Essentials of human disease in dentistry

Cover
Half Title Page
Essentials Series
Title Page
Copyright Page
Contents
Contributors
Preface to the first edition
Preface to the second edition
Acknowledgements
About the companion website
Chapter 1 Clinical examination and history taking
	Components of a medical history
		Presenting complaint
		History of the presenting complaint
		Past medical history
		Allergies
		Past dental history
		Drugs
		‘Recreational’ drugs
	Complementary therapies
		Implanted cardiac devices
		Social history
		Family history
		Psychiatric history
		General questions
		Cardiovascular system
		Respiratory system
		Gastrointestinal system
		Neurological system
		Musculoskeletal system
		Genitourinary system
		Clinical observations in the clothed patient
		Overall view of the patient
		Examination of the hands
		The face
		Examination of the cardiovascular system in the clothed patient
		Jugular venous pressure
		Respiratory system
		Gastrointestinal system
		Vital signs
		Specific lesions
	Summary
	Further Reading
	Multiple Choice Questions
Chapter 2 Inflammation and anti-inflammatory drugs
	Cell and tissue injury – Introduction
	Necrosis
		Coagulative necrosis
		Colliquative necrosis
		Caseous necrosis
		Fibrinoid necrosis
		Fat necrosis
		Gangrene
	Apoptosis
	Wound healing
	Inflammation – Introduction
	Pathogenesis of acute inflammation
		Sequelae of acute inflammation
		Organisation
		Suppuration
		Fibrinous inflammation
		Serous inflammation
		Ulceration
	Pathogenesis of chronic inflammation
	Primary chronic inflammation
		Persistent infection
		Foreign body reactions
		Autoimmune disease
		Granulomatous inflammation
	Systemic effects of inflammation
	Anti-inflammatory drugs
	Antihistamines
		H1 receptor antagonists
		Uses
		Unwanted effects
		Dental uses of antihistamines
	Corticosteroids
		Anti-inflammatory action of corticosteroids
		Anti-inflammatory actions of corticosteroids applicable to dentistry
	Further Reading
	Multiple Choice Questions
Chapter 3 Principles of infection and infection control
Chapter 3A Sterilisation, disinfection and antiseptics
	Sterilisation and disinfection
	General principles
	What should be sterilised?
	Decontamination and pre‐cleaning
	Sterilisation and disinfection methods
	Monitoring efficacy
	Heat
		Dry heat
		Moist heat
	Irradiation
	Filtration
	Chemicals
		Gases
	Antiseptics
		Terminology
		Skin preparations
		Antiseptic mouthwashes (antiplaque agents, plaque-inhibitory agents)
		Chlorhexidine
		Phenols
		Quaternary ammonium compounds (QACs)
Chapter 3B Principles of infection and infection control, diagnosis and treatment of bacterial infections
	Introduction
	Use of the laboratory in the diagnosis of bacterial infections
	Microscopy
		Light microscopy
		Phase contrast microscopy
		Dark ground microscopy
		Fluorescent microscopy
		Electron microscopy
	Staining techniques
		Gram stain
		Bacterial morphology
	Culture and identification
	Bacterial typing
		Antimicrobial susceptibility testing
		Disc sensitivity testing
		Minimum inhibitory concentration (MIC)
	Non-cultural diagnostic techniques
		Latex agglutination testing
		Enzyme-linked immunosorbent assay (ELISA)
		Serology
	Molecular methods
		Gene probes
		Polymerase chain reaction (PCR)
		Restriction enzyme analysis
		Pulsed-field gel electrophoresis
		DNA sequencing
	General principles of specimen collection
	Antibacterial drugs
	Antibacterials that interfere with the bacterial cell wall
		Penicillins and cephalosporins
	Antibacterials that interfere with bacterial protein synthesis
		Tetracyclines
		Erythromycin
		Clindamycin
	Antibacterials that interfere with bacterial nucleic acid
		Metronidazole
		Antimetabolic antibiotics
		Sulphonamides and trimethoprim
	Antibacterial use in dentistry
	Therapeutics
	Prophylaxis
	Unwanted effects of antibacterial drugs
Chapter 3C Viruses and antiviral agents relevant to dentistry
	Viruses relevant to dentistry
		What is a virus?
