COLLEGE OF MEDICAL AND DENTAL SCIENCES School of Dentistry · COLLEGE OF MEDICAL AND DENTAL...
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COLLEGE OF MEDICAL AND DENTAL SCIENCES School of Dentistry BASIC AND APPLIED SYSTEMIC HUMAN DISEASE COURSE [MEDICAL SCIENCES] Handbook and Logbook 2013
Transcript of COLLEGE OF MEDICAL AND DENTAL SCIENCES School of Dentistry · COLLEGE OF MEDICAL AND DENTAL...
COLLEGE OF MEDICAL AND
DENTAL SCIENCES
School of Dentistry
BBAASSIICC AANNDD AAPPPPLLIIEEDD SSYYSSTTEEMMIICC HHUUMMAANN DDIISSEEAASSEE CCOOUURRSSEE
[MEDICAL SCIENCES]
Handbook and Logbook
2013
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Table of Contents
Page 2 Table of Contents Page 3 Introduction to the BASHD Course Page 4 Learning Outcomes for BASHD Course Page 6 Assessment of BASHD Course Page 7 BASHD Course – Preamble Page 8 Learning Outcomes and Syllabus: Infection Page 12 Learning Outcomes and Syllabus: Pathology Page 16 Learning Outcomes and Syllabus: Medicine Page 22 Learning Outcomes and Syllabus: Surgery Page 27 Learning Outcomes and Syllabus: Pharmacology Page 29 Learning Outcomes and Syllabus: Therapeutics Page 31 Reading List Page 32 Core Topics in Medicine and Surgery Pages 33 – 40 Hospital Attachments and Clinical Procedures Logbook
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Introduction to the Basic and Applied Systemic Human Disease Course The Systemic Human Disease Course runs from the beginning of Spring Term of 3
rd year until the end
of spring term of 4th year of the Dental undergraduate course and is held on Mondays and Thursdays
within the 10 week termly periods. Lectures are usually delivered in the University Medical School. Hospital Visits take place in the spring of 4
th year.
The subject matter of this course is very broad and embraces the following areas: Infection & Pathology Medicine & Surgery Pharmacology & Therapeutics The course is highly integrated. The course is a very important component of the undergraduate BDS curriculum, and is increasingly necessary as the numbers of medically compromised patients increase within society. The outcomes of the course are listed on the next page of this handbook. It is important that you are familiar with them so that you are aware of that which is required of you. A significant amount of self-directed learning is necessary – the formal teaching and lecture handouts will provide a framework only. Useful contacts:
Course Director Mr K Webster University Hospital Birmingham [email protected]
Programme Secretary Mrs Jane Norton Dental School, School Office [email protected]
0121 466 5473
Infection Coordinator Dr B A B Martin Medical School
Medicine Coordinator Dr S Taheri University of Birmingham Heartlands Hospital
Pathology Coordinator Professor S Hubscher Medical School
Pharmacology Coordinator Dr M Lacey Medical School
Chair & Surgery Coordinator Mr D Adam Heartlands Hospital
Therapeutics Coordinator Dr J Coleman University of Birmingham, Medical School
The Systemic Human Disease logbook can be found immediately after the syllabus. Please follow the instructions carefully when completing the logbook.
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Learning Outcomes for Basic and Applied Systemic Human Disease The following learning outcomes are based on those identified in the General Dental Council’s ‘The First Five Years’ 2002 and are graded using the definitions within that document. They represent broad general outcomes of the course in Basic and Applied Systemic Human Disease. To help you achieve these outcomes, specific learning outcomes are identified within the individual topic areas of the syllabus. Be competent at: students should have a sound theoretical knowledge and understanding of the subject together with an adequate clinical experience to be able to resolve clinical problems encountered, independently, or without assistance. Have knowledge of: students should have a sound theoretical knowledge of the subject, but need have only limited clinical/practical experience. Be familiar with: students should have a basic understanding of the subject, but need not have direct clinical experience or be expected to carry out procedures independently.
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Be competent at Have knowledge of Be familiar with
• taking a clinical and medical history
• undertaking a basic physical examination of the clothed patient and recognising clinical signs of systemic disease
• carrying out resuscitation techniques which will include: - immediate management of cardiac arrest
-anaphylaxis - steroid [Addisonian] fsdfsshock - upper respiratory
obstruction, inhalation or ingestion of foreign bodies
-immediate management of ‘collapse’ and vasovagal attack
• the management of dental haemorrhage and the warfarinised patient
• the management of diabetic coma
• the management of acute angina
• the prescription of drugs appropriate to particular clinical situations
• knowing when, how and where to refer a patient for general anaesthesia
• managing fear and anxiety with behavioural techniques and empathise with patients in stressful situations
• liaison with, and referral to, other healthcare workers
• scientific principles of sterilisation, disinfection and antisepsis
• systemic disease that impacts on the dental management of the patient, its relevance, implications and actions required to minimise adverse events
• the oral and para-oral manifestations of underlying systemic disease
• the pharmacological properties and side effects of those drugs used in general practice
• the pharmacological properties of drugs used in the management of non- dental conditions that impact on the dental management of a patient
• the diagnosis and management of medical emergencies including the use of appropriate emergency drugs and intravenous techniques
• inhalational and intravenous conscious sedation techniques
• the pathological features and dental relevance of common disorders of the major organ systems
• the role of therapeutics in the management of patients requiring dental treatment
• the general aspects of medicine and surgery
• the main medical disorders that may impinge on dental treatment
• commonly used clinical investigations including blood tests and imaging techniques
• the work of healthcare workers, including newer remits – physician assistants; specialist nurses and nurse prescribers
• the place of dentistry in the provision of healthcare
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Assessment of the Systemic Human Disease Course All students must familiarise themselves with the detailed examination regulations. These are published separately and students are responsible for ensuring that they fully understand these regulations. The course is assessed at the end of spring term (11) of 4
th year.
Supplementary examinations to be completed in the summer term (12) of 4
th year for unsuccessful
candidates. Marks will be returned individually for each of the six sections of the examination
March - 4th BDS exam
1) Infection 30 MCQ and 20 extended matching set questions 2) Pathology 30 MCQ and 20 extended matching set questions 3) Pharmacology 30 MCQ and 20 extended matching set questions 4) Therapeutics 30 MCQ and 20 extended matching set questions 5) Medicine and Surgery 60 MCQ and 40 extended matching set questions 6) Human Disease Clinical Viva: 8 minutes taking focused histories from a simulated patients (actors) observed by the examiners, followed by a 10 minute structure viva on medical and surgical topics. If the examiners deem a student to be clinically unsafe as a result of their performance in the Medicine or Surgery clinical viva, then that student shall fail this section of the 4
th BDS examination
outright. The examiner or their representative will be required to support their decision at the appropriate examination board. A student will be deemed ‘clinically unsafe’ if their knowledge and understanding as demonstrated in the viva, could, in a clinical situation, potentially harm a patient. All students will be trained in CPR during 4
th year and are required to pass the phase test.
DOCUMENTATION FROM THE PHASE TEST MUST BE FORWARDED TO RITA GOVINDBHAI-WOODSTOCK AT THE END OF THE RESUSCITATION PHASE.
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Systemic Human Disease Course - Preamble This contents syllabus and outcomes is intended as a guide for dental students studying the Systemic Human Diseases Course - Infection, Pathology, Medicine, Surgery, Therapeutics and Pharmacology. The following points should be borne in mind. 1. The amount of writing on a particular topic does not of itself necessarily reflect the amount of
knowledge required on that topic. In particular, although all aspects of the syllabus and outcomes are quite comprehensive, those for Medicine and Surgery might be construed as being more detailed than those for Infection and Pathology. Hence, the syllabuses should be read in conjunction with the number and content of lectures and other classes in each discipline.
2. A number of topics are covered by more than one discipline. Hence there may appear to be
considerable overlap in some subjects, but these are approached from different specialist viewpoints and therefore will have a different focus.
3. Whereas the syllabus and outcomes are as up-to-date as possible, it should not be regarded as
axiomatic that every single topic and/or subject about which knowledge and understanding is required - and on which examination questions could be set - is covered. Again, lecture (and other class) content should be used as a guide to any such additional subject matter.
4. It is imperative that the six subject areas are not studied in isolation and they must not be
regarded as mutually exclusive. For example, Therapeutics is an integral part of Medicine and indeed much is taught under the ‘Medicine’ banner.
