Textbook of Medical Dentistry Vishnu Hari Pophale
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1Textbook of Medical Dentistry: For Dental–Medical Students and Practitioners2
3Textbook of Medical Dentistry: for Dental–Medical Students and Practitioners
Hari Vishnu Pophale MBBS, DTM, DTM&H (Engl.), DCH (London) FICA (USA), FAIMS, FICP, FICG, FMSPI Hon Prof Emeritus in Clinical Medicine, Grand Medical College, Mumbai Hon Prof Emeritus in Medicine, Govt. Dental College, Mumbai Ex-Physician Supt GT & St Georges Govt. Hospitals, Mumbai Fellow Emeritus, American College of Chest Physicians (ACCP)
4Published by
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Textbook of Medical Dentistry: For Dental–Medical Students and Practitioners
© 2007, Hari Vishnu Pophale
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 editors and the publisher.
First Edition : 2007
9788180619793
Typeset at JPBMP typesetting unit
Printed and bound in India
5Dedicated to
My Beloved Son Sunil Pophale and My Inspiring Daughter Sunita Ramnathkar6
7
We are a small insignificant part of the Universe and nothing we do more or less will ultimately matter.
Are we really capable of doing anything?
Whatever is done so far, Oh Almighty God, is due to Your kindness.
And whatever shall be done in future will only be through Your kindness and mercy.8
9Preface
Teeth are the part of human body and are governed by all the biological processes and anatomical connections existing in the body. Moreover, they are situated and well protected in the buccal cavity. They initiate the digestive process by chewing the foodstuff and making it suitable for interaction with digestive enzymes in the mouth, stomach and small intestine. Nature has provided all the facilities for teeth function to accomplish perfectly without any problem. Every part of oral cavity assists them in chewing from either side with the help of tongue and cheek before it is suitable to be swallowed. The salivary glands secrete saliva to moisten the morsal during the process of chewing while lips and cheeks prevent the food from coming out. The arch of the roof of the palate provides the required quantity of food to be accommodated for the processes of chewing. The swallowing process is a super-phenomena which pushes the morsal in the esophagus by temporarily closing the opening of the respiratory channel.
The teeth themselves are fixed in bone and get their blood supply and nerve supply through it. Thus anatomically, physiologically, and pathologically all the structures around affect the teeth creating the problems for practicing dentist. Moreover, systemic diseases do affect the teeth directly or indirectly along with surrounding structures of buccal cavity and provide dependable evidence for diagnosis.
Thus the purpose of keeping general medicine in the curriculum of dentistry teaching is valid and essential because without the background of general medicine, dentistry cannot be successfully practised. The practising dentist has to face emergencies connected with systemic diseases and also be vigilant about legal obligatory responsibilities answerable to Consumer Protection Court.
I remember a case of tooth extraction with continuous bleeding and diagnosed a bleeding disorder subsequently and saved the patient after giving transfusions. Thus, it becomes relevant to exclude hemorrhagic diseases, leukemia, hypertension, diabetics, etc. before submitting a patient for surgical treatment.
Again the latest and best dental material required is to be chosen having suitable mechanical and physical properties and is safe locally, and systemically to the human body at large.
The latest ideology is to save the natural tooth than to extract and cure the pathology at the earliest and mainly concentrate on prevention and by giving elaborate instructions in writing. Contact with patients inbetween the appointments surmounts the respect and enhances the faith in treating dentist and prones them more to follow the instructions given by the dentist.
An attempt is made in this book to present the essential knowledge in simple language and style, that is easy to remember. Rarities are left for references and not to overload the reader and tax his memory.
Illustrations, figures, charts and photos are supplemented to facilitate the reader to clearly visualize and remember the facts when needed.
Treatment, a part of important aspect, is dealt especially, to help prescribe the drugs specifically and properly. Only mentioning the generic names does not help actually prescribe. The drugs are mentioned along with the doses and names of the company to facilitate the chemist to dispense promptly. Awareness of contraindications and side effects makes the prescriber more confident to continue or discontinue the drug. This aspect may be considered as an important exclusive in this book which one should keep at hand to use it when needed with due confidence.
Hope the readers are satisfied to the extent expected by the author.
Hari Vishnu Phophale
10Introduction
The planning of this book starts from embryonic development covering the congenital anomalies of teeth, their applied anatomy, and physiology including the surrounding structures of buccal cavity. Then the pathological possible lesions, their investigations, interpretations of results and also preventive and therapeutic aspects. Association with systemic diseases is well illustrated.
It is essential to take required assistance of other specialists such as physician, hematologist, oncologist, surgeon, ENT specialist, plastic and orthopedic surgeons in treating the complicated dental problems.
Every individual complicated case is a book in itself and should be considered separately, precisely, thoroughly when the responsibility of active treatment is undertaken. The precision is an ideal and the top is always vacant. Still everyone should honestly opt for it.
The dimensions of dentistry are rapidly increasing and expanding globally. The public at large have become more and more conscious of the subspecialties and voluntarily approaching for their individual problems to them directly.
Following are the subspecialities commonly known (They will be ever increasing with the advancement of scientific research).
  1. Prosthodontics
  2. Endodontics
  3. Orthodontics
  4. Periodontics
  5. Implants
  6. Oral surgery
  7. Oral radiology and medicine
  8. Pedodontics.
These subspecialties are diagonally connected with systemic medicine and the reader will aptly appreciate and use it for better services to the dental patients.
Over the last few decades, progressive dentists have been active agents in the revolution of transforming the profession from being providers of “Need Dentistry “to” Want Dentistry.” The main obstacles, for the dentist is to provide “Want dentistry” to their patients, are the limits and types of services covered by traditional dental plan, which may prove as barrier to the dentist to treat their patients which they really need. Better understanding will prevail to find out the possible mid-way acceptable to both.
The minimal knowledge of systemic medicine will expand the outlook of the practising clinician and will definitely help him in diagnosing and treating the patients promptly. When other specialists to whom the patient is referred it is imperative that the referring clinician must be in a position to understand the line of treatment suggested by the specialists. This will increase his own experience and knowledge.
Interpretations of investigation reports are also important factor on the basis of which the diagnosis is arrived. Moreover, the modern investigations are needed for any particular case also depend upon the basic knowledge, which is attempted to present in this textbook.