www.pdflobby.com A Practical Guide to Hospital Dentistry www.pdflobby.com A Practical Guide to Hospital Dentistry K George Varghese Vice Principal Professor and Head Dept of Oral and Maxillofacial Surgery Govt.Dental College, Kottayam, Kerala ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Ahmedabad • Bengaluru • Chennai • Hyderabad • Kochi Kolkata • Lucknow • Mumbai • Nagpur www.pdflobby.com Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd B-3 EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Rel: 32558559 Fax: +91-11-23276490, +91-11-23245683 e-mail: jaypee@jaypeebrothers.com, Visit our website: www.jaypeebrothers.com Branches ❒ 2/B, Akruti Society, Jodhpur Gam Road Satellite Ahmedabad 380 015, Phones: +91-079-26926233, Rel: +91-079-32988717 Fax: +91-079-26927094 e-mail: ahmedabad@jaypeebrothers.com ❒ 202 Batavia Chambers, Kumara Krupa Road, Kumara Park East 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Phones: +91-522-3040553, +91-522-3040554 e-mail: lucknow@jaypeebrothers.com ❒ 106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, Parel Mumbai 400 012, Phones: +91-22-24124863, +91-22-24104532, Rel: +91-22-32926896 Fax: +91-22-24160828 e-mail: mumbai@jaypeebrothers.com ❒ “KAMALPUSHPA” 38, Reshimbag, Opp Mohota Science College, Umred Road Nagpur 440 009 (MS), Phones: Rel: 3245220, Fax: 0712-2704275 e-mail: nagpur@jaypeebrothers.com A Practical Guide to Hospital Dentistry © 2008, K George Varghese All rights reserved No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher This book has been published in good faith that the material provided by author is original Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s) In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only First Edition: 2008 ISBN 978-81-8448-243-0 Typeset at Printed at JPBMP typesetting unit Gopsons Paper Ltd A-14, Sector 60, Noida www.pdflobby.com Dedicated to the loving memory of my beloved parents Prof KV Varghese and Mrs Rosakutty Varghese www.pdflobby.com Contributors K George Varghese MDS, DSS (Vienna) Selliamma Kuruvilla MSc Professor and Head Department of Oral and Maxillofacial Surgery Govt.Dental College, Kottayam, Kerala Chapters 1, 2, 3, 4, 6,10,11, 14,16,17 Associate Professor College of Nursing, Kottayam Chapter George Philip MDS, FDSRCS, FFDRCS Senior Lecturer Department of Oral and Maxillofacial Surgery Govt Dental College, Kottayam, Kerala Chapter Professor and Head Department of Anaesthesia Govt Medical College Kottayam, Kerala Chapter 12 TR Sreedevi R Dayananda Babu MSc MS, MNAMS Former Professor and Head Department of Surgery, Govt Medical College, Thrissur, Kottayam and Co-operative Medical College Pariyaram, Kerala Chapters 13, 15 Associate Professor College of Nursing Kottayam, Kerala Chapter Sajeesh Kuriakose MDS, FFDRCS Head Division of Oral and Maxillofacial Surgery PVS Hospital, Kochi Chapter R Sajith Kumar Susamma Andrews MD MD Chief Infectious Diseases Govt.Medical College, Kottayam, Kerala Chapter Tomy Mappalakayil MD Assistant Professor Department of Forensic Medicine, Govt.Medical College, Kottayam, Kerala Chapter 17 George F Moolayil, DCH, PGDMLE National Law School of India, Bangalore Pediatrician and Consultant in Medical Law Chapters 18, 19 www.pdflobby.com Foreword Dentistry in general and maxillofacial surgery in particular has seen an unprecedented advancement by leaps and bounds during the past decade Dental and maxillofacial surgery has become an inevitable part of the Trauma, Head and Neck and Aesthetic Surgery teams Dentistry is keeping pace with the fast track progress technology is making Dental surgeons who work in a hospital set up need to update their knowledge on in-patient management Dr George Varghese, a renowned maxillofacial surgeon and a teacher with repute for the past two decades and more, working in close quarters with Plastic, ENT, Neuro and general surgeons is the apt person to pen this book, ‘A Practical Guide to Hospital Dentistry’ I am sure this book will be helpful for house-surgeons, post-graduate students and general dental surgeons who work in hospitals This is a reference book not only to dental surgeons but to other specialists as well One of the first of its kind, I am sure, this will be a hotly sought after practical guide Varghese Mani Oral and Maxillofacial Surgeon