5. Practical Skills: as part of your course you will undertake practical skills in the following areas:
Management of Medical Emergencies, Venous Access & Patient Observations, and CPR. 6. The lecture course is available on the e-course. The e-course is available at:
www.dentistry.bham.ac.uk/ecourse. This information is continually updated. Each lecturer is asked to submit where possible:
A copy of the PowerPoint lecture A Text handout to accompany the lecture 10 Core facts to accompany lecture 3-4 SAQ’s and EMI’s to accompany the lecture
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Infection At the end of the course, students should be able to:
1. Describe and explain the differences between:
• Viruses and bacteria.
• Prokaryotes and eukaryotes.
• Unicellular and multicellular parasites.
• Fungi, protozoa and helminths.
Lecture: Introduction to the Microbial World
2. Demonstrate detailed knowledge and understanding of the various relationships between the host and infective agents, in particular:
• Describe the range of associations between humans and bacteria.
• Define the terms "commensal", "pathogen", "opportunist" and “immunocompromised”.
• Evaluate the role of the normal flora in maintaining health and causing disease.
• List the criteria used to judge whether a micro-organism isolated from a patient is likely to be the cause of clinically significant infection.
Lecture: How Microorganisms cause Disease
3. Demonstrate detailed knowledge and understanding of transmission of infection, notably:
• Modes of transmission of bacteria and viruses.
• Understanding the patterns of spread.
• Ability to define the terms “epidemic”, endemic”, “sporadic”, “nosocomial”.
• The epidemiological approaches used to study disease transmission.
Lecture: Prevention of Infection 1: Principles of epidemiology & infection control
4. Demonstrate detailed knowledge and understanding of pathogenic mechanisms in infection, in particular:
• How pathogenic micro-organisms gain access to the body.
• The molecular mechanisms underlying the pathogenesis of infectious disease, including how pathogens evade the immune response.
• Examples of acute and chronic, local and systemic and bacterial and viral infections.
Lecture: How Microorganisms cause Disease
5. Demonstrate knowledge and understanding of microbiological specimens in the laboratory diagnosis of infection, in particular:
• The various types of microbiological specimens that may be used.
• How these should be collected, stored and transported to the laboratory.
• The methods used in the clinical microbiology laboratory in the diagnosis of bacterial and viral infection, including microscopy, culture, sensitivity testing, serological and molecular biological approaches.
Lecture: Introduction to the Microbial World Tutorial: Collection, handling and examination of microbial specimens
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6. Demonstrate knowledge and understanding of how bacteria are classified. The following are essential elements of that knowledge:
• Classification of the major types of bacteria according to: - Gram’s-stain - morphology - atmospheric requirements (defining the terms “aerobe”, “anaerobe” and
microaerophilic”) - other cultural properties.
• Mode of transmission and their clinical effects in humans, with particular emphasis on their oral manifestations: Staphylococcus, Streptococcus, Corynebacterium, Clostridium, Actinomyces, Treponema, Neisseria, the enterobacteriaceae, Vibrio, Bordetella, Chlamydia.
Lecture: Introduction to the Microbial World
7. Demonstrate detailed knowledge and understanding of the major viral and fungal
infections that infect humans, in particular:
• Clinical features, mode of transmission, oral manifestations and implications in the management of the dental patient of the following infections:
herpes simplex virus herpes zoster virus cytomegalovirus Epstein-Barr virus poliomyelitis virus rubella virus mumps virus measles virus influenza virus human immunodeficiency virus hepatitis A, B and C viruses Candida albicans Cryptococcus neoforman Aspergillus fumigatus
Lectures: Introduction to the Microbial World
Viral Infections: an overview 8. Demonstrate detailed knowledge and understanding of the management of infections,
in particular:
• Indications for anti-microbial drugs.
• Principles and practice of anti-microbial chemotherapy.
• The concept of selective toxicity.
• Consequences of misuse of antimicrobials.
• Anti-microbial resistance - mechanisms and transmission.
Lecture: Treatment of Infection [See also Pharmacology]
9. Demonstrate knowledge and understanding of the principles of immunisation in
particular:
• Chemotherapeutic and immunological approaches to the prevention of infections.
• The principles of active and passive immunisation procedures.
• Prevention of the diseases produced by the pathogens listed in ‘7’ above.
Lectures: Prevention of Infection 1: Principles of epidemiology & infection control Prevention of infection 2: Immunisation [See also Pharmacology]
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10. Demonstrate detailed knowledge and understanding of infection control and asepsis, in particular:
• Prevention of cross-infection.
• The crucial role of hand washing, antiseptics, disinfection and sterilization and avoidance and management of needlestick injuries.
• Treatments applied to patients' mucosal and skin surfaces, to surgical instruments and to surfaces.
• The properties and uses of common disinfectants (alcohol, aldehydes, phenols, detergents and soaps, oxidising agents).
• Assessment of the effectiveness of antisepsis, disinfection and sterilization.
• Common pitfalls in the sterilization of dental instruments and materials.
• Issues associated with prevention of cross-infection with MRSA and prions.
Lectures: Prevention of Infection 1: Principles of epidemiology & infection control Tutorial: Practical aspects of infection control
11. Demonstrate detailed knowledge and understanding of respiratory infections, with
emphasis on:
• Viral and bacterial causes of sore throat.
• Classification of streptococci according to their patterns of haemolysis and capsular type.
• The aetiology and effects of rheumatic fever.
• The causes and complications of tonsillitis, rhinitis, sinusitis, pharyngitis, laryngitis, pertussis, diphtheria and bronchitis.
• The causes and complications of infectious mononucleosis and the diagnostic tests for it.
• The clinical manifestations and bacterial causes of lobar pneumonia, bronchopneumonia, aspiration pneumonia and lung abscess, with emphasis on their relevance to dental treatment.
• The role of sputum examination in diagnosis of respiratory tract infection. Evaluate risk of respiratory cross infection, especially in the dental surgery.
Lecture: Respiratory and gastrointestinal infections
12. Demonstrate knowledge and understanding of mycobacterial infections, in particular:
• The epidemiology, pathogenesis and clinical manifestations of tuberculosis (particularly in the oral cavity, head and neck) and how it may be controlled and treated.
• Drug resistant tuberculosis.
• The causes and effects of non-tuberculous mycobacterial infections especially in HIV-positive individuals.
Lecture: Tuberculosis and other mycobacterial infections
13. Demonstrate detailed knowledge and understanding of bacterial endocarditis, in
particular:
• The epidemiology, pathogenesis, diagnosis, clinical manifestations, prevention and treatment of bacterial endocarditis.
• The causative agents.
• The risk to dental patients with valvular and congenital heart disease.
• The principles and practice of chemoprophylaxis.
Lecture: Endocarditis and Septicaemia
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14. Demonstrate knowledge and understanding of gastrointestinal infections, with emphasis on:
• The epidemiology, pathogenesis, diagnosis, clinical manifestations, prevention and treatment of gastrointestinal infections.
• Common bacterial diarrhoeal diseases in the UK (Salmonella, Campylobacter, Shigella, E coli, Staph aureus. Cl perfringens) and on childhood gastroenteritis.
Lecture: Respiratory and gastrointestinal infections
15. Demonstrate detailed knowledge and understanding of viral hepatitis, with emphasis
on:
• The epidemiology, causes, clinical features and principles of management of hepatitis A, hepatitis B and hepatitis C.
• The prevention of cross infection in the dental surgery.
• Implications of the infected clinician.
Lecture: Hepatitis 16. Demonstrate knowledge and understanding of infections of the soft tissues, bones and
joints, with emphasis on:
• The epidemiology, causes, clinical features and principles of management of infections of skin, soft tissues, bones and joints.
• Tetanus.
• Bacterial infections of wounds and burns.
• Prevention of infection of surgical wounds and burns.
• The manifestations of skin infections in HIV/AIDS.
Lecture: Soft tissue and bone and joint infections
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Pathology
At the end of the course students should be able to:
1. Demonstrate detailed knowledge and understanding of inflammatory responses. The following are essential elements of that knowledge:
• The meanings of the terms 'acute' and 'chronic' in clinical and histological usage.
• The causes and main pathological features of acute inflammation.
• The vascular response and fluid exudates in acute inflammation.
• Cells involved in acute inflammation, their functions and histologic appearance.
