www.pdflobby.com www.pdflobby.com Medical Problems in Dentistry www.pdflobby.com Commissioning Editor: Alison Taylor Development Editor: Clive Hewat Project Manager: Hemamalini Rajendrababu/Bryan Potter Designer: Charles Gray Illustration Manager: Merlyn Harvey Illustrator: Antbits www.pdflobby.com Medical Problems in Dentistry 6th EDITION Professor Crispian Scully CBE MD, PhD, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed (HC), Dr HC Professor of Special Care Dentistry, UCL – Eastman Dental Institute, London, UK Professor of Oral Medicine, Pathology and Microbiology, University of London, UK Visiting Professor at Universities of Edinburgh, Granada, Helsinki, Middlesex and West of England; Honorary Consultant at University College Hospitals, London, UK; Great Ormond Street Hospital, London; St Savvas Hospital, Athens, Greece, and European Institute for Oncology, Milan, Italy EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2010 www.pdflobby.com Sixth Edition © 2010, Elsevier Limited All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: healthpermissions@elsevier.com You may also complete your request online via the Elsevier website at http://www elsevier.com/permissions ISBN 9780702030574 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notice Knowledge and best practice in this field are constantly changing As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book The Publisher Printed in China www.pdflobby.com PREFACE The aim of this book is to provide a basis for the understanding of how general medical and surgical conditions influence oral health and oral healthcare It is particularly relevant to dental professionals and other persons working in the oral healthcare sciences The reader should thus be able to understand relevant illness identified from the history, physical examination, and investigations; be able to present a succinct and, where appropriate, unified list of all problems that could influence oral healthcare; and formulate a diagnosis/treatment plan for each problem (appropriate to the level of training) The reader should also be able to communicate appropriately with other healthcare providers; to retrieve medical information using the recommended further reading sections and computer, in a manner that reflects understanding of medical language, terminology, and the relationship among medical terms and concepts; to refine search strategies to improve relevance and completeness of retrieved items; and to identify and acquire full-text electronic documents available from the internet sites quoted Though dentistry remains largely a technical subject, there are a number of reasons why dental professionals should have this basis to their education and training Dentistry is a profession and not a trade; medical problems can influence oral health and healthcare, whilst oral health and healthcare can influence general health and healthcare; dental professionals need to understand patients and their attitudes to healthcare; they need to communicate at a reasonable level with other health professionals and with patients and sometimes the media; dental professionals may need to act as advocates for patients; and, finally, dental professionals themselves can find themselves in need of healthcare Since the first edition of this book, the importance of medicine in dentistry, interactions between medicine and dentistry, and the need for medical knowledge by the whole dental team have all radically increased – as has the whole of medicine The knowledge base of medicine has been extended and effective new technologies, techniques and drugs have been developed, many of which have resulted in complications relevant to oral healthcare Many patients who would in earlier times have succumbed, are alive and live to much greater ages, thanks to advances such as public health improvements, transplants, pacemakers, radiotherapy and/or potent drugs – and they need good oral health and may well need oral healthcare A wider range of medical problems has thus become relevant to oral healthcare sciences The world has changed further and the relevance of the book has grown even more, with an increasing number of persons who require special care, and with increasing travel, not least by dental staff and trainees to developing countries An ever increasing number of medical conditions also appear to be influenced by dental health and healthcare: the range of conditions possibly linked to periodontal disease (preeclampsia; pre-term and low birthweight babies; endometrio sis; ischaemic heart