The key here is "their dentist." A dentist is obligated to render
emergency care to his patients of record, or to refer them to another
dentist where such care can be obtained.

It's not that simple when the patient is NOT a patient of record of the
dentist. Human nature being what it is, many people unwisely
procrastinate in taking care of their regular dental maintenance needs.
It is not unusual for a few people to go years without visiting a
dentist for the normal six-month exams and maintenance visits. Then
when their self-inflicted dental pain occurs, they have no dentist.

Although a dentist should help people in need, he has no obligation to
get out of bed at 2 A.M. six nights a week to attend to the predictable
consequences of procrastination by people who aren't even his own
patients.

Most dentists can tell you that their patients rarely have emergencies
in the first place -- because most dentists require their patients to
have the sort of dental treatment that prevents emergencies from
occurring. The number of unpreventable emergencies is relatively small,
and the average dentist is prepared to handle such cases in their own
patients.

How do they know they have an abscess? Who made the diagnosis? If a
dentist made the diagnosis, then he would be rendering appropriate
treatment or prescribing medications until treatment could be
performed.

It's not unusual for narcotic addicts to call doctors and tell them
they "need" a prescription for an antibiotic -- and by the way, some
Vicodin too, please -- because "their dentist" could not see them. This
is a VERY common scam on the part of narcotic addicts. They just keep
calling doctors until somebody gives them the controlled substances
they want.

If the dental emergency is legitimate, the patient's own dentist of
record should be attending the case. Patients calling doctors for
medications sounds a little fishy.

That certainly makes sense.

Dentists do indeed have the authority to prescribe whatever medication
is determined to be necessary for the treatment of a dental problem --
for patients of record.

I agree with you. Legitimate cases should be seen by a dentist. But
remember that some "patients" are just fishing for narcotics and are
using the "dental excuse" to persuade you to feed their habits.
- dentaldoc

That is odd. Not sure why a dentist would send his own patient elsewhere for
something as innocuous as antibiotics.

In infections are infections and 9 times out of 10 a dental emergency involves
pain that is associated with an infection.

Most dental emergencies are due to neglect. I used to make special
considerations for anyone who called with an emergency, then I started asking
people who needed to be seen "now" when the problem started. Many would say, oh,
it started last week but I couldn't get here until now. I'm sorry, but that
isn't an emergency. I will not put my life on hold for someone who can't alter
their schedule to take care of themselves. Experience has taught me to
distinguish between real emergencies and procrastination that has become
uncomfortable.

In my state just having a dental license allows one to prescribe
antibiotics...no special prescribing certificate needed.

T

snip

Matt,

Others have addressed you question on antibiotics. Ironically today I had a
patient that left his denture with me for a repair and addition so he could go
to his MD for antibiotics for a infection of dental origin. Hopefully his MD
said the same thing as me, that being he should be seeing a dentist for his
dental infection. Antibiotics might help in the short term but unless the source
of infection is corrected, chances are the infection will return. I'll bet the
patient did not tell their MD that they simply refuse to see a dentist unless it
is absolutely necessary (due to their fear and mistrust of the profession).

I am going to go out on a limb and say that I think you should be able to
recognize obvious dental problems and incorporate a cursory "dental exam" into
every physical. I believe it would help you determine a better evaluation of
your patient, their overall health and their attitude towards health care. Plus
it would help direct patients to receive some care they actually need, which
many times, affects health issues that fall into your realm.

My opinion might offend Joel Eichen, a dentist and regular poster on this
newsgroup, since he strongly states that only a qualified *DENTIST* should be
making oral diagnosis. He states that other health professionals just don't have
the exact same training as a dentist to make a diagnosis. He just can't accept
that other health professionals are trained to make informed assessments and
refer on for a diagnosis. He and I have bantered over this issue for years in
this newsgroup. I say it would be analogous to a nurse practitioner making an
assessment, bringing it to you for a diagnosis, which you might refer on to a
specialist for a differential diagnosis.