• Pathogenesis of the acute inflammatory response
• Common examples of acute inflammatory conditions
• The possible sequelae of acute inflammation (including resolution, progression to chronic inflammation, tissue destruction and healing).
• The causes and main pathological features of chronic inflammation.
• Cells involved in chronic inflammation, their functions and histologic appearance.
• Pathogenesis of chronic inflammation
• The possible sequelae of chronic inflammation (including consequences of tissue destruction and healing, chronic inflammation as a potentially pre-neoplastic condition).
• Granulomatous inflammation [eg TB] as an example of a chronic inflammatory disease.
Lectures: Acute inflammation Chronic inflammation
2. Describe and demonstrate understanding of the ‘Cell Cycle’ and healing and repair processes in both soft and hard tissues, in particular:
• Normal cell turnover and control of cell division.
• Classification of tissues according to their potential for cell division.
• Classification of cells within tissues according to their state of cell division.
• The definitions of hyperplasia, hypertrophy, hypoplasia, atrophy.
• The definitions of metaplasia and dysplasia; dysplasia as a premalignant condition (in situ neoplasia); common examples of metaplasia and dysplasia illustrating their clinical consequences
• Mechanisms and causes of cell death by apoptosis and necrosis.
• The definitions of healing, repair and regeneration; their dependence on cell division.
• Granulation tissue: its nature, formation and outcome.
• Repair and regeneration exemplified in soft and hard tissues; healing of bone fractures.
Lectures: Cell turnover and disorders of cell growth Healing and repair, including bone healing
3. Demonstrate understanding and knowledge of basic vascular pathology and its effects on normal blood flow, in particular:
• Definitions of thrombosis, embolism, ischaemia and infarction.
• Relationship to other vascular diseases (e.g. atherosclerosis)
• Thrombosis: risk factors, causes and effects.
• Common examples of thrombosis (e.g. deep vein thrombosis, coronary artery thrombosis).
• Embolism: main types (thrombus, air, fat, tumour, other); causes and effects.
• Ischaemia – causes and effects
• Infarction – causes, evolution of pathological changes and effects
• Pulmonary embolism – pathogenesis and consequences
• Common examples illustrating complications of ischaemia and infarction (e.g. myocardial infarction, peripheral vascular disease). Lecture: Thrombosis, embolism and infarction
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4. Demonstrate detailed knowledge and understanding of the nature of neoplasia. The following are essential elements of that knowledge:
• The definition of neoplasia, including loss of normal control of cell growth and division
• Changes in cell morphology and cell division compared with normal cells.
• The classification of neoplasms according to behaviour (benign versus malignant neoplasms) and histiogenesis; other methods used to classify neoplasms
• The definitions of differentiation and histological grading and their clinical relevance for prognosis and treatment.
• The spread of malignant neoplasms - local invasion, distant metastasis.
• Metastasis – main routes of spread and their consequences
• Effects of tumours – local and systemic.
• The definition of staging; common examples of staging systems used (e.g. TNM, Dukes' staging) and their clinical relevance for prognosis and treatment.
• Examples of common benign neoplasms
• Examples of common malignant neoplasms (epithelial and non-epithelial)
Lectures: The nature and classification of neoplasms The spread and effects of tumours: staging and prognosis Benign neoplasms Malignant neoplasms I: epithelial tumours Malignant neoplasms II: non-epithelial tumours
5. Demonstrate knowledge and understanding of pathology of the respiratory tract. In
particular:
• Primary defence mechanisms of the upper respiratory tract.
• The aetiology, pathology and complications of rhinitis, sinusitis, pharyngitis and laryngitis.
• The pathology and effects of Wegener's granulomatosis and lethal midline granuloma.
• The aetiology and pathology of benign and malignant tumours of the paranasal sinuses, nasopharynx and larynx.
• The aetiology and pathology of bronchial carcinoma and mesothelioma.
• The aetiology, pathology and complications of lung infection - bronchopneumonia, lobar pneumonia, opportunistic lung infections and TB.
• The aetiology, pathology and complications of chronic bronchitis, emphysema, bronchiectasis, asthma, and bronchial obstruction (including inhalation of teeth, dental materials and instruments).
Lectures: Pathology of the lung
Pathology of the upper respiratory tract disease 6. Demonstrate knowledge and understanding of pathology of cardiovascular disease. In
particular:
• The causes and effects of atherosclerosis, especially effects on the heart.
• The effects of myocardial ischaemia; angina pectoris.
• The causes, effects and prognosis of myocardial infarction.
• The causes and effects of left and right heart failure; congestive heart failure.
• The causes of hypertension and its effects on the heart.
• The effects and complications of rheumatic heart disease; infective endocarditis.
• The functional effects of mitral, aortic, tricuspid and pulmonary valve disease.
• The effects and prognosis of congenital heart disease: e.g. septal and valvular defects.
Lectures: Cardiovascular pathology I: atherosclerosis & ischaemic heart disease Cardiovascular pathology II: other cardiovascular diseases
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7. Demonstrate knowledge and understanding of pathology of the gastrointestinal tract. In particular:
• Causes of dysphagia and oesophageal obstruction;
• Causes of oesophagitis; effects of reflux oesophagitis.
• Causes, effects and complications of gastritis; peptic ulceration.
• The aetiology and pathology of coeliac disease, Crohn's disease and ulcerative colitis.
• The classification, aetiology, spread, staging and pathological features of common tumours of the gastrointestinal tract.
Lectures: Pathology of the GI tract: oesophagus and stomach
Pathology of the GI tract: small and large intestines 8. Demonstrate knowledge and understanding of liver pathology. In particular:
• The role of liver biopsy in investigating medical liver diseases
• The classification, causes and consequences of viral hepatitis.
• The causes and consequences of chronic hepatitis
• The causes and consequences of fatty liver disease (alcoholic and non-alcoholic)
• Pathological features and other diagnostic findings in chronic cholestatic liver diseases (primary biliary cirrhosis, primary sclerosing cholangitis)
• The classification, causes and consequences of liver cirrhosis.
• Drug induced liver damage: predictable and idiosyncratic reactions; examples of common drug-induced liver lesions.
• The classification, aetiology and pathological features of common neoplasms of the liver (primary and metastatic).
Lecture: Pathology of the Liver
9. Demonstrate knowledge and understanding of renal pathology. In particular:
• The pathology of congenital and acquired renal disorders.
• Disorders of the renal circulation and acute renal failure.
• Immunological disease and the kidney.
• Tumours of the kidney.
Lecture: Renal disease
10. Demonstrate knowledge and understanding of bone pathology. In particular:
• The classification and effects of hyperparathyroidism.
• The classification, causes and effects of osteoporosis.
• The definition, causes and effects of osteomalacia and rickets.
• The effects, complications and prognosis of Paget's disease of bone.
• The classification, causes and effects of osteomyelitis (acute and chronic)
• The classification of bone tumours.
• Principles of the pathology of osteoma, chondroma, osteosarcoma, chondrosarcoma, Ewing's tumour and giant cell tumours of bone.
• Multiple myeloma as a bone tumour; its manifestation in the jaw and skull.
• Histiocytosis X; lesions in the jaw and skull.
• Metastatic bone tumours: their primary sites and distribution in the skeleton.
Lectures: Bone Pathology I: non-neoplastic diseases Bone Pathology II: neoplastic diseases
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11. Demonstrate knowledge and understanding of neuropathology. In particular:
• Cerebrovascular disease: cerebral infarction and intracranial haemorrhage (intracerebral, subarachnoid, subdural and extradural).
• Principles of the causation and effects of raised intracranial pressure.
• Cerebral infections: bacterial and viral meningitis, brain abscess, infections in immunocompromised patients, the prion diseases, e.g. Creutzfeld-Jacob disease and its variants.
• Degenerative diseases of the central nervous system and dementia: Alzheimer's disease, Huntington's disease, Parkinson's disease, motor neurone disease.
• Tumours of the central and peripheral nervous systems.
Lecture: Neuropathology
12. Demonstrate knowledge and understanding of pathology of the skin. In particular:
• The pathology of common inflammatory skin disease (dermatitis, eczema, psoriasis, lichen planus)
• Melanocytic naevi.
• Benign skin tumours (e.g.seborrhoeic keratosis, squamous cell papilloma).
• Malignant skin tumours (basal cell carcinoma, squamous cell carcinoma, malignant melanoma) – pathological features, spread and prognosis.