disease; cerebrovascular disease; aspiration pneumonia; diabetes mellitus; metabolic syndrome; chronic kidney disease; osteoporosis; Alzheimer disease; pancreatic cancer; and even oral cancer) is a prime example In general terms, dental professionals need to develop strategies to identify patients at risk of medical problems, to assess the severity of those risks and, where necessary, recognize the need for help and be able to seek advice from a colleague with special competence in the relevant fields This text has become one of the most widely used sources of information for all dental staff who need to contend with the increasing variety of medical problems, particularly as they are aware that they face a growing risk of litigation if they not keep themselves familiar with current knowledge, in line with the increasing acceptance of the need for continuing professional education and development The management of patients with these various diseases should take into consideration the severity of the condition; the type of operative procedure envisioned, and in particular the amount of trauma, likely distress and time taken; other risk factors; and the healthcare setting (skills/facilities) available Issues of access and informed consent, and the desirability of preventive oral healthcare and avoidance of harm, apply to virtually all situations The comments and recommendations herein should be used as guidelines to care, not commandments Unfortunately, there are very few randomized controlled trials available to provide evidence for the various practices, and so many of the recommendations have to be based on consensus Since the fifth edition, my co-author for 25 years, Professor Rod Cawson, has sadly passed away Nevertheless, the fact that this text had become a best-seller and prize-winner, and has provided probably the most comprehensive coverage available worldwide, stimulated me into renewed efforts to keep it abreast of the understanding of diseases and developments in medical and surgical care relevant to the oral healthcare sciences I have updated and re-organized the whole text Key points have been added in relation to the most important medical conditions, and the focus on dentally relevant and changing areas has been increased Much of the material is presented alphabetically in order to enhance access This edition is, therefore, essentially a complete re-write and the opportunity has been used to remove the arrows inserted in the previous editions This edition now also includes, for the first time, a number of disorders not previously included, plus alternative and complementary medicine, health promotion, men’s issues and occupational issues Included in a number of new areas are autoinflammatory disorders, biological response modifiers, cosmetic procedures, craniofacial transplantation, drug reactions, drug-resistant microbial infections (nosocomial infections, tuberculosis and HIV), IgG4-related plasmacytic disease, osteomyelitis, osteonecrosis, immune reconstitution syndrome and transgender issues New illustrations have also been added, as well as selected recent references and up-to-date Internet websites Eponymous conditions appear in a separate chapter National and even v www.pdflobby.com PREFACE international guidelines that have been beginning to appear have been included where considered relevant In an effort to keep the size manageable, and the publisher happy, I have removed some of the less relevant material One of the major differences between most textbooks and original articles is that the latter are peer-reviewed In an effort to try to enhance the quality of this edition, I have therefore sought peer review from an Advisory Board constituted from a group of specialist colleagues from the UK, who have scrutinized the material relevant to their particular areas of interest, to try to ensure that only accurate and contemporary material has been included, that there are no obvious deficits and that the latest advances have been incorporated Nevertheless, any errors that might remain are mine, and readers should always check the most recent guidelines, drug doses, and potential reactions and interactions before use, discuss management issues with the patient, and never proceed with any intervention without the clear formal informed consent of the patient and consultation with their healthcare advisers This book has never purported to be a comprehensive textbook, particularly of oral physiology or oral medicine and pathology, though a considerable amount of relevant material is discussed herein The