Introduction

First, Do No Harm

First, do no harm. This directive is central to providing health care and is a part of the Hippocratic oath. This issue of the Journal of the California Dental Association is dedicated to the management of the types of patients to whom, inadvertently, it may be possible to do more harm than good. This group of patients is commonly referred to as medically compromised or, more appropriately, medically complex.

The obvious and essential first step in ascertaining whether a patient is medically complex is to take a good medical history and follow it up with an interview. The opening article by my colleagues and I provides a revised, updated, and complete health history. We also provide an interview sheet that is formatted to ensure that the most important health history questions are properly asked and that the patient fully understands the health history questionnaire. The questionnaire has also been translated into 10 languages, which make up 95 percent of the languages, other than English, spoken by Californians. The use of a translated questionnaire ensures that the questions are properly understood. As importantly, it documents that dental practitioners and the California Dental Association are committed to the highest quality of dental care for the state’s diverse population.

This issue also contains excellent articles on specific aspects of medical complexities. Michael J. Wahl, DDS, in his article, "Demystifying Medical Complexities," looks at some of the dental mythology regarding medical management. Richard L. Wynn, PhD, has written a review of medications used for cardiovascular disease and their affect on dentistry. He provides some excellent protocols on how to safely manage patients on anti-coagulants.

Finally, because medically complex patients are, well, complex, and there is always more to be known, Lewis R. Eversole, DDS, MSD, MA, and William M. Carpenter, DDS, MS, have provided a list of resources, including the American Dental Association and National Institutes of Health, from which additional information can be obtained about specific medical problems or treatment protocols. Certainly there are some worthwhile Internet resources to bookmark for quick access.

Next month’s Journal will contain four more articles to help complete your library of information on the frequently encountered challenge of doing no harm.

Contributing Editor

Peter L. Jacobsen, PhD, DDS, is the director of oral medicine at the University of the Pacific School of Dentistry.