Lecture: Pathology of the skin
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Medicine
At the end the course students should be able to:
1. Demonstrate an understanding of the impact of disease in society
• The meaning of prevalence and incidence of disease. Comparison of relative frequencies in the World and the UK.
• The meaning of morbidity and mortality; those diseases giving rise to highest morbidity and mortality in the UK and globally.
• Economic and human costs of disease.
• The axiom that prevention is better than cure.
• The historical record: diseases that have been eradicated (e.g. smallpox), diseases that have been controlled (e.g. tuberculosis), diseases that recur (e.g. influenza), diseases that threaten (e.g. AIDS).
• Mechanisms of prevention, their efficacy and resistance to them. Vector eradication, nutrition and malnutrition; the role of education and culture.
Lectures: The frequency, incidence and geography of disease
Disease prevention and disease control
2. Demonstrate knowledge and understanding of childhood infections
• Common childhood exanthemata and their oral manifestations.
• Severe childhood infections including meningitis.
• The prevention and treatment of childhood infections.
• The concepts of bacteraemia and septicaemia.
Lecture: Infectious diseases of childhood
3. Demonstrate knowledge and understanding of genetic disease
• The distinction between genetic and developmental disease. Basic mechanisms of genetic disease; its persistence in the light of evolutionary theory.
• Genetic disease; probability and counselling. Examples of specific genetic diseases of significance to the dentist: haematological disorders (bleeding disorders, thalassaemias and sickle cell disease), osteogenesis imperfecta, neurofibromatosis, the basal cell naevus syndrome (BCNS), cystic fibrosis, Down's syndrome, congenital heart disease.
Lecture: Genetic Disease
4. Demonstrate knowledge and understanding of child abuse
• The meaning of 'abuse'; types of abuse; the legal definition of 'abuse'. Abusers of children.
• The responsibilities and rights of parents; the rights of children; rights and responsibilities of local authorities.
• Recognition of child abuse and what actions to take.
• The medical defence societies and the clinician in the context of suspected abuse.
Lecture: Child Abuse
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5. Demonstrate knowledge and understanding of health care delivery in the UK and the clinical process, in particular:
• Organisation of UK medical services. Primary, secondary and tertiary care.
• How to seek clinical advice and methods of patient referral.
• The objectives and principles of history taking and diagnosis.
• Communication skills.
• The significance of social history.
• Symptoms and signs, and how to elicit them.
• Clinical investigations.
• Interpretation of clinical information.
• The meaning and significance of prognosis.
Lectures: The clinical process: history taking & principles of patient examination Ward rounds and hospital attachments
Ethics [mainly taught in other modules within the BDS course]
6. Demonstrate clinical knowledge and understanding of respiratory tract disease, notably:
• Chest Infection
• Asthma: aetiology, clinical features; principles of prevention and management; treatment of severe acute asthma; local and systemic corticosteroids and their side-effects.
• COAD Chronic bronchitis and emphysema: incidence, causes, effects and management; the effects on respiratory function; general anaestheic considerations. Respiratory failure.
• Inhalation of foreign bodies, e.g. teeth, dental materials; necessity for immediate referral; effects, especially pulmonary collapse, segmental pneumonia and lung abscess.
• The law and occupational respiratory disease; responsibilities of employers and employees. Aerosols in the dental surgery and their significance for staff and patients; risks to atopic subjects. Occupational asthma.
Lecture: Obstructive airway disease and its management
Occupational lung disease
7. Demonstrate clinical knowledge and understanding of the cardiovascular system, in particular:
• The symptoms of heart disease: chest pain; dyspnoea; fatigue; palpitation; dizziness and syncope.
• The signs of heart disease: oedema; cyanosis; coldness of the extremities; finger clubbing.
• The measurement of pulse and blood pressure and their significance.
• Heart failure: aetiology; clinical features; diagnosis; complications; treatment.
• The significance of heart disease in dentistry; liaison with general and specialist medical practitioners in the dental management of patients.
• Ischaemic heart disease and angina: causes and prevention; treatment and prognosis. Myocardial infarction: aetiology, treatment and prognosis; emergency treatment; complications.
• Hypertension. Definitions, causes and diagnosis of essential, secondary and accelerated hypertension; clinical features and effects on the heart, brain and kidneys. Management of hypertension. Implications of hypertension for dental treatment.
• Sinoatrial disease, heart block and tachyarrhythmias; the significance for dentistry. The causes and immediate treatment of ventricular fibrillation and cardiac arrest.
• The definition, causes and clinical effects of mitral stenosis, mitral regurgitation, aortic regurgitation, tricuspid valve disease and pulmonary valve disease; the effects on cardiac function and the significance for dentistry.
• Rheumatic fever: its causes, clinical effects and complications.
• Infective endocarditis: its causes and prevention, recommended prophylactic drugs and regimes [see also therapeutics].
Lectures: Cardiac arrhythmia and valvular heart disease Ischaemic heart disease, hypertension and heart failure
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8. Demonstrate clinical knowledge and understanding of renal medicine, in particular:
Chronic kidney disease
• Common causes (diabetes/hypertension/vascular disease)
• Epidemiology of CKD
• Clinical findings and complications (anaemia, hypertension, renal osteodystrophy/calcium phosphate/vitamin D metabolism, bleeding tendency, impaired immune response, ischaemic heart disease)
• Awareness of dialysis and transplantation and therapeutic immunosuppression
• Be able to identify a patient with renal disease, dialysis, or renal transplant
• Renal indications for antibiotic prophylaxis
• Modification of drug prescribing according to renal function
• Effect of uraemia on oral tissues
Lecture: Chronic kidney disease
Renal Physiology
• Be aware of the kidneys’ role in water, sodium, potassium and acid/base homeostasis.
• Renal excretion of drugs and their metabolites and the effect of impaired renal function on drug metabolism.
• Dental Relevance
• Impaired drug excretion and modification of prescription
• Complications of CKD and increased risk for patients undergoing dental procedures
• Indications for antibiotic prophylaxis
• Dialysis patients - increased risk of carriage of blood borne viruses, anticoagulation
• Be aware of the management of patients on long-term steroid therapy
• Drugs causing gingival hyperplasia
Lecture: Renal Physiology
9. Demonstrate clinical knowledge and understanding of the gastrointestinal tract, in
particular:
• The oral cavity as part of the digestive tract.
• Aetiology, clinical features, principles of management, complications and mechanisms of malabsorption in inflammatory bowel disease [Crohn's disease and ulcerative colitis].
• Aetiology, clinical features, principles of management, complications and mechanisms of malabsorption in Coeliac disease.
• Oral manifestations and mechanisms of oral tissue damage in IBD and Coeliac disease.
• Anorexia as a symptom of disease, especially alimentary disease and hepatitis.
• Definition and causes of jaundice.
• The principles of liver function tests.
• Viral hepatitis: its epidemiology, aetiology, clinical features and complications; implications for the dental team.
• The aetiology, clinical features and complications of liver disease [Hypoalbuminaemia, portal hypertension, ascites and disorders of coagulation].
• Chronic active hepatitis and primary biliary cirrhosis; oral manifestations.
• The role of the liver in drug detoxification.
• The effects of liver disease on drug metabolism.
• The side-effects of drugs on the liver.
Lectures: Diseases of the Gastrointestinal Tract 1 – Dysphagia, peptic ulceration and coeliac disease Diseases of the Gastrointestinal Tract 2 – Inflammatory bowel disease and GIT malignancy Jaundice and liver failure
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10. Demonstrate clinical knowledge and understanding of endocrinology, in particular:
Diabetes
• Aetiology and classification of diabetes mellitus.
• Obesity; its incidence by age and social class in the Western World.
• Insulin-dependent and non-insulin-dependent patients.
• Clinical features of diabetes mellitus; the effects of hyper- and hypo-glycaemia.
• Chronic complications of diabetes mellitus: eye disease; neuropathy; renal disease; hyperlipidaemia; cardio- and cerebro-vascular disease; peripheral vascular disease; infections; arthropathy.
• Routine management of diabetes mellitus: diet, oral hypoglycaemics and insulin.
• Immediate management of diabetic emergencies.
• The dental management of diabetic patients: the risk of infection; healing; the dental care of patients with cardiovascular complications.
Lecture: Diabetes mellitus
Other Endocrine Disease
• The pituitary gland: effects of hypersecretion on endocrine functions; effects on oral tissues of gigantism and acromegaly.