	Virus classification
	The major groups of animal viruses
		The DNA viruses
		The RNA viruses
	Diagnosis of virus infections
	Hepatitis
		Hepatitis A and E
		Hepatitis B virus (HBV)
		Hepatitis C (HCV)
		Hepatitis D
		Chronic hepatitis
	Blood-borne virus infections: prevention
	Herpes simplex virus (HSV)
		Biology and epidemiology
		Clinical presentation
		Specimen collection and laboratory diagnosis
		Treatment
	Varicella zoster virus (VZV)
		Biology and epidemiology
		Clinical presentation
		Sample collection and laboratory diagnosis
		Treatment
		Prevention
	Cytomegalovirus (CMV)
		Biology and epidemiology
		Clinical presentation
		Specimen collection and laboratory diagnosis
		Treatment
	Epstein–Barr virus (EBV)
		Biology and epidemiology
		Clinical presentation
		Specimen collection and laboratory diagnosis
		Treatment
	Enteroviruses
		Biology and clinical presentation
		Herpangina
		HFMD
		Diagnosis
		Treatment
	Mumps
		Biology and epidemiology
		Clinical presentation
		Diagnosis
		Treatment
	Adenovirus
		Biology and epidemiology
		Clinical presentation
		Laboratory diagnosis
	Treatment
		Other respiratory infections
	Antiviral agents
	Mechanism of action of antiviral medications
	Unwanted effects of antiviral agents
	Drug interactions with antiviral agents
Chapter 3D Infection with immunodeficiency virus and implications for the oral cavity:: Infection with HIV
	Introduction
	Epidemiology
	Clinical presentations
	Oral manifestations of HIV disease
	Fungal infections
		Candidiasis
		Clinical features
		Differential diagnosis
		Diagnosis
		Treatment
		Topical treatment
		Systemic treatment
		Prognostic significance
	Histoplasmosis
		Cryptococcus neoformans
	Human papillomavirus lesions
		Clinical features
		Differential diagnosis
		Prognosis
		Treatment
	Hairy leukoplakia and EBV
		Hairy leukoplakia and the progression of HIV disease
		Clinical appearance and manifestations
		Differential diagnosis
		Diagnosis
		Treatment
	Bacterial lesions
		Periodontal disease
		Differential diagnosis
		Different course in HIV infection
	Neoplastic lesions
		Kaposi’s sarcoma (KS)
		Clinical features
		Differential diagnosis
		Treatment
	Lymphoma
		Clinical features
		Differential diagnosis
		Treatment
	Other oral lesions associated with HIV disease
		Oral ulceration
		Diagnosis
		Treatment
		Idiopathic thrombocytopaenic purpura (ITP)
		Clinical features
		Differential diagnosis
		Salivary gland disease and xerostomia
		Management
	Diagnosis of HIV infection
	Principles of treatment
Chapter 3E Fungi and antifungal agents
	Fungi
	Antifungal agents
	Unwanted effects of antifungal medication
	Further Reading
	Multiple Choice Questions
Chapter 4 Immunological disease
	Introduction
	Overview of a normal immune response
	What is immunodeficiency?
	What are the consequences of immunodeficiency?
		Infection
		Autoimmunity and malignancy
	What are the symptoms and signs of immunodeficiency?
	Examples of specific primary immunodeficiencies seen in dental practice
		Common variable immunodeficiency (CVID)
		Wiskott–Aldrich syndrome (WAS)
	Chronic mucocutaneous candidiasis (CMC)
	Chronic granulomatous disease (CGD)
	Deficiency of C1 esterase inhibitor (hereditary angioedema)
	Implications of immunodeficiency in dental practice
	Common conditions can be features of immunodeficiency
	Allergy in dental practice
		Introduction
		Incidence of allergic diseases
		Allergens and irritants in dental practice
	Type I hypersensitivity (allergy)
		Pathogenesis
		Clinical features of allergic reactions
	Diagnosis of type I hypersensitivity reactions
		Laboratory investigations
		Skin prick tests
		Challenge tests
	Causes of type I hypersensitivity reactions in dental practice
		Latex allergy
	Other agents associated with type I hypersensitivity reactions in dental practice
		Chlorhexidine
		Local anaesthetics
	Treatment of type I hypersensitivity reactions
		Minor reactions
		Major reactions/anaphylaxis
	Other reactions
	Stomatitis
	Oral erythema
	Cheilitis
	Autoimmune disease
	Examples of autoimmune disease seen in dental practice
		Organ specific
		Systemic autoimmunity
	IgG4-related disease
	Immunosuppressants
	Dental problems of immunosuppressed patients
		Fungal infections
		Viral infections
		Malignancy
		Ciclosporin-induced gingival overgrowth
	Further Reading
	Multiple Choice Questions
Chapter 5 Cardiovascular disorders
Chapter 5A Introduction to cardiovascular disease (CVD)
	The heart and circulation
	Electrical control
	Cardiac circulation
	Cardiovascular pathology
	Atherosclerosis
		Definitions
		Risk factors
		Pathogenesis of atherosclerosis
		Drugs used in the prevention of atherosclerosis
		Consequences of atherosclerosis
	Aneurysms
	Thrombosis, embolism, ischaemia and infarction
		Definitions
	Thrombosis
		Arterial thrombosis
