Faculty Bibliography

The practice of modern craniomaxillofacial surgery has been defined by emergent technologies allowing for the acquisition, storage, utilization, and transfer of massive amounts of sensitive and identifiable patient data. This alone has thrust providers into an unlikely and unprecedented role as the stewards of vast databases of digital information. This data powers the potent surgical tool of virtual surgical planning, a method by which craniomaxillofacial surgeons plan and simulate procedural outcomes in a digital environment. Further complicating this new terrain is the involvement of third-party contractors-a necessary presence in bringing raw data to bear in the office, virtual space, and operating room. The individual privileges and responsibilities of patients, providers, and vendors towards data are situated within the most recent U.S. court rulings and regulations. This paper offers guidance for overseeing the safe and responsible transfer to third-party contractors, and provides suggestions for negotiating the trinary relationship between physicians, their patients, and the vendors offering this transformative technology.

Purpose: Currently, indications and algorithms for oral and dental clearance prior to transplant and cardiac surgeries can be cryptic for referring surgical teams. Care coordination and timing is often suboptimal. Our group has subsequently devised an algorithm for patients to receive oral health clearance prior to relevant surgical and medical therapies, streamlining the process for the patient, referring transplant team, and dental/OMFS team.
Background(s): In a multitude of health circumstances, patients are asked to receive pre-treatment oral health clearance. Related literature on efficacy and appropriate delivery is often sparse and/or inconclusive. Patients planned for cardiac surgery, solid organ transplant, bone marrow transplant, radiation therapy, and immunologic drugs are often asked to procure dental evaluation and "clearance" prior to treatment. Arguably, the most vulnerable populations include heart transplant patients, whom are also placed on postsurgical immune-suppressive therapy, and those undergoing cardiac valve replacement, at risk for subsequent endocarditis. These patient groups often present with poor dentition, notably including periodontitis and apical periodontitis, which both have been associated with postoperative infections and unfavorable surgical outcomes.
Method(s): Our group has developed a presentation to be delivered to an interdisciplinary group of physicians, nurse practitioners, and physician assistants, comprising teams of cardiothoracic surgery, transplant surgery, hematology-oncology, radiation oncology, and internal medicine. The goals are to increase knowledge about dental clearance's importance, and to expedite the process of receiving care. Additionally, the authors have developed a corresponding "dental pathway" within our hospital's electronic medical record (EMR) system to expedite clearance, as well as to increase compliance with presurgical dental clearance. Topics discussed in the presentation include pathways of transmission, the clearance process for inpatients, the separate process for clearance in outpatients, as well as a discussion on what occurs during a clearance visit.
Conclusion(s): The presentation created aims to increase interdisciplinary health care providers' background on oral health clearance. A topic that is often esoteric to other medical providers, the authors have devised a simple avenue to provide insight into the topic. Furthermore, our EMR pathway will provide coordinated collaboration between medical and dental providers, hopefully fostering effective and efficient oral health clearance prior to relevant surgical therapies. References: 1. Allareddy V, Elangovan S, Rampa S, et al. Presence of Gingivitis and Periodontitis Significantly Increases Hospital Charges in Patients Undergoing Heart Valve Surgery. J Mass Dent Soc. 2015; 63: 10-16. 2. Goldman KE. Dental Management of Patients with Bone Marrow and Solid Organ Transplantation. Dental Clinics of North America. 2006:659-676. 3. Meyur U, et al. Heart Transplants - Assessment of Dental Procedures. Clinical Oral Investigations. 1999 Jun;(3)2:79-83. 4. Souza AF, et al. Dental Management for Patients Undergoing Heart Valve Surgery. Journal of Cardiac Surgery. 2017;32:627-632. 5. Strojan P, et al. Treatment of Late Sequelae After Radiotherapy for Head and Neck Cancer. Cancer Treat Rev. 2017 September;59:79-92. 6. Smith MM, et al. Morbidity and mortality associated with dental extraction before cardiac operation. Ann Thorac Surg, 97 (2014), pp. 838-844. 7. Sollecito, Thomas P., et al. The Use of Prophylactic Antibiotics Prior to Dental Procedures in Patients with Prosthetic Joints. The Journal of the American Dental Association, vol. 146, no. 1, 2015,. [Figure presented] [Figure presented] [Figure presented]
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