• The thyroid gland: the causes and effects of hypo- and hyper-thyroidism; cardiovascular complications and their relevance to dental treatment.
• The adrenal gland: Cushing's syndrome; Addison's disease; Addisonian crisis - cause, prevention and management.
• Hyperparathyroidism: its causes, effects and oral manifestations.
Lecture: Other Endocrine diseases
11. Demonstrate clinical knowledge and understanding of the connective tissue diseases
• Aetiology, clinical features, principles of management, complications and orofacial aspects of rheumatoid arthritis and the other connective tissue diseases [SLE, systemic sclerosis, Sjogren’s syndrome].
• The vasculitides including temporal arteritis and its orofacial complications.
• The HLA complex and susceptibility to disease.
• Novel therapeutic strategies [e.g. cytotoxics; anti-TNF alpha and other monoclonal antibodies in the regulation of the inflammatory response].
Lecture: Rheumatology and the connective tissue diseases
12. Demonstrate basic knowledge and understanding of psychiatric and neurological
disease, in particular:
Psychiatry
• The classification of psychiatric disorders; principles of psychiatric assessment.
• Principles of medical management of persons with neurotic and psychotic disorders. Psychiatric emergencies: recognizing the suicidal patient; the epidemiology of suicide; suicide in the medical and dental professions.
• The epidemiology of stress, anxiety and depression.
• Stress, anxiety and depression as occupational hazards, especially in the dental profession. The clinical features and recognition of depression.
• Principles of the management of anxious patients; the dentist as counsellor; communicating bad news.
• Phobias, including dental phobia; hysteria.
• Obesity as a disorder of intake and as a symptom of disease. Obesity as a risk factor for disease and as a complicating factor in surgery.
• Anorexia/bulimia as psychiatric disorders: epidemiology, aetiology, clinical features and management.
20
Neurology
• Epilepsy: its definition and variants; [childhood, focal and generalized].
• Clinical features of epilepsy.
• Status epilepticus - immediate management. The causes, effects, recognition and management of raised intracranial pressure.
• Cerebrovascular accidents - Stroke and TIAs
Lectures: Neuroses and psychoses, including the eating disorders Stress, anxiety and depression Clinical neurology - Epilepsy and Cerebrovascular disease
13. Demonstrate clinical knowledge and understanding of dermatological disease and its oral manifestations:
• Definitions of papules, pustules, vesicles, bullae and boils.
• The classification, aetiology, symptoms and signs of dermatitis and eczema.
• Contact dermatitis; atopic dermatitis; urticaria.
• Skin infections: localised infections; manifestations of generalised infections;
• Aetiology, clinical features, including oral features, and management of papulosquamous diseases: psoriasis; lichen planus.
• Aetiology, clinical features, including oral features, and management of vesiculobullous diseases: erythema multiforme; pemphigus; pemphigoid; porphyria; epidermolysis bullosa.
• Cutaneous neoplasia [in particular basal cell carcinoma, malignant melanoma and squamous cell carcinoma]. (see also ‘Head and Neck Cancer Symposium’).
Lecture: Skin diseases
14. Demonstrate clinical knowledge and understanding of the ageing process, in
particular:
• Ageing as physiological and pathological processes; changes in metabolic rate and cell turnover; convalescence and wound healing.
• The signs and symptoms of advancing age: deteriorating senses; skin and mucosal changes.
• The demography of populations in the UK and worldwide by age; recent and prospective shifts in distribution in the UK.
• The effects on disease frequency, health care demands, drug demands and nursing care.
• Care of the aged in the community.
• Mental disorders of advancing age: dementia, Alzheimer’s. [see also Special Needs Module].
• Physical disorders of advancing age: vascular disorders; Parkinsonism, arthritides and immobility; ataxia; malignancy.
Lecture: Diseases of ageing
21
15. Demonstrate clinical knowledge and understanding of haematological disorders:
• Interpretation of the full blood count including red cell morphology.
• The signs and symptoms of anaemia.
• The aetiology, principles of diagnosis, laboratory tests for and clinical manifestations [including oral] of iron, folate and vitamin B12 deficiencies.
• Management of the deficiency anaemias.
• Haemoglobinopathies - sickle cell disease and thalassaemia; their genetics and molecular defects, rheological and haemolytic consequences. Diagnostic tests for homozygotes and heterozygotes. Dental management of patients.
• Investigation of bleeding diatheses. Hereditary disorders of blood coagulation. Dental management of haemophilia and von Willebrand's disease. Hereditary and acquired platelet defects. Vitamin K deficiency and other acquired bleeding disorders. Anticoagulants and oral surgery.
• Bone marrow disease including the leukaemias and lymphomas. The definition and effects of leucopaenia and leucocytosis. Investigations. Oral manifestations and dental management of patients with bone marrow disease. Management problems in the immunosuppressed patient. Stem cell transplantation and Graft versus Host Disease.
Lectures: The anaemias, including haemoglobinopathies
Understanding the full blood count – a series of clinical cases Bleeding disorders Leukaemias, lymphomas and other disorders of the bone marrow
16. Demonstrate clinical knowledge and understanding of obesity, notably:
• Definition of obesity – the body mass index (BMI)
• Measures of obesity
• Causes of obesity (genes Vs. environment)
• Prevalence of obesity
• Obesity associated co-morbidities (emphasis on the underlined): o Cardiovascular: hypertension, coronary artery disease, angina pectoris, congestive heart
failure o Cerebrovascular: stroke o Hyperlipidemia o Metabolic syndrome/type 2 diabetes o Cholelithiasis o Gout, uric acid nephrolithiasis o Osteoarthritis o Obstructive sleep apnea, hypoventilation o Hyperandrogenism, hirsutism, irregular menses, complications of pregnancy, stress
incontinence o Malignancies: breast, endometrium, colon, prostate o Increased surgical risk o Psychological disorders
• Current treatments for obesity including bariatric surgery o Medical management o Surgical management/bariatric surgery o Gastric band o Gastric bypass o Sleeve Gastrectomy
• Issues to consider with patient who has had bariatric surgery o Malabsorption o Malnutrition o Vitamin Deficiency
Lecture: Obesity
22
Surgery At the end of the course students should be able to: 1. Demonstrate detailed knowledge and understanding of legal issues, with emphasis on:
• Legal issues and informed consent for anaesthesia and surgery.
• Inter-personal professional relationships in surgery.
• Public perception of surgery and the surgeon.
• Response of the patient and relative to elective, emergency and palliative surgery including the relationship between psychological state and surgical success.
• Mechanisms of alleviating patient anxiety.
Lectures: Legal issues and consent including professional ethics and law update 2. Demonstrate detailed knowledge and understanding of neoplasia. The following are
essential elements of that knowledge:
• Growth and local and systemic spread of neoplasms.
• Diagnosis and assessment of the extent of malignant disease by clinical examination, imaging (including plain X-ray, computerised tomography, radio-isotope bone scan and magnetic resonance imaging) and tumour markers.
• Curative and palliative treatment.
• Principles of surgery, radiotherapy, chemotherapy and combination therapy.
• Assessment of prognosis for patients with malignancy with respect to morbidity and mortality.
• Role of the dental practitioner in the management of malignant disease. Lecture: Tumour growth, management and prognosis. 3. Demonstrate detailed knowledge and understanding of cardiac arrest & other dental
emergencies. The following are essential elements of that knowledge:
• Causes of cardiac arrest.
• Diagnosis of cardiac arrest and differentiation from respiratory arrest.
• Management of cardiac arrest including summoning help, airway maintenance, techniques of cardiopulmonary resuscitation, monitoring of attempted resuscitation, and defibrillation.
• Prognosis of cardiac arrest.
• Necessity for, and technique of, referral to hospital.
• Diagnosis and management of dental emergencies including acute asthmatic attacks, respiratory arrest, hypertension, hypotension and syncope, allergy and anaphylaxis, fainting, fits and epilepsy, and diabetic crises.
• Training, techniques, drugs, equipment and minimal legal requirements for the management of emergencies and resuscitation in dental practice.
• Importance of avoiding emergencies by obtaining a thorough medical history and seeking medical opinion.
Lecture: Cardiac arrest and other emergencies in the dental surgery Tutorial: CPR phase test
23
4. Demonstrate detailed knowledge and understanding of general anaesthesia, with emphasis on:
• Assessment of the patient for general anaesthesia including indications, contra-indications and complications.
