Fundamentals of Treatment Planning. Lino Calvani
Antiparkinsonian.
22. Antipsychotics.
23. Antithyroid.
24. Antivirals.
25. Anxiolytics/sedatives.
26. Asthma preventives.
27. Bronchodilators.
28. Calcium-affecting drugs.
29. Cancer chemotherapeutics.
30. Cardiovascular drugs.
31. Central nervous system stimulants.
32. Decongestants.
33. Diuretics.
34. Glucocorticoids.
35. Gallstone drugs.
36. Solubilization medications.
37. Hemorheological medications.
38. Immunomodulators.
39. Immunosuppressants.
40. Methylxanthines.
41. Nicotine cessation drugs.
42. Ophthalmics.
43. Systemic retinoids.
44. Salivary stimulants.
45. Skeletal muscle relaxants.
46. Vitamins.
Fever and hyperthermia
Fever and hyperthermia, which are also signs and symptoms in dental medicine,75 have different causes and should therefore be carefully investigated in order to make a proper differential diagnosis.76
Hyperthermia is an increase of body temperature beyond 100.4°F (38°C) due to either an external heat increase in the environment or internal sources such as excessive intake of hot beverages; physical muscle activity; hyperthyroidism; use of drugs such as interferons; excessive use of drugs such as atropines, antiepileptic drugs, and phenothiazines; or due to intoxications caused by aspirin, antibiotics or carbon monoxide. These aspects need to be identified during the examination if we are faced with an unclear increase in a patient’s body temperature.77-79
Fever, on the other hand, is an increase in body temperature beyond 98.6°F (37°C). This clinical sign is a very important indicator of a possible disease or condition that needs to be identified and healed.80 The presence of fever means two things: one negative and one positive. First, it indicates that the body is reacting to a pathogen, which is a negative sign and a warning of a present invasive problem. Second, it indicates that the body is reacting to such a pathogen, which is a positive sign because it indicates that the host’s defense system is functioning healthily.
Fever induces an overall increase in lymphocyte activity, leucocytes migration, phagocytosis, natural interferon production, and plasmatic iron.81 It must be assessed to understand its causes. Furthermore, although it needs to be respected, we should not try to eliminate it completely as it is an important signal of something being wrong; instead, we should try to lower it, and then only if it creates discomfort for the patient.
Fever caused by ear, nose (sinusitis), and other oropharyngeal infections often occurs and may be confused with fever caused by dental or periodontal problems.
Fever in dental patients may mean an infection somewhere, and its origin may indeed be found in the mouth. However, even if this is the case, it may not necessarily be due to a localized dental or periodontal problem, but rather to a bacterial infection that originated intraorally and afterwards created infective foci elsewhere in the body. An example of this is infective endocarditis (IE), which is ‘silent’ until the disease is evident.82 Many oral microbiota are responsible for IE and many other infections, the main symptom of which may be even a slight fever. They are all associated with the most common routine activities such as toothbrushing, flossing, and chewing. Therefore, during the chairside physical examination, we need to make a differential diagnosis between an occurring general infection, an oropharyngeal infection, a dental infection, and the side effect of a drug. The collection of patients’ data and findings is fundamental to ascertain how all these aspects are related.
Both young and elderly patients are particularly vulnerable to fever as their immune systems are either not fully developed or becoming deficient. Moreover, prosthodontic patients are often elderly.75,83-86
In case of a fever, detecting the source of infection is fundamental during the physical head and neck examination and diagnosis, as many viral and bacterial infections begin in the oral cavity; therefore, the oral cavity should be the first point of treatment to control the pathogens and prevent their spread.82,87
Consultation with the patient’s physician may be necessary to determine susceptibility to bacteria-induced infections (such as IE), and specific antibiotics are recommended for all dental procedures involving manipulation of the gingival tissue or the periapical region of teeth in this type of patient.
Therefore, behind the simple symptom or sign of even a slight fever there might be a number of causes that need to be assessed to arrive at a correct diagnosis.
Semiotics and dental semiotics
The word semiotics derives from the Greek sēmeiōtikos meaning ‘observance of signs’, from sēmeion, which means ‘sign or mark’. The word was originally used prior to 1676 by Henry Stubbes to define that branch of medical science that studies the interpretation of body signs.88
Humans (like all animals) naturally relate to the environment through the five senses of sight, touch, hearing, smell, and taste. We do this for two main reasons: food and reproduction.89 Since humans have the capacity for intellect (consciousness), their senses are not as highly developed as in other animals. Despite this, our five senses still serve the survival purpose for which they were intended.90
The sense of taste was once used in medicine to establish the characteristics of certain secretions and excretions. For instance, in 1675 the British physician, Thomas Willis, coined the name ‘diabetes mellitus’ (mellitus is Latin for honey) because he made his diagnosis by tasting the patients’ urine, which in the case of this disease is sweet. Obviously and fortunately, this is no longer the way we test for the presence of this disease clinically and in the modern laboratory!
Since we are aware that we already naturally use our senses, we must become experts at using them when meeting and examining our patients and collecting clinical information. It follows that it has become a natural process to observe and study the best way to use our senses when performing patient examinations.4,6,91 The diagnostic action of using our senses has been formally