Abstract
Dental treatment for medically compromised patients had often been performed by oral surgeons or oral anesthesiologists for minimization or decrease in incidence of medically oriented accidents. If dental treatment is required for these patients in the setting of general or private practice, they may be recommended to a hospital with a dental department with a utilizing departmental cooperation system. The open system which belongs to a cooperative network system in a general hospital was introduced to improve the quality of treatment. We herein report 2 cases of medically compromised patients whom were treated and managed by dentists in private practice utilizing an open system between private practice and the general hospital.
Case1: A 54-year-old male patient with a history of anaphylactic shock from adverse effects of local anesthesia during dental treatment consulted a dentist in private practice for dental problems. He required dental treatment under local anesthesia for treatment of dental pulpitis and cavity. Therefore, I selected a multidisciplinary joint treatment and management with an anesthesiologist using the open system. Under proper medical management, I was able to accomplish the required pulpectomy and extraction without encountering any anaphylactic shock associated with anesthesia in the operating room.
Case 2: A 43-year-old male patient with a history of atrial fibrillation and transitory focal cerebral ischemia complained of teeth movement in upper and lower dentition. I considered the incidence or risk of general complications such as thromboembolism resulting from the stimulation caused during teeth extraction. Therefore, I selected a multidisciplinary joint team treatment with the general hospital utilizing the open system since the patient required intravenous sedation and rapid thrombolytic therapy for treatment. The extraction was performed by the dentist in private practice without any complications or problems under the sedation and monitoring by the oral anesthesiologist.
It was difficult to use the open system for treatment of minor dental problems due to the tight schedule of the anesthesiologist, operation room and inadequate fee. In addition to the above described difficulties, the clinical indications whether to select the open system or not have not been clarified. However, with the use of the open system, I was able to treat minor dental problems without encountering any accidents utilizing the open system.