		Venous thrombosis
		Cardiac thrombosis
	Embolism
		Pulmonary embolism
		Systemic embolism
	Ischaemia and infarction
	Clinical features of CVD
		Symptoms
	Signs detectable in the clothed patient
	Cardiac investigations
	Clinical aspects of MI
	Angina
Chapter 5B Heart failure
	Introduction
	Pathophysiology
	Cardiac causes of heart failure
	Neurohormonal adaptive responses
	Exacerbating conditions
	Clinical aspects of heart failure
	Treatment of heart failure
	Drugs used to manage heart failure
Chapter 5C Cardiac arrhythmias
	Pathophysiology
	Tachycardias
	Bradycardias
	Clinical aspects of arrhythmias
	Drugs used to manage cardiac arrhythmias
	Class I: membrane-stabilising drugs
		Mechanism of action
		Impact on oral structures and dental management
		Drug interactions relevant to dental practice
	Class II: β-adrenoreceptor antagonists
		Mechanism of action
	Class III: agents influencing potassium channels
		Mechanism of action
		Impact on oral structures and denta lmanagement
		Drug interactions relevant to dental practice
	Class IV: calcium channel blockers
		Mechanism of action
	Cardiac glycosides
		Mechanism of action
		Impact on oral structures and dental management
		Drug interactions relevant to dental practice
Chapter 5D Valvular heart disease
	Introduction
	Pathology of valvular heart disease
	Rheumatic fever
	Infective endocarditis
		Prophylaxis against infective endocarditis
Chapter 5E Hypertension
	Measurement of blood pressure
	Drugs used to treat hypertension
	Diuretics and aldosterone antagonists
		Mechanism of action
		Impact on oral structures and dental management
		Drug interactions relevant to dental practice
	ACE inhibitors
		Mechanism of action
		Impact on oral structures and dental management
		Drug interactions relevant to dental practice
	Angiotensin II receptor antagonists
		Mechanism of action
		Impact on oral structures and dental management
		Drug interactions relevant to dental practice
	Calcium channel blockers
		Mechanism of action
		Impact on oral structures and dental management
		Drug interactions relevant to dental practice
	β-Adrenoreceptor antagonists
		Mechanism of action
		Impact on oral structures and dental management
		Drug interactions relevant to dental practice
	α-Adrenoreceptor blockers
		Mechanism of action
		Impact on oral structures and dental management
	Vasodilators
		Mechanism of action
		Impact on oral structures and dental management
	Centrally acting drugs
		Mechanism of action
		Impact on oral structures and dental management
	Treatment of hypertension
Chapter 5F Anticoagulants, drugs affecting blood clotting
	Heparin
	Pharmacodynamics
	Pharmacological properties
	Unwanted effects
	Oral anticoagulants
	Pharmacological properties
	Monitoring patients on oral anticoagulants
	Unwanted effects
		Dental management of patients on warfarin
	Uses of anticoagulants
	Antiplatelet drugs
	Aspirin
		Use of aspirin as an antiplatelet drug
	Clopidogrel
	Prasugrel
	Dipyridamole
	Fibrinolytic and antifibrinolytic drugs
		Fibrinolytic drugs
		Antifibrinolytic drugs
Chapter 5G Dental implications of CVD
	Hypertensive patients
	Patients post-MI
	Other aspects of management
	Smoking and the cardiovascular system
Chapter 5H Peripheral vascular and cardiac surgical disorders
	Peripheral vascular disorders
	The chronically ischaemic leg
		Management: claudication
		Management: critical ischaemia
	The acutely ischaemic leg
	Peripheral arterial aneurysms
		Complications of aneurysms
	AAAs
	Carotid disease
	Venous disease and leg ulcers
		Varicose veins
		DVT and pulmonary embolism
		DVT
		Pulmonary embolism
		Prophylaxis against DVT
		Leg ulceration
		Treatment of leg ulceration
	Swollen legs/lymphoedema
	Causes of secondary lymphoedema
	Cardiac surgical disorders
	Coronary artery bypass surgery
		Diagnosis
		Management
	Percutaneous coronary intervention (PCI)
	Coronary artery bypass grafting (CABG)
	Valvular heart disease
		Symptoms
		Aetiology and individual valve lesions
		Diagnosis
		Treatment
	Cardiac transplantation
	Congenital heart disease
		Classification
		PDA
		ASDs
		VSDs
		Coarctation of the aorta
		Truncus arteriosus
		Transposition of great vessels
		Tetralogy of Fallot
		Aetiology
		Management
	Further Reading
	Multiple Choice Questions
Chapter 6 Respiratory disorders
	Introduction
	Clinical assessment
	Symptoms
	Examination
	General medical history
	Investigating respiratory disease
	Asthma
	Drugs used to treat asthma
		Bronchodilators (‘relievers’)
		Anti-inflammatory drugs (‘preventers’)
	COPD
	Lung cancer
	Obstructive sleep apnoea syndrome (OSAS)
	Respiratory tract infections
	Cystic fibrosis and bronchiectasis
	Pulmonary embolism
	Fibrotic lung disease
	Management of inhaled foreign body
		What happens in the accident and emergency department?
