Questions from the Readers

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Questions From ReadersThis week I am grateful to the two readers who wrote in regarding dental issues. Many patients often attend their GP with oral complaints, some of which a GP can treat, others which are better managed by a qualified dentist.

Questions From Readers

This week I am grateful to the two readers who wrote in regarding dental issues. Many patients often attend their GP with oral complaints, some of which a GP can treat, others which are better managed by a qualified dentist.

Question – I have been told I need a heart valve operation. I was expecting this as I have been under a specialist for years. They were watching it until it became bad enough that it needed an operation. What surprised me was that they wanted me to see a dentist before the operation – John, 73.

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Answer – The heart contains four valves, essentially doors between the chambers. They ensure that blood flows in the correct direction through what can be thought of as a one-way-system.

Problems with heart valves are picked up in two or more ways. They may be detected during a routine examination of the heart. If a person complains of breathlessness, the doctor or nurse treating them will listen to the heart and lungs, as part of the initial assessment.

It is important to state that not all murmurs are a sign of serious disease. When children are unwell for example with a viral illness, the increased blood flow will cause something called a “flow murmur.” When they become better, this murmur will disappear.

If a murmur is detected, the next step is to organise an echocardiogram. Colloquially known as a “Jelly Scan,” this is the same technology used to see babies in the womb.

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Some valves become narrow (known as stenosis) or leaky (regurgitation). A narrowed valve allows less blood to go in the correct direction. A leaky valve allows some blood to flow backwards, in the wrong direction.

Valves may only be minorly narrowed or leaky, and it may take years for them to progress to the point where the person is unwell, or needs surgery.

The point of having good dental hygiene is that an artificial valve is a foreign body. If bacteria from the teeth enter the bloodstream, they may end up on the valve. This is called seeding. This may cause the valve to fail, with potentially catastrophic consequences.

Maintaining good dental hygiene is very important, irrespective of whether you need a heart valve procedure.

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Question – Why is my GP so reluctant to treat a dental abscess. I really struggle to get a dentist appointment, and it also costs – Jake, 31

Answer – While I empathise with your predicament, it is important to say that most doctors are not dentally trained. The only ones who are, are usually maxillofacial surgeons, who have done dentistry first, then returned to university to study medicine. This speciality deals with complex disorders of the mouth and face.

Patients are usually referred to maxillofacial surgeons by either their GP, or dentist.

However, most general practitioners will not have any special training outside of what they learned at medical school.

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This does not mean that they will not be able to perform a robust assessment of your intra-oral health. GPs are trained to spot changes in the tongue, cheeks, hard and soft palate that may be suggestive of oral cancer, among other diseases.

Yet they are not trained to deal with dental conditions. Nor does their medical indemnity cover them, such that if a patient with a dental condition was mismanaged by a GP, this may be seen as medical negligence, rather than helping the patient.

There is also the issue of how to manage a dental abscess. A course of antibiotics may seem like a quick fix. Dentists will likely examine all the teeth, request x-rays as appropriate, perform a procedure to drain the abscess, and then see the patient at some point soon after. A course of antibiotics is only a tiny part of the management.

Having routine check ups with a dentist, will hopefully mean that your oral health will be better, that any changes including oral cancer are spotted very early and that issues like dental abscesses are avoided in the first place.

In addition, brushing and flossing, as well as the use of a non-alcohol containing mouthwash should be a part of your regular routine.

Dr Zakariya Waqar-Uddin

General Practitioner

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