Principal Mar Baselios Dental College Kothamangalam, Kerala, India www.pdflobby.com Preface During the past two decades the hospital environment, needs and expectations of the society as well as the medical profession have made a quantum leap In the past, with minimal personnel and material support the hospital dentist cared for patients in primitive ambulatory care facilities and operating rooms Their work was mainly restricted to management of acute infections and dentoalveolar trauma The advances made in modern diagnostic and therapeutic dentistry as well as in maxillofacial surgery has widened the scope of hospital dental practice And at the same time it has increased the duties and responsibilities of the dentists working in hospitals This book is intended mainly for postgraduate students, fresh graduates and students who are about to start or continue their training in the hospital environment and also for the general dentists who are members of the hospital dental department or serve as part time consultants in hospitals This book also will be a guide to the administrators to establish and direct the dental department in an efficient manner consistent with the needs of the hospital, the profession and the society Even though certain books are available on hospital dental practice, they are published from western countries which are written to suit to their existing needs and requirements K George Varghese www.pdflobby.com Acknowledgements At the outset we thank the God Almighty, who has made our dream of writing this book a reality Nothing is possible without his blessings I acknowledge with great respect my post graduate teacher Dr PI John, Former Professor and Head of the Department of Oral and Maxillofacial Surgery, Government Dental College, Thiruvananthapuram for teaching the basics of maxillofacial surgery and who inducted me into the speciality I am indebted to Dr VK Kuriakose (late) whom I consider as my mentor Under his guidance I started my career as a maxillofacial surgeon My sincere thanks to Dr Varghese Mani, Principal, Mar Baselios Dental College, Kothamangalam who blessed me with a befitting foreword for this book I would like to express my deep appreciation to all contributors, whose untiring efforts have made this possible I am grateful to Dr B Ekbal, former Vice-Chancellor, University of Kerala and former Professor of Neuro Surgery, Medical College, Kottayam for necessary guidance in writing the section on “Management of Head Injury” I would like to thank Dr George Paul, Oral and Maxillofacial Surgeon, for permitting me to adapt the section “Dental / Oral and Maxillofacial Surgeon as Expert Witness” My special thanks to my wife Alice for her constant support and encouragement to accomplish this endeavor I am also grateful to Jaypee Brothers Medical Publishers (P) Ltd Delhi, who encouraged me to write this book and for publishing it www.pdflobby.com Contents Organization of Dental Department Admission and Medical Record Casualty Service The Medically Compromised Patient 26 Management of Odontogenic Infections 58 Common Medical and Nursing Procedures 72 Conscious Sedation 92 Infection Control in Dental Practice 111 Preoperative Preparations 127 10 Operation Theater Setup and Aseptic Procedures 139 11 Postoperative Management 148 12 Management of Shock in Trauma 155 13 Intravenous Fluids and Postoperative Fluid Management 166 14 Transfusion of Blood and Blood Products 173 15 Surgical Site Infection 191 16 Prevention and Management of Oral Problems of Cancer Therapy 194 17 Dental Jurisprudence 213 18 Medical Negligence 225 19 Consumer Protection Act and its Relevance to Dental Practice 234 Appendices 241 Index 247 www.pdflobby.com .. .A Practical Guide to Hospital Dentistry www.pdflobby.com A Practical Guide to Hospital Dentistry K George Varghese Vice Principal Professor and Head Dept of Oral and Maxillofacial Surgery... management of medical problems during the hospital stay The availability of an experienced oral and maxillofacial surgeons in the dental department is mandatory in managing casualty and inpatients... Casualty Service K George Varghese Casualty Service in more advanced hospitals have a dental team available for dental, oral and maxillofacial emergencies As specialists most qualified to diagnose