	Respiratory disorders and dentistry
	Examination of the clothed patient
	Specific disorders
		Asthma
		Infections
		Chronic suppurative respiratory disorders
		TB
		Lung abscess
		Legionnaire’s disease
		Lung cancer
		Sarcoidosis
		OSAS
		Acute respiratory distress syndrome (ARDS)
	Further Reading
	Multiple Choice Questions
Chapter 7 Gastrointestinal disorders
	Introduction
	Relevant points in the history
	Examination
	Liver disease
		Liver failure
		Cirrhosis
		Haemochromatosis
		Wilson’s disease
		Alpha 1-antitrypsin deficiency
		Budd–Chiari syndrome
		Primary biliary cirrhosis (primary biliary cholangitis) – PBC
		Gilbert’s syndrome
		Jaundice
		Liver tumours
		Coagulation and liver disease
		Prescribing in liver disease
	Nutritional disorders
	Vitamin B deficiencies
	Iron deficiency anaemia
	Vitamin A deficiency
	Vitamin D deficiency
	Vitamin E deficiency
	Vitamin K deficiency
	Vitamin C deficiency
	Dental aspects of GI system disorders
	Ulcer-healing drugs and antacids
		Unwanted effects of antiulcer drugs in the mouth and perioral structures
		Drug interactions
	Further Reading
	Multiple Choice Questions
Chapter 8 Renal disorders
	Introduction
	Structure of the kidneys
	The glomerulus
	The tubule
	The loop of Henle
	Measurement of renal function
		Glomerular filtration rate (GFR)
		Creatinine
		Creatinine clearance (CrCl)
		Formal assessment of GFR by inulin
		Estimating GFR from serum creatinine measurements
		Control of acid–base balance
		Regulation of body fluid volume and composition
		Excretion (waste, drugs)
		Endocrine activity
		Blood pressure control: renin–angiotensin–aldosterone system
	Clinical presentation of abnormal renal function
		Asymptomatic patient with abnormal urinalysis or blood tests
		Proteinuria
		Haematuria
		Nephritic syndrome
		Nephrotic syndrome
		AKI
		Pre-renal AKI
		Intrinsic renal AKI
		Post-renal AKI
	CKD
		Classification of CKD
		Complications of CKD
		Management of patients with CKD
	Management of renal anaemia
	Management of mineral and bone disorders
	Approach to managing patients with impaired renal function
		Investigation
		Urine analysis
		Imaging of the kidneys
		Renal biopsy
	The kidneys and systemic disease
		Diabetes mellitus
		Microscopic vasculitis (microscopic angiitis)
		Anti-GBM disease
		Amyloid
		IgA nephropathy and Henoch–Schönlein purpura
		Sarcoid
		Systemic lupus erythematosus (SLE)
		Systemic sclerosis
		Abnormalities secondary to infections
		HIV-related nephropathy (HIVAN)
		Inherited renal disease
		Reflux nephropathy (chronic pyelonephritis)
		Renal stone disease
		Hypertensive nephrosclerosis and atheromatous renovascular disease
		CKD–Mineral and Bone Disorders (CKD‐MBD)
		ESRD and RRT
		CAPD
		APD
	Dental aspects relating to renal patients
	Prescribing in renal disease
	Further Reading
	Multiple Choice Questions
Chapter 9 Neurology and special senses
Chapter 9A Neurology
	Head injury
	Signs of skull fracture
	Types of brain injury
		Concussion
		Contusion
		Diffuse axonal injury
		Cerebral oedema
		Intracranial haemorrhage
		Extradural haemorrhage
		Subdural haemorrhage
		Intracerebral haemorrhage
		Assessment
	General signs and symptoms of brain injury
	Spinal injury
	Complications
	Brain abscess
	Space-occupying lesions
	Meningitis
Chapter 9B ENT
	Deafness
	Conductive deafness
	Sensorineural deafness
	Clinical testing
	Rinne’s test
		Weber’s test
	Tinnitus
	Vertigo
	Dizziness
	Infections and inflammatory disorders of the ear, nose, sinuses and tonsils
		Ear infections
		Nasal obstruction
		Paranasal sinuses
		Carcinoma of the pharyngeal tonsil
		Stridor
Chapter 9C Neurological disorders and dental practice
	Relevant points in the history
	Facial pain
	Other disorders
	General examination
	Cranial nerves
	Neurological disorders: management considerations in dental practice
Chapter 9D Stroke, speech and swallowing
	Stroke
	Pathology of stroke
	Risk factors and prevention
	Clinical features of stroke or TIA
	Management of acute stroke
	Stroke rehabilitation
	Dental aspects of stroke
	Speech
	Swallowing
	Elements of swallowing
	Swallowing disorders
	Assessment and treatment of swallowing problems
Chapter 9E Ophthalmology
	Measurement of vision
	Common causes of visual loss
		Age-related macular degeneration
		Cataract
		Open-angle glaucoma
		Diabetic retinopathy