Let me give you a bit of background on me. I'm a Denturist in Ontario which is a
drugless practitioner trained to treat individuals in the area of removable
dental prosthetics.  Local law allows us to perform procedures within the oral
cavity but restricts invasive procedures below the surface of enamel, the
gumline or soft tissues. Our training includes histology, microbiology,
physiology, pathophysiology, oral pathology and so on. The post secondary
education is a 3 year program focusing on 1 of 6 areas of dentistry. Which are
removable prosthetics, fixed prosthetics, restorative dentistry, periodontics,
endodontics and periodontics.

At some point of time, I am going to assume when medicine and dentistry became
separate professions the mouth became separated from the rest of the body in the
eyes of the medical practitioner. The insurance industry has helped further that
division. I have asked various MD's, which are patients of mine, what they
actually look at when they look in the mouth. The typical response is that the
teeth, gums and dentures are ignored because they are in the care of the dental
profession.

I can look up the stats, which give details by geographic zone, sex, age and
dental insurance coverage if you want. But I would say that about 1/3 of your
patient base has not been seen by a dental health professional in at least 5
years, about 1/2 of those in at least 10 years. I've had numerous patients that
have not seen a dental health professional in 20, 30 or even 40 years. That
means that for those patients no one has been actively looking for the signs of
medical conditions that frequently show up in the mouth.

I'm suggesting that before you ask you patients to 'open up and say ahhh' during
a general exam, you first ask them when the last time was they had seen a dental
health professional. The longer it has been, the closer you should be looking at
dental issues as they will help you be a better practitioner with your patients
medical issues. There are numerous threads in the archives of Google for this
newsgroup, that talk about the various relationships. If you want, the group can
make you aware of some of the issues.

My first patient today would be a prime example. The patient's daughter called
wanting to cancel the appointment because one of  her mothers various MD's said
her sore mouth was possibly related to a vitamin deficiency. He may be partly
correct but I knew differently because I knew the history. 4 months ago another
MD repeatedly prescribed topical Nystatin for a couple of months to resolve a
tongue issue. The Nystatin helped but did not clear up the tip of the tongue. I
was seeing the patient at that point to add a tooth to her denture that she had
lost over a year ago.

I observed that the patients Parkinson tremors were much worse than when I
initially fabricated the dentures 4 years ago. Closer observation showed that
the tip of her tongue was rubbing along the edge of the lower partial denture
where one would not normally expect this to happen. Simple solution was to alter
the denture so the tongue did not repeatedly touch it, to do so meant adding
some denture base to the inferior border to maintain the strength of the
denture. Two weeks later, sans Nystatin, the tip of the tongue is clearing up.

Unfortunately, a sore spot started showing up near the lingual frenum, so I
reduced some of the area that I had added two weeks prior. Although the severity
of the sore had reduced in the last weeks, this soreness is what the one MD
thought was a result of a vitamin deficiency. Had that MD asked when the last
time the patient had seen a dental professional, they might have been able to
correlate the appearance of a sore with the timing of a denture modification.
Hopefully, further modifications to the denture today will eliminate the primary
cause of the sore.

Matt, I could go on for days with examples like this. Next time you see a
patient that has had long term elusive complaints with their digestive system,
have a look in their mouth. Chances are there are extremely worn denture teeth
making the patient unable to chew their food properly.

--
Roy

Time to recommend a new dentist. I am sure there are many caring
dentists who would accept your referred patients!

In fact, if you mention your town, we can have one call or e-mail you.

Joel

Certainly as a physician you can prescribe anything. However many times
you will incounter drug addicts that will call you for pain meds.
Giving out an Rx on a word of a patient you never met without examining
the patient will get you in trouble.
If you gave a patient antibiotics without doing a dental exam it will
hide the problem and make it difficult for us to determine which tooth
is responsible. An exception to this would be if the infection is so
large that it is life threatening and needs to be drained.
Certainly your comfort level should be the key when to step away and
refer.