• Preparation of the patient for general anaesthesia including the use of premedication.
• Choice of anaesthetic agents (inhalational, endotracheal, intravenous).
• Stages of general anaesthesia (induction, maintenance and recovery).
• Cardiovascular, respiratory and neurological monitoring during general anaesthesia.
• Principles of airway protection and the presentation and management of airway obstruction.
• General anaesthesia in dentistry – CMO/CDO 2000- “A Conscious Decision”, General Dental Council recommendations and medico-legal aspects.
Lecture: General anaesthetic techniques 5. Demonstrate detailed knowledge and understanding of pre-operative assessment and
post-operative care, with emphasis on:
• Pre-operative assessment of fitness for elective and emergency surgery and general anaesthesia with emphasis on age, co-morbidity, current medications, drug reactions, and previous history of surgery and anaesthesia.
• Post-operative care including airway maintenance, fluid administration, wound care, monitoring of vital signs, pain control and the importance of communication with patient, staff and relatives.
• Aetiology, pathophysiology, principles of treatment and prevention of common post-operative surgical complications including shock, pain, haemorrhage, infection, venous thromboembolism, dehydration, urinary retention, acidosis and alkalosis and chest complications.
• Relative responsibilities of the surgeon, anaesthetist and nursing staff in pre-operative assessment and post-operative care.
• Role of the High Dependency Unit and Intensive Care Unit.
Lectures: Pre-operative assessment and fitness for surgery and general anaesthesia
Post-operative care, recovery and complications 6. Demonstrate detailed knowledge and understanding of the mechanisms of pain and
analgesia. The following are essential elements of that knowledge:
• Causes, pathophysiology and types of pain.
• Psychology of pain including placebo effects of treatment and individual pain thresholds. Techniques to prevent pain including local anaesthesia, good surgical technique and psychology.
• Principles of pain relief and pain control by chemotherapy, psychotherapy, hypnotherapy and surgical methods.
• Causes, prevention and control of post-operative dental pain and trigeminal neuralgia.
• Intractable pain and the philosophy and success of palliative care techniques and Hospices. Lecture: Pain and pain control - principles of analgesic therapy
24
7. Demonstrate detailed knowledge and understanding of surgical wounds, haemostasis and infection. The following are essential elements of that knowledge:
• Definition and classification of wounds including the principles of design of surgical incisions and aesthetic considerations.
• Asepsis and aseptic techniques.
• Definition, classification, presentation and management of shock including haemorrhagic, hypovolaemic, septic, anaphylactic and cardiogenic shock.
• Physiology of normal and abnormal haemostasis (coagulation and fibrinolysis).
• Haemostasis in the surgical and accidental wound.
• Assessment of haemorrhagic tendency, haemorrhagic disease, and drugs that produce haemorrhage tendency with emphasis on the necessity for consultation and/or hospitalisation in the treatment of patients with bleeding diathesis.
• Methods of haemorrhage control including topical and systemic drugs and their contraindications and side effects.
• Manifestations of infection.
• Definition and causes of nosocomial infection including exogenous and endogenous infection. MRSA.
• Aetiology, management and prevention of post-operative surgical wound infection.
• Principles of treatment of surgical infection.
Lectures: The surgical wound and haemostasis and surgical and hospital infection
8. Demonstrate detailed knowledge of the management of the pregnant patient in the
dental chair. The following are essential elements of that knowledge:
• Changes in cardiovascular physiology secondary to pregnancy.
• Postural management.
• Anaesthetic management. Lecture: The pregnant patient and dentistry 9. Demonstrate detailed knowledge and understanding of postural disorders, with
emphasis on:
• Definition of posture and the role of bones, joints, musculature and nerves in correct posture.
• Classification of postural disorders (including congenital and acquired forms, and disorders in bones, joints, musculature and nerves) and the effects of incorrect posture.
• Recognition of the early stages of postural disorders, principles of management including physiotherapy, manipulation, surgery, alternative medicine.
• Significance of postural disorders as occupational hazards in dentistry.
• The recognition, effects and legal implications of repetitive strain injury. Lectures: Postural disorders
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10. Demonstrate detailed knowledge and understanding of trauma, with emphasis on:
• Causes of trauma such as accidental, iatrogenic and intentional injury.
• Assessment of the injured patient with respect to overt and occult injuries, surface and internal injuries, soft tissue and bony injuries.
• Principles of management of trauma with emphasis on maintenance of airway and ventilation, cervical spine control, control of bleeding and optimisation of circulation.
• Definition and diagnosis of brain stem death and the implication for organ donation.
• Aetiology and pathophysiology of the different types of head injury including superficial and soft tissue trauma, skull fractures, brain injury, intracranial haemorrhage and cerebrospinal fluid leakage.
• Presenting symptoms and signs and prognosis of different types of head injury.
• Assessment and treatment of head injuries.
• Management of the unconscious patient.
• Pathophysiology of cerebrovascular accidents and other causes of sudden loss of consciousness.
• Definition, aetiology and classification of burns.
• Management of a patient with burns in the early (analgesia, management of circulatory shock and prevention of secondary infection) and late phase (skin grafting).
• Definition, aetiology and classification of maxillo-facial injuries.
• Assessment, complications and treatment of maxillo-facial injuries. Lectures: The management of trauma Head injuries Burns Maxillo-facial injuries 11. Demonstrate basic knowledge and understanding of orthopaedic surgery, with
emphasis on:
• Principles of orthopaedic surgery.
• Classification of bone fractures and principles of fracture management.
• Complications of bone fractures including delayed healing, infection, fat embolism. Principles of the management of osteomyelitis.
• Principals of joint replacement.
• Principles of bone tumour surgery. Lecture: Orthopaedic surgery and bone fractures 12. Demonstrate detailed knowledge and understanding of ENT disease. The following are
essential elements of that knowledge:
• Definition and classification of ENT disease.
• Presenting signs and symptoms of ENT disease including deafness, tinnitus, aural discharge, nasal discharge, nasal obstruction and dysphagia.
• Definition, aetiology, pathophysiology and management of common benign ENT diseases including otitis, mastoiditis, sinusitis, tonsillitis, pharyngitis, nasal and antral polyps, and Plummer-Vinson syndrome.
• Definition, aetiology, pathophysiology and management of malignant ENT diseases including nasopharyngeal and laryngeal carcinoma.
• Definition, aetiology, pathophysiology and differentiation of congenital, genetic and developmental ENT diseases and disorders of the head and neck including cleft lip and palate, lympho-epithelial cyst, branchial fistula and thyroglossal duct cyst.
Lectures: Cancer of the head and neck ENT Surgery
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13. Demonstrate basic knowledge and understanding of ophthalmology, with emphasis on:
• Aetiology, classification, assessment and prevention of disorders of sight.
• Definition of eye-strain and blindness.
• Significance of eye disorders as occupational hazards (especially in dentists and computer operators) and the need for eye protection from foreign bodies, ultra-violet light and lasers.
• Basic principles of ophthalmic surgery.
• Oral manifestations of ocular disease/syndromes [Behcet’s, Reiter’s, mucous membrane pemphigoid]
Lecture: Ophthalmology 14. Demonstrate basic knowledge and understanding of plastic surgery, with emphasis
on:
• Scope of plastic surgery.
• Aetiology and classification of burns.
• Management of the local and systemic effects of burns including analgesia, management of circulatory shock, prevention of secondary infection and skin grafting.
• Types of wounds, complications and management.
• Principles of tissue grafting including skin, mucosa and bone.
• Principles of reconstruction of the face and jaws including soft and hard tissue reconstruction, aesthetic and functional considerations and prostheses.
• Role of the dentist in rehabilitation. Lecture: Plastic surgery 15. Demonstrate detailed knowledge and understanding of cardiac conditions requiring
surgical intervention and their implications to dental practice. The following are essential elements of that knowledge:
• Signs and symptoms of heart valve disease, the principles of surgical correction of mitral and aortic valve disease and the complications of prosthetic valve replacement.
• Causes and effects of ischemic heart disease, the principles and complications of coronary artery by-pass grafting.
• Indications, complications and prognosis for heart and heart-lung transplantation.
• Dental implications of the above conditions.
Lectures: Cardiac conditions requiring surgical intervention and their dental implications
16. Demonstrate basic knowledge and understanding of organ transplantation and
immunosuppression. The following are essential elements of that knowledge:
• Principles of transplantation including the requirement for organs and future prospects.