		The acute red eye
		Conjunctivitis (very common, no pain, no loss of vision)
		Subconjunctival haemorrhage (very common, no pain, no loss of vision)
		Episcleritis (common, mild pain, no loss of vision)
		Corneal ulceration (severe pain, possible loss of vision)
		Acute uveitis (uncommon, pain, loss of vision)
		Acute glaucoma (very uncommon, severe pain, marked loss of vision)
	Conditions of common interest
		Giant cell arteritis
		Sjögren syndrome
		Behçet’s disease
		Ophthalmic complications of dental anaesthesia
		Transmission of infections through the ocular surface
		Facial trauma and the eye
Chapter 9F Anticonvulsant and anti-Parkinsonian drugs
	Anticonvulsant drugs
		Drug classification
		Mechanism of action
		Unwanted effects of anticonvulsant medication
	Anti-Parkinsonian drugs
		Drug classification
		Mechanism of action
		Unwanted effects
	Further Reading
	Multiple Choice Questions
Chapter 10 Shock
	Introduction
	Pathophysiology
	Aetiology of shock
	Hypovolemic shock
	Cardiogenic shock
	Obstructive shock
	Apparent hypovolemia
	Clinical features
		Principles of management
	Monitoring
	Refractory shock
	Summary
	References
	Multiple Choice Questions
Chapter 11 Musculoskeletal disorders
	Introduction
	Classifying musculoskeletal problems
	Osteoarthritis
		Clinical features
		Symptoms
		Signs
		Risk factors for osteoarthritis
		Demographic changes
		Management
	Rheumatoid arthritis
		Clinical features
		Symptoms
		Signs
		Radiographic signs of rheumatoid arthritis
		Burden of rheumatoid arthritis
		Management of rheumatoid arthritis
	Reactive arthritis
		Clinical features
		Signs and symptoms
		Radiographic signs of reactive arthritis
		Management of reactive arthritis
	Other joint disorders
	Disorders mainly involving soft tissues
	Management of fractures and joint replacements
	Joint replacements
	Metabolic bone disease and calcium
		Physiology of calcium metabolism
		Investigations of bone disease
		Biochemical tests
		Imaging tests
		Drugs used in bone disease
	Parathyroid disorders
		Hypoparathyroidism
		Hyperparathyroidism
	Important bone conditions
		Osteomalacia and rickets
		Osteoporosis
		Bone metastases
		Paget’s disease of bone
	Other bone disorders
	Dental treatment in patients with musculoskeletal disorders
	Patients with syndromes
	Patients with joint disorders
	Other disorders
	Summary
	References
	Multiple Choice Questions
Chapter 12 Dermatology and mucosal lesions
	Introduction
	Assessment of a patient presenting with skin lesions
	Nail changes
	Finger clubbing
	Diseases of the skin
		Eczema and dermatitis
		Atopic dermatitis (eczema)
		Urticaria
		Contact dermatitis
	Disorders of keratinization
		Psoriasis
	Infections and skin manifestations
		Superficial bacterial skin infections
		Deep bacterial skin infections
		Bacterial exanthemata
	Fungal infections (mycoses)
		Tinea
		Candidal infections
		Chronic mucocutaneous candidiasis
		Oral lesions secondary to fungal infections
	Viral infections of the skin
		Shingles
		Herpetic whitlow
		Herpes labialis ‘cold sore’
		Oral lesions secondary to viral infections
	Dermatological manifestations of systemic disease
		Deficiency states
	Dermatological manifestations of GI disease
	Dermatological manifestations of endocrine disease
		Hyperthyroidism
		Hypothyroidism
		Diabetes mellitus
		Cushing’s syndrome
	Actinic disorders of the skin
		Actinic keratoses
		Actinic cheilitis
	Squamous cell carcinoma of the skin (SCC)
	Basal cell carcinoma (BCC)
	Referral of patients with suspected skin malignancy
		Keratoacanthoma
	Disorders of skin and oral pigmentation
	External causes of pigmentation of skin
	Internal causes of pigmentation of skin and oral mucosa
		Generalised/multiple areas of pigmentation
		Localised pigmented skin lesions secondary to melanin accumulation in the skin cells (no melanocytic proliferation
		Melanocytic pigmented lesions of the skin
	Pigmentation of the oral mucosa
	Clinical management of intra-oral pigmentation
	Autoimmune dermatological disease
		LP
	Pemphigoid
		Mucous membrane pemphigoid (MMP)
		Bullous pemphigoid
	Erythema multiforme (EM), Stevens–Johnson syndrome and toxic epidermal necrolysis
	Stevens–Johnson syndrome and toxic epidermal necrolysis
	Pemphigus
		Pemphigus vulgaris
	Dermatitis herpetiformis
	Lupus erythematosus (LE)
