A government dental doctor has flagged the Indian Dental Association (IDA), saying most dental surgeons, unlike general physicians and surgeons, do not prescribe viral markers and other important blood investigations before doing a procedure, risking the patients and themselves.
In an e-mail to the national IDA president and secretary on Sunday, Dr Jyotirmay Singh, associate professor, department of orthodontics and dentofacial orthopaedics, Patna Dental College and Hospital, said an average of two out of 10 dental surgeons were advising blood investigations before a simple tooth extraction or any other dental procedure.
“HIV (to check for AIDS), HBsAg (hepatitis B), HCV (hepatitis C), bleeding and clotting time (time taken for blood to clot during surgery), prothrombin time or PT (to detect a bleeding or excessive clotting disorder) are essential investigations a dental surgeon must prescribe before any procedure. Not doing tests for HIV/AIDS and hepatitis may lead to spread of infection arising out of a cut in the gums and put at risk the doctor and other patients through contaminated equipment,” said Dr Singh.
Similarly, blood sugar (affects the healing of wounds), thyroid profile and complete blood count (to check haemoglobin, platelets, white blood corpuscle levels, etc. for other chronic diseases or long-term oral infection), are equally important, Dr Singh added.
“A simple tooth extraction procedure may require blood transfusion or even be fatal if the blood sugar, blood pressure, PT, bleeding and clotting time parameters are deranged. However, most dental surgeons, at best, prescribe teeth X-ray before doing a procedure like a root canal treatment along with cap and bridge, scaling (teeth cleaning) and deep curettage (cleaning of gums), etc.” added Dr Singh.
He urged the IDA to disseminate information about the importance of these tests among its members.
By not prescribing such blood investigations, most dental surgeons were risking themselves and their patients of serious complications, said Dr Shivendra Choudhary, professor and head, dentistry department at the Patna Medical College Hospital (PMCH).
“At least 60% dentists in the state lack awareness and do not go for proper work-up by prescribing blood tests before a procedure. We do it at PMCH,” he said.
“Some doctors, in private setup, do not want to miss patients by prescribing a battery of tests, which pinches a patient’s pocket because the investigations are expensive. I have personal experience of patients not returning to me for a procedure after consulting me when I have prescribed them essential blood tests. From doctors’ ethics, personal and patient safety, dentists need to follow a protocol and prescribe blood investigations before doing any oral intervention. Patients will come to terms with it when all doctors follow the protocol,” said Dr Choudhary.
Dr Nimmi Singh, associate professor, oral medicine and radiology department of dentistry at the Indira Gandhi Institute of Medical Sciences (IGIMS), also regretted the lack of awareness among dentists.
“Many patients referred to our centre from rural areas are not prescribed viral marker or blood tests. However, at IGIMS, we insist on these tests, along with rapid antigen or real-time polymerase chain reaction (RT-PCR) for Covid-19, as dental surgeons are most prone to airborne and blood-transmitted diseases,” she said