, DDS, EdD, MBA, secretary of the American Association of Hospital Dentists and later editor of the Journal of Hospital Dental Practice (now part of Special Care in Dentistry), in a speech presented before the American Hospital Association in 1972, took a visionary look at the development of hospital dental services that focuses success in three areas:5
* Total patient services;
* Education -- predoctoral and postdoctoral; and
* Community outreach extensions.
His vision is just as vivid and clear today as it was in 1972. Because of space limitations, I cannot list all the great pioneers and contributors who fashioned the environment that is furthered today by another generation of skilled hospital dentists. Dr. Zambito’s message is on target for future planning and is the core of what we attempt to do today.
The articles in this edition are a small attempt to cover the field. I want to acknowledge our specialty colleagues who also contribute extensively to education and practice in the hospital environment, including oral and maxillofacial surgeons, pediatric dentists, periodontists, and other specialty colleagues and supporting dental auxiliary personnel. Certainly, I also want to acknowledge the tremendous support received from our physician, nursing, and administration co-workers. More often than not, a cooperative environment exists to further patient care, education, and community outreach.
Authors Dennis Kalebjian, DDS, and Carole Murphy-Tong, DDS, in their article "A Focus on the Institutionalized Aged and Special Care Patient for Today’s Practice" review working with elderly and institutionalized patient populations. As you read through the article, the issue of access to care becomes critical. Care-facility dental evaluation and treatment is often rendered by dentists who see patients in the facility or in the dental office. Quite often treatment, based on the patient’s psychological and physiological status, requires a hospital operating room. Patients in these facilities often have complex needs and are on multiple prescribed medications. The dentist must have a knowledge base particularly appropriate in managing dental care for these individuals. The special care curriculum of GPR and AEGD programs should include dental education experience in this complex area of care.
The contributing editor authors two articles. The first is titled "Developmental Disabilities and Understanding the Needs of Patients with Mental Retardation and Down Syndrome." This article reviews the topics of developmental disabilities and application of the Americans With Disabilities Act, and then focuses on two specific diagnostic categories:
* Mental retardation and
* Down syndrome.
The second article is titled "Developmental Disabilities: Epilepsy, Cerebral Palsy, and Autism." This article focuses on three developmental disabilities, which do not have mental retardation as a diagnostic component but have critical dental and medical considerations that must be understood:
* Epilepsy;
* Cerebral Palsy; and
* Autism.
The author stresses that improving access to care is successful when barriers between patients with special needs and oral health services are removed. Increased understanding allows progress in this area. Oral Health in America: A Report of the Surgeon General, among its many recommendations, emphasizes the need to eliminate oral health disparities of people in this country.6
Authors Ronald Sani, DDS, and Richard Spencer, DDS, in their article "Integrating Hospital Dentistry into General Practice," review the clinical approach to managing patients requiring dental treatment in the operating room. The article takes the reader from assessment of the patient in the dental office to the hospital operating room, including postoperative recovery and patient discharge from the facility with scheduled follow-up and management.
Every dentist must understand the parameters of hospital treatment as practiced by our dentist colleagues who hold hospital medical staff privileges. Advanced postgraduate general dental education programs capably train future practitioners in this important area. These articles should enlighten the dental community and increase the level of understanding of hospital general dental practice. The contributing editor’s hope is that the reader will be encouraged to explore the issues raised in this edition to successfully manage care of their patients, including those with special needs.
Contributing Editor
Stanley R. Surabian, DDS, JD, is chief of dental services and program director for the general practice residency at Community Medical Centers in Fresno, Calif.
References
1. Zambito RF, The institute of hospital dental service. J Am Dent Assoc 86(5):1034-5, 1973.
2. Swanson RK, General practice residency and hospital dental service accreditation. Spec Care Dent 2(2):84-6, 1982.
3. Handelman SL, Meyerowitz C, et al, The growth of postgraduate dentistry programs. Spec Care Dent 15(1):5-10, 1995.
4. Glassman P, Meyerowitz C, Redding S, Accreditation issues in post-doctoral general dentistry programs. Spec Care Dent 19(1):15-9, 1999.
5. Zambito RF, The dentist member of the medical staff. Hospital Medical Staff, Am Hospital Assoc 2:1-8, 1973.
6. US Department of Health and Human Services, Oral Health in America: A Report of the Surgeon General. US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, Rockville, MD, 2000.
To request a printed copy of this article, please contact/ Stanley R. Surabian, DDS, JD, University Medical Center, Division of Dentistry, 445 S. Cedar Ave., Fresno, CA 93702 or at ssurabiandds@communitymedical.org