		Systemic lupus erythematosus (SLE)
		Discoid lupus erythematosus (DLE)
	Behçet’s syndrome (BS)
	Graft versus host disease (GVHD)
	Drug-induced causes of oral/dermatological lesions
	Lichenoid lesions
	Fixed drug eruption
	Drug-induced bullous disease
	Further Reading
	Multiple Choice Questions
Chapter 13 Endocrinology and diabetes
	Introduction
	Regulation and feedback
	Mechanisms of endocrine disease
	Important endocrine syndromes
		The adrenal glands
		The thyroid gland
		The pituitary gland
		The parathyroid glands
	Diabetes mellitus
		Terminology and classification
		Types of diabetes
		Clinical features and diagnosis
		Management
		Complications of diabetes
		Long-term complications of diabetes mellitus
		Diabetes during surgery
		Oral contraceptives
		Impact on dental management
		Drug interactions
	Pregnancy
	Other endocrine conditions of relevance
	Dental aspects in endocrine patients
	Further Reading
	Multiple Choice Questions
Chapter 14 Pain and anxiety control
	Introduction
	Local anaesthetics
		Introduction
		Pharmacology of local anaesthetics
		Mechanism of action
		Physicochemical properties influencing local anaesthetic action
		Metabolism of local anaesthetics
		Vasoconstrictors
		Adverse effects of dental local anaesthesia
		Allergy
		Toxicity
		Drug interactions
	Analgesia in dentistry
		Peripherally acting analgesics
		Centrally acting analgesics
	Drugs used in conscious sedation
		Introduction
	Intravenous sedation
		Benzodiazepines
	Inhalational sedation
		N2O
	Oral sedation
	Transmucosal sedation
	Further Reading
	Multiple Choice Questions
Chapter 15 Adverse drug reactions and interactions
	Adverse drug reactions
	Salivary glands
		Drug-induced xerostomia
		Management of drug-induced xerostomia
		Drug-induced sialorrhoea
		Drug-induced pain and swelling of the salivary glands
		Drug-induced taste disturbances
	Oral mucosa and tongue
		Drug-induced vesiculobullous lesions
		Lichen planus
		Other drug-related white lesions of the oral mucosa
		Drug-induced discoloration of the oral mucosa
		Drug-induced oral ulceration
	Local irritants
		Drug-related aphthous-type ulceration
		Fixed drug eruptions
	Dental structures
		Tooth development
		Drug-induced staining of the dental structures
	Sugar-based medicines
	Periodontal tissues
		Drug-induced gingival overgrowth
		Risk factors for drug-induced gingival overgrowth
		Pathogenesis of drug-induced gingival overgrowth
		Treatment of drug-induced gingival overgrowth
		Drug-induced desquamative gingivitis
		Drugs that can increase the expression of periodontal disease
	Alveolar bone
		Bisphosphonate-induced osteonecrosis
		Prevention of bisphosphonate-induced osteonecrosis
		Treatment of bisphosphonate-induced osteonecrosis
		Dry socket (alveolar osteitis)
	Cleft lip and palate
	Miscellaneous oral adverse drug reactions
		Angioedema and ACE inhibitors
		Drug-induced dyskinesias
		Summary
	Drug interactions
		Mechanisms of drug interactions
		Pharmacokinetic interactions
		Pharmacodynamic interactions
		Relevance of drug interactions in dental practice
		Agents that interfere with local anaesthetics and vasoconstrictors
		Interactions with local anaesthetics
		Interactions with vasoconstrictors
		Drugs acting on the CNS
		Drugs of abuse
		Drugs that interact with oral and intravenous sedation
		Drugs that act on the CNS
		Drugs acting on the gastrointestinal tract
		Local anaesthetics
		Muscle relaxants
	Drugs that interfere with analgesics prescribed by dentists
		Aspirin
		Ibuprofen
		Paracetamol
		Drugs that interfere with antimicrobials prescribed by dentists
		Drugs used in the treatment of gout
		Oral contraceptives
		Erythromycin
		Metronidazole
		Tetracyclines
		Antifungals
		Summary
	Further Reading
	Multiple Choice Questions
Chapter 16 General oncology
	Introduction
	Disorders of growth and differentiation
		Introduction
		Disorders of growth
		Disorders of differentiation
	Neoplasia
		Definitions and terminology
		General features of neoplasia
		Metabolic effects of neoplasia
		Classification of neoplasms
	Biological characteristics of cancer
	Clinical oncology
	Tumour identification and diagnosis
	Management of malignant disease
		Surgery
		Radiotherapy
		Chemotherapy
		Hormonal manipulation
	Prognosis
		Type of cancer
		Stage