• Immunology of rejection and graft versus host disease and testing for compatibility.
• Principles of kidney transplant surgery including prognosis.
• Complications of immunosuppression including increased risk of cancer, viral and fungal infections, especially of the mouth, and gingival hyperplasia.
• Antibiotic prophylaxis for transplant patients.
• The ethics of transplantation surgery. Lecture: Organ transplantation, immunosuppression and graft versus host
disease
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Pharmacology
At the end of the course, students are expected to be able to demonstrate the following general outcomes:
1. Understanding of the mechanism of action of the various drugs encountered during the course and state the main adverse effects likely to be associated with their use.
2. Understanding of the implications of medication on the dental management of the patient. 3. Appreciation of how knowledge of the mechanism of action and adverse effects of a drug may
influence therapy.
1. The Pharmacology of Antimicrobial Drugs
• Knowledge of what is meant by “selective toxicity” of antibacterial, antiviral and antifungal drugs, and understand the various mechanisms by which it can be achieved.
• Awareness of the problems of superinfection and resistance that can occur during therapy with antimicrobial drugs, and understanding of the strategies by which these problems may be minimised.
Lectures: Antibacterial Drugs
Antiviral and antifungal drugs
2. Cardiovascular Pharmacology
• Understanding of the various pharmacological strategies for the control of blood pressure.
• Comprehension of the various mechanisms by which drugs can be useful in the treatment of cardiac dysfunction, e.g. in MI, angina, dysrhythmia, and chronic heart failure.
Lecture: Drugs and the cardiovascular system Tutorial: Cardiovascular drugs x 4 groups.
3. Respiratory Pharmacology
• Understanding of the various pharmacological strategies used in the treatment of asthma.
• Awareness of the types of drugs that can cause respiratory depression, and the mechanisms by which this occurs.
• Knowledge of the uses and adverse effects of oxygen therapy.
Lecture: Respiratory pharmacology 4. The Pharmacology of Anticoagulants and Platelet Inhibitors
• A good understanding of the processes of platelet aggregation and blood coagulation, of how these processes interact in haemostasis, and of how (and why) these processes can be inhibited by drugs.
Lecture: Anticoagulants and haemostasis
5. The Pharmacology of the Autonomic Nervous System
• Awareness of the structure, function and role of the autonomic nervous system.
• Understanding of the effects and clinical uses of drugs affecting the normal functioning of the parasympathetic and sympathetic nervous systems.
Lectures: Autonomic pharmacology 1
Autonomic pharmacology 2
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6. The Pharmacology of Anti-inflammatory Drugs
• Familiarity with the main types and clinical uses of the non-steroidal anti-inflammatory drugs, and the main differences between them.
• Comprehension of how the adverse effects of the non-steroidal anti-inflammatory drugs limit their usefulness.
• Familiarity with alternative pharmacological strategies that may supersede the use of the non-steroidal anti-inflammatory drugs.
• Understanding of the effects of the anti-inflammatory steroids and appreciation of how these effects are produced.
• Knowledge of the importance of the adverse effects of the anti-inflammatory steroids, and of how these effects may be minimised.
• Immunomodulators as anti-inflammatories [e.g. anti-TNF alpha drugs/cytotoxics]
Lectures: Non steroidal anti-inflammatory drugs Anti-inflammatory steroids
7. The Pharmacology of Adverse Drug Reactions
• Familiarity with the nature, mechanisms and consequences of systemic adverse drug events, and how they can be prevented.
Lecture: Systemic adverse drug reactions
8. The Pharmacology of Substance Abuse
• Understanding of the effects of alcohol and of how these effects are produced.
• Familiarity with the concepts of drug abuse, drug dependence, addiction and tolerance, and awareness of the factors that may contribute to these phenomena.
Lecture: Alcohol and drug abuse
9. Pharmacology of Psychoactive Drugs
• Knowledge of the mechanisms of action, effects and clinical uses of anxiolytic and sedative drugs.
• Knowledge of the mode of action of the various types of anti-depressant drugs, and their shortcomings, including implications for the management of dental patients and their use in dentistry.
Lectures: Sedative and anxiolytic drugs Antidepressant drugs
10. Tutorials: Chemotherapy x 4 groups.
29
Therapeutics
At the end of the course, students are expected to demonstrate detailed knowledge and understanding of the role and implications of therapeutic interventions in the management of patients requiring dental treatment. 1. Prescribing Considerations
• Principles of Rational Prescribing
• Ability to write valid prescriptions
• Sources of Drug Information (e.g. BNF)
• Proprietary and generic drugs.
• Prescribing guidelines and formularies
• Taking a medication history
• The law relating to administration of drugs - drugs that the dentist can administer and prescribe.
• The law relating to controlled drugs.
• Adverse drug reactions and drug interactions. Classification, nature and reporting.
• Allergic drug reactions – e.g. penicillins.
• Principles of weighing the benefits and disadvantages of drug administration.
• Oral side affects of drugs.
• Drug metabolism and liver disease.
• Drug addiction.
Small Group Tutorial: Introduction to Therapeutics Lectures: Drugs and the Law: drug abuse
The role and efficacy of drugs, adverse effects & drug interactions Adverse drug reactions and the oral mucosa
2. The Practical Application and Use of Medicines with Reference to Dentistry
• Anticoagulants and platelet inhibitors.
• Local and systemic corticosteroids and their side effects; cautions and contraindications in their usage.
• Dental management of the insulin dependent diabetic patient.
Lecture: Anticoagulants, Insulin and Steroids for the dental Patient
3. Analgesics in Dentistry
• Principles of analgesic therapy.
• Types of analgesics – centrally and peripherally acting; Opiates; NSAIDs, [COX2].
• Precautions and contraindications in prescribing.
• Adverse events. Lecture: Analgesics and pain management
4. Anti-infective Strategies in Dentistry
• Therapeutic and prophylactic interventions – indications and regimes.
• Principles of the drug treatment of bacterial, viral and fungal infections.
• Examples of specific drugs and specific diseases.
• Principles of the choice of antimicrobials: indications; regimes; cautions; contraindications; adverse events.
• Antibiotic policies. Economic and epidemiological strategy. [see Infection lectures]
Lectures: Therapy of systemic infection
30
5. Medical Emergencies Requiring Drug Intervention
• Hypoglycaemia
• Acute asthmatic attack
• Anaphylaxis
• Addisonian crisis
• [Cardiac arrest]
Lecture: Emergency drugs in the dental surgery
6. Drug Therapy of Cardiovascular Disease
• Drugs acting on the cardiovascular system: the myocardium and conducting tissue; anti-arrhythmics, vasodilators; diuretics.
• Classes of anti-hypertensive drugs [beta blockers, diuretics, Ca channel blockers, ACE inhibitors]
• Side effects of drugs used to treat cardiovascular diseases; their interactions with other drugs; contraindications.
• The significance of drugs used to treat cardiovascular disease in the management of the dental patient
Lecture: Treatment of cardiovascular disease
7. Drug Therapy of Respiratory Disease
• Drugs acting on the respiratory system. [Types of bronchodilators, corticosteroids, cromoglicate].
• Management of asthma and COAD.
• Local and systemic side effects of drugs used to treat respiratory diseases; their interactions with other drugs; contraindications.
• The significance of drugs used to treat respiratory disease in the management of the dental patient.
