Sibil Shibu is a Clinical Ethics Consultant at an academic medical center in the United States named the University of Alabama Birmingham Hospital. She graduated with a Bachelor of Arts in Bioethics and Health Studies, and a minor in Theology from Saint Louis University during the Summer of 2022. After her undergraduate education, she completed a Master of Bioethics and a Certificate in Leadership for Public Health and Healthcare through the Berman Institute of Bioethics at the Johns Hopkins Bloomberg School of Public Health. She will be starting her Doctoral Degree in Bioethics in January 2024. Her initial exposure to the field of Bioethics was through an ethics course during her junior year of high school at the Illinois Mathematics and Science Academy. During her undergraduate education, she took a wide variety of bioethics courses through the Albert Gnaegi Center for Health Care Ethics, which instigated a deeper desire in her to pursue further education in this interdisciplinary field. The various health care ethics internships, research opportunities, conferences, and fellowships she partook in have equipped her with various skills to become an innovative leader in this field. Her multifaceted research interests include health policy, dental ethics, neonatal bioethics, ethics and mission integration, the intersection between religion/spirituality and medicine, ethical and policy issues regarding genomic and technological advancements in maternal-fetal medicine, holistic health care, clinical ethics, and systems ethics. She aspires to utilize her background in Bioethics to compliment her fervent drive to serve a community of diverse individuals as an advocate of health equity and justice
Abstract:
ABSTRACT:
Decision making capacity(DMC) is a determination tool utilized across clinical settings to determine if a patient is able to partake in conversations regarding their course of treatment. Scholars around the globe have utilized various approaches to determine if a patient has DMC. Physician and scholar Paul S. Applebaum presents four criteria to determine if a patient has DMC. This includes one’s ability to: communicate a choice, understand the relevant information, appreciate the situation and its consequences, and reason about treatment options. Although conversations around DMC are prevalent in a medical context, there is a lack of conversation around DMC for patients in dental settings. In this project, I present various considerations to determine DMC in a dental setting. This is accomplished by presenting various clinical cases of diverse patients who interact with the realm of dentistry. An analysis of these case studies present practical tools to uphold the autonomy of patients in dental encounters, even patients who may lack DMC.
EXAMPLE OF A CASE STUDY IN MY PRESENTATION:
Patient Jane Doe is a 24-year-old female patient with an intellectual disability residing in a group home. Ms. Doe presents to a dental clinical after recurrent tooth pain. After further analysis, her dentist recommended that tooth extractions would be necessary to treat her gingivitis. As the patient lacks decision making capacity, her surrogate decision maker is her aunt, who she doesn’t reside with. As the date for the scheduled tooth extraction arrives, Ms. Doe presented to the dental clinic with her caregiver from her group home. As the oral surgeon approaches Ms. Doe prior to the tooth extraction, she becomes frustrated and is not compliant with undergoing the tooth extraction. Although her aunt had consented to the procedure, there was an element of dissent present. This brings about an ethical dilemma on whether it would be appropriate to proceed with the tooth extraction over the patient’s objection or to postpone the tooth extraction. After further conversation with the patient it was revealed that she did not want to undergo the extraction as she felt uncomfortable without the presence of her aunt at the clinic. Although the patient lacks decision making capacity, it is beneficial to take into consent the notion of assent and dissent to uphold the patient’s autonomy. After further conversation, the medical team determined that it may be appropriate to postpone the procedure as postponing the tooth extraction would not be medically detrimental if oral antibiotics were utilized as treatment. Although Ms. Doe would eventually need to have tooth extractions, postponing this treatment till the patient’s aunt would be available to accompany her in clinic was vital to build trust in the dentist-patient relationship.
Background:-Gap arthroplasty is a one of the techniques used torelease TMJ bony ankylosis with reported many advantages anddisadvantages. The aim of this study was to present and evaluatenew semi-sagittal split osteotomy of ankylosing bony mass to releasetemporomandibular joint bony ankylosis. It was intended to minimizethe disadvantage of gap arthroplasty. Patient and methods:-Twelve patients suffering from TMJ bonyankylosis were included in the present study. New semi-sagittal splitosteotomy of ankylosing bony mass was implemented. This cut wasextended from the most superior point of ankylosing bone masslaterally and directed downward and medially towards the most inferiorpoint of the most constricted part just above the mandibularforamen. Pterygomasseteric sling release was performed. Sixquantitative and qualitative calipers were used to assess the technique. Results:-Postoperative interincisal opening was increased significantlyand the lower jaw displaced downward without shortening of themandibular ramus. Only one case out of twelve (8.3%) representedpostoperative anterior open bite. Conclusion:-Semi-sagittal split osteotomy of ankylosing bony masswas recommended to preserve the major vital structures at the base ofthe skull in long standing and recurrent temporomandibular joint bonyankylosis especially with bulbous bony mass.