	Introduction to head and neck oncology
	Oral complications of malignancy
	Management of head and neck radiotherapy patients
	Management of patients on chemotherapy
	Palliative care
	The future
	Further Reading
	Multiple Choice Questions
Chapter 17 Child health
	Development
	Specific areas of development
	Range of normality and individual variation
		Rate of development
		Pattern of development
		Eventual level of attainment
	Key milestones
	Child health surveillance
	Language and speech
		Language and speech delay
		Language and speech disorders
	Hearing
		Hearing loss
	Vision
	Respiratory infections in childhood
		URTIs
		Otitis media (OM)
		Tonsillitis
		Acute lower respiratory tract infection
	Bacterial pneumonia
	Measles
	Croup
	Bronchiolitis
	Pertussis
	Cystic fibrosis (CF)
	Asthma
	Oral infections
	Viral
		Primary herpes simplex infection
		Secondary herpes simplex infection
		Varicella zoster
		Mumps
		Measles
		Herpangina
		Hand, foot and mouth disease
		Infectious mononucleosis
		Human papillomavirus
	Bacterial
		Staphylococcal infections
		Streptococcal infection
		Congenital syphilis
		Tuberculosis
		Cat-scratch disease
	Fungal
		Candida
		Actinomycosis
	Protozoal
	Clefts of the lip and palate
	Aetiology of clefts
		Genetic factors
		Environmental factors
	Child physical abuse
		Introduction
		Prevalence
		Aetiology
		Identification
		Types of orofacial injuries in child physical abuse
	Conclusions
	Further Reading
	Multiple Choice Questions
Chapter 18 Medicine for the elderly
	Introduction
	Ageing
	Features of illness in old age
	Non-specific presentations
	Multiple pathology, and consequent polypharmacy
	Impaired homeostasis, resistance to disease and recovery
	Loss of functional independence
	Care settings for older people
	Assessment and rehabilitation
	Long-term care
	History taking
	Examination
	General principles of management
	Mental capacity
	Prescribing for older dental patients
	Practical tips on prescribing
	Further Reading
	Multiple Choice Questions
Chapter 19 Psychiatric disorders
Chapter 19A General psychiatry
	Introduction – what is psychiatry?
	Relevance to dental practitioners
	The nature and diagnosis of psychiatric disorders
	Psychiatric presentations encountered by dentists
	Anxiety disorders
		Dental anxiety – anxiety related to visiting the dentist
		Dental phobia
	Anxiety and avoidance
		Management of dental anxiety
		Preventative measures
		Treatment
	Obsessive compulsive disorder (OCD)
		Management of OCD
	Hypochondriasis
		Management of hypochondriasis
	Psychogenic pain
		Management of psychogenic pain – general principles
	Atypical facial pain
	TMJ dysfunction syndrome
	Atypical odontalgia
	Oral dysaesthesia
	Eating disorders
		Anorexia nervosa
		Bulimia nervosa
	Substance misuse
	Alcohol abuse
		Management of drug and alcohol misuse
	Schizophrenia
		Positive symptoms of schizophrenia
		Negative symptoms of schizophrenia
		Antipsychotics
		Other treatments
	Schizophrenia and the dentist
	Mood disorders
	Depression
		Management of depression
		Antidepressants
		Augmentation
		Electroconvulsive therapy (ECT)
		Psychological therapies
		Dental aspects of depression
	Bipolar affective disorder (mania)
		Management of bipolar affective disorder
		Lithium
		Relapse prevention and rehabilitation
		Dental aspects of bipolar affective disorder
	Specific groups for special consideration: children
	Autistic spectrum disorders
		Aetiology
		Management
	Hyperkinetic disorder (or ‘attention-deficit hyperactivity disorder’, ADHD)
		Management
	Anxiety disorders and phobias
	Specific groups for special consideration: the elderly
	Dementia
	Delirium
		Management of delirium
	Specific groups for special consideration: people with learning disabilities
		Presentation
		Aetiology
		Dental aspects
		Down syndrome (trisomy 21)
	Dental aspects
	Capacity and consent
	Assessment of capacity
	Referral to psychiatric services
	Indications and routes of referral
	Basic psychiatric assessment
Chapter 19B Drug abuse
	Alcohol
		Effects on orodental structures
		Effect on management
		Drug interactions
	Smoking
		Effects on orodental structures
		Effect on management
		Drug interactions
	Cannabis
		Effects on orodental structures
		Effect on management
	Heroin and methadone
		Effects on orodental structures
		Effect on management
