Dental Medicine: Exploring the Health Dimension

Public Health

Dr Randhir Seewoodharry Buguth

Pierre Fauchard (1679-1761), a French physician, is credited as the ‘father of modern dentistry.’ His groundbreaking book detailed oral anatomy, pathology symptoms, operative methods for decay treatment, orthodontics, tooth transplantation, and more. Fauchard was remarkably ahead of his time.

The first dental surgery college opened in Baltimore, USA, in 1840, founded by Horace H. Hayden (1769-1844) and Chaplin Harris (1806-1860). This marked a departure from traditional barber-surgeon practices. In Europe, the initial dental school opened in London in 1859, followed by Paris in 1879.

Today, the journey to becoming a dental practitioner involves a 5- to 6-year full-time course with stringent academic requirements. Prospective students must excel in sciences and mathematics, and admission to well-established universities is highly competitive and expensive.

Dental practitioners require an in-depth knowledge of psychology, as many patients experience pain and dentophobia. The medical procedure starts with a comprehensive medical and dental history, extra and intra-oral examinations, and mandatory oral cancer screenings in the UK. X-rays and, occasionally, blood tests may also be necessary.

Following these initial steps, treatment plans, options, consent, costs, and prognosis are explained to patients. Thorough documentation is crucial for medico-legal purposes. It is essential to ensure the patient’s mental capacity to comprehend the treatment.

A fully qualified, competent, and experienced dental surgeon needs precise manual dexterity, knowledge of human anatomy, physiology, pathology, and pharmacology. Communication skills, analytical and critical skills, along with empathy, probity, and ethics, are paramount to achieve the gold standard.

While prescribing medications related to dental surgery, all medical details of patients need to be checked to avoid allergies, drug interactions, and side effects. Dosage, strength, frequency, and duration of medications must be clearly written on the prescription.

Maintaining a delicate balance between the medical and business aspects of dentistry is crucial. Patients should be treated with kindness, respect, compassion, and dignity, free from judgment. Although practitioners have no legal obligation for results, they must leverage their knowledge, skills, experience, and the latest technology to achieve optimal outcomes.

The dental profession’s reputation can suffer from malpractices, lack of clear explanations, and working beyond one’s competency. The patient’s best interest should always take precedence, sometimes necessitating referral to a more experienced colleague or specialist. The successful management of stress and pain in a dental surgery is a practice builder through word of mouth.

In the UK’s ‘Bolam Test,’ practitioners must demonstrate adherence to a responsible body of medical opinion to avoid negligence, providing protection for the patient. Treating patients with various comorbidities and mental health issues can be very challenging, and ignoring or untreated severe dental infections may lead to life-threatening conditions like sepsis.

Returning to Mauritius after completing studies in 1987, I found that societal misconceptions about dentistry were apparent. I met a banker in Port Louis who asked me: ‘Quand to pou ouvert to l’atelier?’.

Some months later, I attended a safran (wedding eve ceremony) and while having dinner with the relatives in Chemin Grenier, a man explained to his friend that he would not go to queue up for a dental extraction at the hospital. ‘To neque ena pou fou li Rs 40.00 et li pou tire to lédent dans privé’. The tasty food did not go down very well. A complete lack of respect for the dental surgeon!

In my surgery in Curepipe, while filling the medical questionnaire, a man shouted at me: ‘Couma dire pe faire l’enquête la police!’ Little did he know that this was to prevent any mishaps affecting his general health.

An eye-opening incident worth mentioning happened in my surgery when a hospital doctor (my patient) asked me about my thoughts on sending her brilliant QEC-educated daughter to a new local dental school which closed down later. I explained the importance of infrastructure, syllabus, and the CV and experience of the professors. Her answer was, ‘Have you met any poor dentists?’ An appalling and frustrating response where earning money was prioritized over medical training, exposing how materialistic society had become.

We have had dentists in parliament, and I am unsure if issues like patient complaints, illegal practice of dentistry, and delivery of substandard treatments have been adequately addressed.

Finally, we have a duty to maintain an updated list of drugs in our medical emergency kit for dental procedures: Adrenal crisis, Syncope, Cardiac pain or Stroke, Seizures, Hypoglycemia, Anaphylactic shock, and Asthma attack. It is mandatory by law to have regular CPR (cardiopulmonary resuscitation) courses for the entire dental staff. Oxygen needs to be available, and an AED (Automated External Defibrillator) can save the life of a patient with cardiac arrest.

Mauritius Times ePaper Friday 2 February 2024