Background: Dental fluorosis is a condition of altered enamel formation caused by excessive intake of fluoride during tooth formation, with a wide range of severity. It is characterized by hypomineralization of the tooth structure. The increased prevalence of dental fluorosis worldwide has caused esthetic displeasure in children, leading to psychological and behavioral complications in the affected individuals.
Aim: To assess the impact of Dental Fluorosis on the (OHRQoL) in 10-14 year old children.
Methodology: The present study included a total of 545 children aged 10-14 years. All the children were screened to note DMFT, OHI-S, and Dean Fluorosis indices followed by which children were asked to answer a Child Perception questionnaire of their local language. Screening at schools ended with an oral health care talk. The data collected was compiled, tabulated, and subjected to statistical analysis.
Results synthesis: Among the 545 subjects in the study 58.3% were males and 41.7% were females. The mean Deans Fluorosis Index score was 2.48±0.77. The means of domains oral symptoms, functional limitations, emotional well-being, and social well-being were 2.41±2.56, 2.14±2.70, 3.73±4.58 and 4.38±5.55 respectively. Multiple regression analysis of the data showed that dental fluorosis had a significant impact on OHRQoL in children.
Conclusion: Dental Fluorosis has a negative impact on OHRQoL children. Children with Dental Fluorosis have been avoiding smiling and laughing because of their aesthetic concerns. Dental Fluorosis mainly affects the social well-being of children. A comparison of OHRQL scores between various Dean’s fluorosis index scores shows that OHRQoL was mostly affected in children with severe fluorosis followed by moderate fluorosis.
Keywords: Dental Fluorosis, Child Perception, Oral Health-Related Quality of Life.
Post graduation in the field of Periodontics, India
Abstract:
ABSTRACT
Cerebral palsy (CP), a neurological condition resulting from non-progressive brain injury or malformation during developmental stages, predominantly impacts various aspects of body movement, muscle coordination, tone, reflex, posture, balance, and both fine and gross motor skills. Individuals with spastic cerebral palsy experience spasticity affecting both upper and lower limbs. When this spasticity affects the upper limb, it creates challenges in executing routine tasks, leading to complications in precision grip, grasping ability, and muscle coordination, particularly hindering the efficient use of a toothbrush. In response to these challenges hampering proper oral hygiene upkeep, a groundbreaking concept emerged—a visionary "all in one glove" designed to revolutionize oral care for cerebral palsy patients. A 3D model of this innovative glove has been crafted, featuring customizable measurements to accommodate varying hand sizes. The glove also incorporates strategically placed openings to house oral hygiene tools. This avant-garde "all in one glove" integrates toothbrushes, gum massagers, and interdental aids, all linked to vibrators powered by a 3.7V lithium battery. This cutting-edge oral hygiene glove facilitates comprehensive oral care in a single application, proving not only effective for cerebral palsy patients but also beneficial for individuals facing challenges in manual dexterity. It stands as a testament to inventive solutions addressing the unique needs of those with compromised motor skills. This innovative creation has secured a patent, attesting to its unique and original nature.
About the author – I Dr. Sucharitha Palanisamy, currently pursuing Post graduation in the field of Periodontics. My unwavering dedication centers around prioritizing dental hygiene and care for individuals with special health care needs. I have consistently focused on contributing to the oral health of those with special requirements, aiming to satisfy a lasting hunger for improved care. This innovative initiative is crafted to simplify oral hygiene practices for individuals with special health care needs, playing a pivotal role in self-motivating patients toward comprehensive oral care.
Objective: To determine the incidence and type of different drug allergies and medical comorbid conditions in individuals presenting to Oral medicine department.
Study Design:Systematic reviews/meta-analysis
Place and Duration: Outpatient Department (OPD) of oral medicine and diagnostics department of CMH medical college Lahore, from June 2023 to September 2023.