		Drug interactions
	Cocaine
		Effects on orodental structures
		Effect on management
		Drug interactions
	Amphetamines and ecstasy
		Effects on orodental structures
		Effect on management
		Drug interactions
	Hallucinogens
		Effects on orodental structures
		Effect on management
		Drug interactions
	Solvent abuse
		Effects on orodental structures
		Effect on management
	Anabolic steroids and performance enhancers
		Effects on orodental structures
		Effect on management
Chapter 19C Anxiolytic and hypnotic drugs
	Anxiolytic drugs
	Hypnotic drugs
	Further Reading
	Multiple Choice Questions
Chapter Chapter 20 Haematology
Chapter 20A General haematology, haemato-oncology
	Normal haemopoiesis
	The bone marrow stroma
	Erythropoiesis
	Haemoglobin
	Red cell metabolism
	Anaemia
	General features of anaemia
	Iron deficiency anaemia
		Iron absorption and distribution
		Causes of iron deficiency
		Clinical features of iron deficiency anaemia
		Laboratory investigation of suspected iron deficiency
		Treatment
	Megaloblastic anaemias
		Absorption of vitamin B12
		Folate deficiency
		Clinical features of megaloblastic anaemia
		Laboratory investigations
		Treatment
	Anaemia of chronic disease
	Haemolytic anaemias
		Classification of haemolytic anaemias
		Laboratory investigation of haemolysis
		Red cell membrane defects
		Hereditary spherocytosis (HS)
	Haemoglobinopathies
	Sickle cell disease (SCD)
		Clinical features of SCD
		Acute management of a painful crisis
	α-Thalassaemia
		Pathophysiology
	β-Thalassaemia
		Pathophysiology
	Red cell fragmentation syndromes
	Multiple myeloma
		Clinical presentation
		Investigations
		Prognosis
		Treatment
	Osteonecrosis of the jaw
	Bone marrow failure syndromes
		Acute leukaemias
	Chronic myeloproliferative disorders (MPDs)
	Lymphomas
	Hodgkin lymphoma
		NLPHL
		CHL
		Treatment
	NHL
Chapter 20B Haemostasis
	Overview of normal haemostasis
	Inherited bleeding disorders
		Haemophilia A
		Haemophilia B
		Laboratory diagnosis
		Treatment
		The development of recombinant products
		Management of haemophilia patients undergoing dental surgery
	von Willebrand disease
		Clinical features
		Laboratory diagnosis
		Treatment
		Acquired vWD
	Rare inherited coagulation disorders
		Inherited platelet disorders
	Acquired disorders of haemostasis
	Acquired platelet disorders
	Warfarin and dental surgery
	Mechanism of action of warfarin
	Warfarin and bleeding risk
	The risk of bleeding following dental surgery
	The risk of discontinuing anticoagulation prior to surgery
	Direct Oral Anticoagulants (DOACs)
	DOACs and dental surgery
Chapter 20C Transfusion medicine
	Introduction
	Blood group systems
	The ABO blood group system
	The Rhesus (Rh) blood group system
	Red cell antibodies
	Alloantibody production
	Alloantibodies in pregnancy
	Blood components
	High-titre testing
	Hospital pre-transfusion testing
	Selecting ABO-compatible blood
	Haemovigilance in the UK
	Minimising errors in blood transfusion
	‘Right blood, right patient’
	Platelets
	Fresh frozen plasma
	Indications for FFP
	Cryoprecipitate
	Risks of transfusion
	Preventing transfusion reactions
	Alternatives to blood transfusion
	Further Reading
	Multiple Choice Questions
Chapter 21 Medical emergencies
	Introduction
	The ABCDE approach to the sick patient
	The collapsed patient
	Fainting (vasovagal syncope)
		Signs and symptoms
		Management
	Chest pain
		Signs and symptoms
		Management
	The diabetic patient
	Diabetic emergencies
		Signs and symptoms
		Management
	Hypersensitivity reactions – anaphylaxis
		Signs and symptoms
		Management
	‘Second-line’ drugs – not required to be administered by dental practitioners
	Angioedema
	Fits
		Signs and symptoms
		Management
	Cardiac arrest
		Possible causes of cardiac arrest
		Signs and symptoms
		Management
	Use of defibrillation
	Pacemakers
	Asthma
		Signs and symptoms
		Management
	Hyperventilation
		Signs and symptoms
		Management
	Choking
	Adrenal crisis
		Signs and symptoms
		Management
	Local anaesthetics emergencies
	Cardiovascular problems in association with local anaesthetics
	Temporary facial palsy or diplopia
	Stroke
	Needle breakage
	Sedation emergencies
		Management
	Emergencies arising from impaired haemostasis
	Summary
	Further Reading
	Multiple Choice Questions
Appendix: normal reference ranges
Index
EULA