Lecture: Drug Therapy of Respiratory Disease
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READING LIST
Infection
Only one of the books on this reading list is needed as core reading for this course. The book which is closest to ideal for your course is Samaranayake, 'Essential Microbiology for Dentistry'. However, it is the most expensive. 1. S. Gillespie, K. Bamford. Medical Microbiology and Infection at a Glance. Blackwell Publishing, ISBN 1405152559. £18.99 2. C. Scully, S. Bain, J. Hamburger. Common Medical Conditions. Wiley-Blackwell, 2010. ISBN: 978-1405185936. £38.89
Pathology 1. Mcmohon R & Sloan P. Essentials of Pathology for Dentistry (2000). Churchill Livingstone
2. Robbins. Basic Pathology 8th ed. Saunders, 2007.
ISBN 1416029737 / 9781416029731. £47.99
3. Greenwood, Seymour, Meechan. Textbook of Human Disease in Dentistry ISBN: 978-1-4051-7033-8
OR
3. Underwood. General and Systematic Pathology 3rd ed. Churchill Livingstone, 2000. 0443062862. £37.95
Medicine
1. Kumar & Clark. Clinical Medicine, 5th ed. Bailliere Tindall, 2002. 0702020192. £39.99
2. Wray, Lowe, Dagg, Felix, Scully. Textbook of General and Oral Medicine. Churchill & Livingstone. 0443051895. £32.95
3. Scully and Cawson. Medical problems in Dentistry, Hardcover. £59.84
Surgery 1. Ellis & Calne. Lecture Notes on General Surgery, 9th ed. Blackwell, 1998. 0865427682. £15.95
OR
O.J. Garden, A.W. Bradbury, J.L.R. Forsyth. Principles and Practice of Surgery, 5th Ed
Churchill Livingstone, 2007
2. Hill & Morris. General Anaesthesia and Sedation in Dentistry, 2nd ed. Wright, 1991. 0723622191. £25.00 Pharmacology / Therapeutics 1. Rang, Dale, Ritter, Flower & Henderson. Pharmacology. 7
th Edition. Churchill Livingstone.
RRP. £45 2. Seymour, Meechan and Yates. Pharmacology and Dental Therapeutics. Oxford UP.
0192629522. 3rd
ed £32.50
3. BNF (British National Formulary)
General Purpose Revision Text 1. Sooriakumaran, Jayasena and Scully. Key Topics in Human Diseases for
Dental Students. Taylor and Francis, ISBN: 1-84184-435-7, £25.00
32
CORE TOPICS IN MEDICINE AND SURGERY The following subjects are regarded as “core” topics in Medicine and Surgery and are considered to be an essential knowledge requirement. In particular, students are expected to know the clinical implications of the conditions listed and actions that are required to ensure safe patient management in the dental context. Although the topics have been divided into ‘Medical and Surgical’ this is arbitrary and it is acknowledged there is overlap. Poor knowledge and/or understanding of these topics in the Medicine/Surgery clinical or viva examinations will seriously compromise a student’s examination performance. Medicine: Clotting/bleeding diatheses Infections – Infective endocarditis /Hepatitis B Cardiac disease
Hypertension Anaphylaxis CPR
Respiratory failure Management of patients on corticosteroid therapy
Drugs and the dentist Diabetes Anaemias
Recognition and implications of serious underlying disease Sudden collapse in the dental surgery Oral manifestations of systemic disease Surgery: Diabetes and its implications for [oral] surgery Local anaesthesia Airway obstruction/aspiration Anticoagulants and [oral] surgery Suitability for outpatient anaesthesia Spread of infection/tumours The immunocompromised patient
Oral/head and neck cancer Oral surgery in the pregnant patient Management of medical emergencies and CPR
33
COLLEGE OF MEDICAL AND DENTAL SCIENCES
School of Dentistry
BBAASSIICC AANNDD AAPPPPLLIIEEDD SSYYSSTTEEMMIICC HHUUMMAANN DDIISSEEAASSEE CCOOUURRSSEE
[MEDICAL SCIENCES]
HOSPITAL ATTACHMENTS
&
CLINICAL PROCEDURES LOGBOOK
2013
34
HOSPITAL ATTACHMENTS and CLINICAL SKILLS TRAINING
There are hospital attachments scheduled in the 4th year of the course. These include:
CPR training Clinical Skills training Medical Emergencies History taking ward rounds Attachment to a district general hospital – 1 week residency to include an Introduction to Surgery These attachments provide an extremely valuable opportunity to gain experience in clerking patients, observing a variety of physical signs and also visiting various medical and/or surgical departments of particular interest to you. They also allow you insight into the workings of a district general hospital within the NHS. In addition, the General Dental Council undergraduate training document ‘The First Five Years’ requires Dental undergraduates to have some experience of attending Accident and Emergency departments and also the administration of intramuscular, intravenous and subcutaneous injections- IT IS ESSENTIAL THAT AT THE CPR TRAINING SESSION[S], WARD ROUNDS AND HOSPITAL ATTACHMENTS, THE APPROPRIATE BOXES ON THE RELEVANT ATTACHED FORMS ARE COMPLETED AND SIGNED BY THE SUPERVISING MEMBER OF STAFF. The General Dental Council expect dentists to be able to deal with medical emergencies and resuscitation in the dentist’s workplace. Training sessions covering these areas have been arranged via the Clinical Skills Lab and Resuscitation Service at University Hospital Birmingham NHS Foundation Trust. Each student will attend three sessions: Resuscitation: This is Hospital Life Support (HLS) training which includes the ABCDE approach to the sick patient, CPR, choking, basic airway management (including BVM ventilation) and AED use. Clinical Skills: Venous Access (Cannulation, IV injections and IM injections) and Patient Observations (BP – automatic and manual, pulse, temperature, respirations, oxygen saturations and blood glucose monitoring) Medical Emergencies: Anaphylactic reaction, hypoglycaemia, upper respiratory obstruction, fits, vasovagal attack, inhalation or ingestion of foreign bodies and haemorrhage There will be a workbook to accompany each session and at the end of each session you will be issued with a certificate confirming you have completed these areas.
35
Residential attachment to a district general hospital – A student guide. During the spring term of your 4
th Year course in Medical Sciences, the School of Dentistry has
arranged a week’s residence in a district general hospital. You will be allocated to a Consultant Oral and Maxillofacial Surgeon’s team. The purpose of this attachment is to allow you to undertake an introductory course in Surgery & Medicine, and to achieve a greater insight into in-patient care, particularly, but not exclusively, with regard to Surgery & Medicine in the district general hospital setting. It is expected that you should attend the following activities:
1. The Accident and Emergency department. [At least 2 sessions – evenings may be particularly useful]. 2. A Day Case Operating List. 3. Ward rounds. 4. A Medical Out patient clinics 5. A Surgical Out patient clinic 6. Patient Care via Ward Nurses.
The week in residence will also provide you with a potential opportunity to see an aspect of Medicine or Surgery that is of particular interest to you – ask your supervisor to see what can be arranged. In addition you should undertake the following procedures:
1. Measurement of blood pressure 2. Venous access 3. Subcutaneous injection 4. Intramuscular injection
YOU ARE REQUIRED TO COMPLETE THE RELEVANT SECTIONS IN YOUR MEDICAL SCIENCES LOGBOOK, INDICATING THE EXPERIENCE YOU HAVE GAINED. ALL ENTRIES MUST BE COUNTERSIGNED BY STAFF. YOU ARE ALSO REMINDED THAT THE TECHNIQUES LISTED ABOVE, TOGETHER WITH ATTENDANCE AT A CASUALTY DEPARTMENT, ARE A GENERAL DENTAL COUNCIL REQUIREMENT, STIPULATED IN THE ‘FIRST FIVE YEARS’ DOCUMENT.
Please remember that your supervisor will be very busy. Be helpful, show interest, ask questions and actively participate. Behave with professionalism at all times and be a good ambassador for the University of Birmingham School of Dentistry. What you get out of the week is very dependant on what you are prepared to put in, so make the most of this excellent opportunity and enjoy yourself.
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MEDICAL SCIENCES COURSE – 4TH YEAR REMOVED
1. History taking sessions [2 pages]
Please indicate in the boxes below the cases and physical signs observed together with the nature of any procedures undertaken
Date Hospital Tutor
Date Hospital Tutor
Date Hospital Tutor
37
History taking sessions [cont]
Please indicate in the boxes below the cases and physical signs observed together with the nature of any procedures undertaken
Date Hospital Tutor
Date Hospital Tutor
Date Hospital Tutor
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2. District General Hospital Attachment – Week in Residence [3 pages] NB – At least 2 sessions should be spent in A & E – evenings may be particularly beneficial
Student Name
Dates Supervising consultant
Depts. Attended Staff name and signature
Monday am
Monday pm
Tuesday am
Tuesday pm
Wednesday am
Wednesday pm
Thursday am
Thursday pm
Friday am
Friday pm
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District General Hospital Attachment – Week in Residence [cont] Student Name
You should undertake the following procedures Blood Pressure Ward Staff signature and date � � � � � � Intravenous access (day case or main theatre session) � � �
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District General Hospital Attachment – Week in Residence [cont] - Attendance at A & E department
Student name
List observations/procedures carried out in A & E e.g. resuscitation, incision and drainage,
List conditions observed in A & E e.g. MI, asthma, trauma