Methods: A total of 6462 patients with significant medical history were included for conducting this study. Patients’ histories were obtained through a computerized system which included separate sections for medical alerts and drug allergies. The variables used were gender, medical comorbid conditions and drug allergies.
Results: Among the 6462 individuals in this study, 46% were males, and 53% were females. The most prevalent comorbid condition was hypertension, followed by diabetes. Penicillin drug allergy had the highest incidence, followed by NSAIDs and sulfonamides.
Conclusion: Individuals seeking oral medicine frequently presented with medical comorbid conditions and drug allergies. The most prevalent medical alerts were hypertension, diabetes, hep B, and asthma, with penicillin allergy being the most common. It’s crucial to document these alerts and allergies for improved patient care, management, and to prevent potential medical emergencies resulting from insufficient patient assessment by dental practitioners.
INTRODUCTION Clinical or a dental audit is a techniqueThat fouses on improving quality of type ofcare provided to patient by systematicallyevaluating care, based on clear criteria.
The potentialforclinical audit in Expansive and rapidly growing field of dentistry is endless. (1)
In this realm of dentistry, it’s crucial to highlight all medical allergies since every drug class commonly employed in dental practice maybe involved. When documented in a patients record it’s essential to explore the nature of the reaction since many patients may misconstrue allergic reactions with intolerances. E.g sometimes patient confuses side effects of a medicine with allergy. This is important to document to avoid giving patients medications they are allergic to. (02) The existence of comorbidities is a significant concern associated with poorer health outcomes and increased medicinal cost.
Comorbidity refers to the presence of one or more added medical illness along with the presenting ailments. It is that challenge which is quite hard to handle and many individuals are still oblivious to it. (05)
Many patients that present to dental OPD with their oral health issues are mostly ignorant of the importance of giving a detailed medical history which includes their existing medical conditions. This is due to various reasons ; sometimes they are not comfortable sharing, or sometimes they think it’s not related to their dental issue or sometimes simply they’ are unaware of presence of any existent medical condition. Many times they do not share their previous illnesses or surgeries because they feel it has been treated. (1)
The dental practitioner must grasp the potential complications arising from dental treatment in medically compromised patients and discern when pre or post treatment medications or emergency care is warranted. Therefore, it’s crucial for a dentist to thoroughly gather a patient’s medical history before any therapeutic procedure. Overlooking certain medical conditions could result in adverse consequences and repercussions.(22)
We planned this study to evaluate the incidence of different medical conditions and drug allergies based on the history provided, among the patients reporting with oral diseases at Oral Medicine Department of Institute of Dentistry, CMH medical college Lahore.
With this gathered information, we can help our House Officers and dental practitioners with providing the best dental treatment to medically compromised patients whilst keeping their safety in mind and avoiding any medical emergency on a dental unit.
METHODOLOGY
ETHICAL COMMITTEE APPROVAL
After approval from ethical committee, all patients which reported to the oral medicine department of CMH Lahore for general OPD before referrals to other departments were included collectively from June 2023 to September 2023.
SAMPLE COLLECTION
Patient details were obtained from history forms, which featured dedicated sections for medical alerts and known allergies. This information was entered into computers for record-keeping purposes. Furthermore, specific inquiries about drug allergies were made and meticulously documented to ensure the accuracy of information provided by the patients.
The variables used for this study included gender , allergies and medical comorbidities such as diabetes, ischemic heart disease, hypertension, HEP B and C, psychiatric and bleeding disorders.
RESULTS
Out of a total of 6462 individuals included in this study 3011 (46%) were males and 3451 (53%) were females as shown in table 1.
Common comorbid conditions that were observed were hypertension, Diabetes Mellitus, Asthma, Hep B, Acid reflux disease, epilepsy, depression, bleeding disorders and others. Out of these 258 patients had Hypertension, making it the most common comorbid condition followed by diabetes (190) and then Hep B and Asthma ( 44 and 43 respectively) as shown in figure 2.
When allergies to drug classes were recorded, 18 patients were found to allergic to Penicillin which was the highest. 12 patients were found allergic to NSAIDs and 9 patients were found allergic to Sulfonamides as shown in figure 3.
Number of patients from June 2023 to September 2023