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Letters: Medical testing

August 17, 2015 Prior to retirement, I spent a good 40 years in practice, employing a very heavy oral medicine-based philosophy interfacing with and reflecting upon my relationships, both professional and personal, with other disciplines in “medicine.” I also raised a young man, a practicing gastroenterologist these past 20 years. I came to the conviction, a long time ago, that stomatology, of which procedures on the teeth, mouth, and jaws, are a therapeutic arm, is a medical specialty. I practiced as I felt it ought to be practiced, in the same fashion that other medical disciplines practice their science and art. Hence, as I see it, if a patient presents a dental office with a medical history which might be suspect, short of an emergency situation which might be safely managed, that patient should be referred directly for a medical workup and not treated further until the patient’s current physical status has been determined and stabilized as necessary. In my life’s experience, both as a doctor and a patient, following family member’s health care, as well as my own, and interfacing with my son’s professional activities, I have never known ophthalmologists, ear, nose and throat physicians, plastic surgeons, cardiologists and endocrinologists to perform other than limited in-office testing within the purview of their immediate diagnostic needs. Other studies, including but not limited to labs, are referred out. Other than a blood pressure determination and a glucose stick to answer an immediate and pressing need, the best service a dentist can provide for a patient with a questionable medical history is to write a “please rule out” referral for a workup pending treatment. An explanation as to the reason for the referral as well as the anticipated oral health care needs should be included. It took a couple of years of ‘ego seasoning’ for me to come to the epiphany that “medical clearance” did not mean that an M.D. was giving me permission to treat. It was telling me that my patient was physically ready to safely undergo treatment. The last three paragraphs of the article (“CDP Weighs Medical Testing in Dental Office,” July 13 ADA News) pretty much summarize all the reasons why following the present medical model of evaluation and referral is ultimately in the best interests of both dentist and the patient. Even if a dentist were medically qualified to interpret the findings of the studies suggested, the findings would be outside their area of expertise to manage. So why waste valuable time and resources?  Do no harm.

Arnold Rosenstock, D.D.S.
Boca Raton, Florida