content provided is for information and educational purposes only: in no way should it be considered as a substitute for medical consultation with a qualified professional A physician should always be consulted for any health problem or medical condition Commonly used acronyms such as BP (blood pressure), ECG (electrocardiogram), ESR (erythrocyte sedimentation rate); FBP (full blood picture), LA (local anaesthesia), GA (general anaesthesia), IHD (ischaemic heart disease), NSAIDS (nonsteroidal anti-inflammatory drugs), CNS (central nervous system), CT (computed tomography), MRI (magnetic resonance imaging) and TMJ (temporomandibular joint) are not given full explanation on each occasion they appear Clinicians are advised always to consult the latest guidelines from bodies such as the National Institute for Health and Clinical Excellence (NICE), the Royal Colleges of Surgeons, the Royal Colleges of Physicians, the British Dental Association (BDA), the General Dental Council (GDC), the Resuscitation Council and those of the various specialist medical and dental societies or associations The increasing spectre of litigation increasingly influences decisions and, although in some instances guidelines may have not led to clarity, clinicians may find their decisions difficult to defend if they fail to record very good reason for not adhering to the guidelines Further information can be found on the Internet (all sites were verified August 2009 and many have been used to source material), or in recent texts, such as: • http://health.nih.gov/ • http://www.nlm.nih.gov/medlineplus/medlineplus.html • http://www.mayoclinic.com/health/diseases/index • http://www.cochrane.org vi • • • • • • • • http://emedicine.medscape.com http://www.rcseng.ac.uk/fds http://en.wikipedia.org/wiki/ http://www.dh.gov.uk/ http://www.cancerbackup.org.uk/Home http://www.sign.ac.uk/index.html http://www.library.nhs.uk/default.aspx Oral and Maxillofacial Diseases (Scully C, Flint SF, Porter SR, Moos K, 2010 Dunitz, Taylor & Francis, London) I am especially grateful to the Editorial Advisory Board for their advice on this edition, and to Dr Athanasios Kalantzis for his helpful suggestions on the previous edition Drs Oslei Paes de Almeida, Jose Vicente Bagan, Pedro diz Dios, and Andy Wolff have, through various discussions, been helpful I am also grateful to Dr David Croser, Dr Francesco D’Aiuto, Mrs Lesley Derry, Dr Janice Fiske, Professor Stephen Flint, Professor Mark Griffiths, Dr Anne Hegarty, Dr Stephen Henderson, Dr Kevin Johnston, Mr David Koppel, Dr Samintharaj Kumar, Professor Kursheed Moos, Professor Jonathan Sandy and Dr Rosie Shotts for other helpful comments, and to John Evans for assistance I am, as always, grateful to Dental Protection for guidance I am grateful to Professor Peter Simpson (Royal College of Anaesthetists) and the late Professor John Lowry (Standing Dental Advisory Committee) for their permission to reproduce the SDAC Executive Summary on Conscious Sedation; to the Health and Safety Executive for permission to use material from their website on latex allergy; to Dr Christine Randall for material on endocarditis prophylaxis; and to C Kurt-Gabel, L Taylor & Dr C Howard, Directors of A to E Training & Solutions Ltd, for their help and advice on the management of medical emergencies (the treatment algorithms, reproduced with their permission, were developed as part of the A to E Medical Emergencies in Dental Practice course [info@ atoetraininigandsolutions.co.uk]) Dr Mike Rubens, Ms Lesley Garlick, Professor Rodney Grahame, Dr Navdeep Kumar, Dr Mohamed El-Maaytah, Professor Stephen Flint, Professor Stephen Porter, Professor John Langdon and Professor Jonathan Shepherd have kindly helped with some of the illustrations Any comments or criticisms from readers will of course be gratefully received, though I hope that the further significant improvements in this edition, together with the dearth of criticism of previous editions, means that I have fulfilled the aims as best I can As Rod Cawson said in the preface to one of his other books: “Some people will criticize this for being too brief, some for being too long but, sad as it may be, this is the best I can do” Crispian Scully London 2010 www.pdflobby.com CONTENTS SECTION A: GENERAL 1 Medical emergencies 24 Trauma and burns 552 SECTION D: OTHER HEALTH ISSUES 567 Medical history and risk assessment 19 25 Age and gender issues 569 Perioperative care 45 26 Alternative and complementary medicine 591 Signs and symptoms 74 27 Dietary factors and health and disease 597 SECTION B: ORGAN SYSTEMS MEDICINE 97 28 Impairment and Disability 613 Cardiovascular medicine 99 29 Materials and drugs 625 Endocrinology 133 30 Minority groups 642 Gastrointestinal and pancreatic disorders 162 31 Occupational hazards 649 Haematology 177 32 Sexual health 660 Hepatology 234 33 Sports, travel and leisure, pets 668 10 Mental health 253 34 Substance dependence 680 11 Mucosal, oral and cutaneous disorders 281 35 Transplantation and tissue regeneration 704 12 Nephrology 296 SECTION E: APPENDIX 715 13 Neurology 305 36 Health promotion 717 14 Otorhinolaryngology 353 37 Eponymous and acronymous diseases and signs 720 15 Respiratory medicine 363 16 Rheumatology and orthopaedics 383 Index 727 SECTION C: OTHER SYSTEMS MEDICINE 409 17 Allergies 411 18 Autoimmune disease 425 19 Immunity, inflammatory disorders, immunosuppressive and anti-inflammatory agents 439 20 Immunodeficiencies 451 21 Infections and infestations 475 22 Malignant disease 517 23 Metabolic disorders 539 vii www.pdflobby.com This page intentionally left blank www.pdflobby.com EDITORIAL ADVISORY BOARD Professor Steve Bain Professor of Medicine (Diabetes), Swansea University & ABM University NHS Trust, Swansea, Wales Endocrinology, Nephrology Dr David Croser Dento-legal Adviser, Dental Protection Ltd, London, UK Medical History and Risk Assessment Professor Duncan Empey Foundation Professor and Dean, Bedfordshire and Hertfordshire Postgraduate Medical School, University of Hertfordshire, Hatfield, UK Respiratory Medicine Dr Charlotte Feinman Senior Lecturer, UCL Eastman Dental Institute, London, UK Mental Health Dr Paul L.F Giangrande Director, Oxford Haemophilia & Thrombosis Centre, Churchill Hospital, Oxford, UK Haematology Professor Michael Gleeson Professor of Otolaryngology and Skull Base Surgery, The National Hospital for Neurology & Neurosurgery, Guy’s, Kings & St Thomas’ Hospitals, Great Ormond Street Hospital for Sick Children, London, UK Otorhinolaryngology Professor Rodney Grahame Consultant Rheumatologist, University College Hospital; Honorary Consultant in Paediatric Rheumatology, Great Ormond Street Hospital for Children; Honorary Professor at University College London in the Department of Medicine Centre for Rheumatology, University College Hospital, London, UK Rheumatology Dr Robin Graham-Brown Director of Services for Older People; Consultant Dermatologist University Hospitals of Leicester, Leicester, UK Mucosal, cutaneous and mucocutaneous Professor Michael Hanna Consultant Neurologist, National Hospital for Neurology and Neurosurgery, UCLH, Queen Square, London, and Director MRC Centre for Neuromuscular Disease, Institute of Neurology, UCL, London, UK Neurology Dr Stuart Harris Consultant Cardiologist and Electrophysiologist, The Essex Cardiothoracic Centre, Basildon and Thurrock NHS Trust, UK Cardiovascular Medicine Dr Anne Hegarty Specialist Registrar Oral Medicine, Eastman Dental Hospital, UCLH Foundation Trust, London, UK Medical History and Risk Assessment Dr Stephen Henderson Dento-legal Adviser, Dental Protection Ltd, London, UK Medical History and Risk Assessment Dr Tim Hodgson Consultant in Oral Medicine, Eastman Dental Hospital, UCLH Foundation Trust, London, UK Emergencies Dr Athanasios Kalantzis Specialist Registrar, Oral and Maxillofacial Surgery Unit, The John Radcliffe Hospital, Oxford, UK Perioperative Care Professor John Langdon Emeritus Professor of Maxillofacial Surgery, King’s College London, UK Trauma Professor Neil McIntyre Emeritus Professor, Royal Free and University College Medical School, London, UK Hepatology Dr Christopher M Nutting Consultant and Senior Lecturer in Clinical Oncology, Royal Marsden Hospital, London, UK Malignant Disease Dr Rosie Shotts General Medical Practitioner, Chesham, Bucks, UK Age and Gender Issues Dr Philip Welsby University Teaching Fellow, Consultant in Infectious Diseases (retired), Regional Infectious Disease Unit, Western General Hospital, Edinburgh, UK Immunodeficiencies, Infections ix ... in dentistry, interactions between medicine and dentistry, and the need for medical knowledge by the whole dental team have all radically increased – as has the whole of medicine The knowledge... sedation is used, when there are invasive or painful procedures, or when medically complex individuals are being treated ‘Forewarned is forearmed’, and dental practitioners must ensure that medical. .. management MEDICAL HISTORY AND RISK ASSESSMENT Risks increased by Risks reduced by Increasing age Planned treatment Medical treatments Non-invasive procedures Surgical treatments Monitoring Lengthy