Dento-legal medicine

Abstract

Dento-legal medicine concerns both medical and dental practitioners in that they both have a duty of care to a patient to provide appropriate examination, investigation, diagnosis and treatment, or referral to a specialist, of oral conditions. All health-care professionals must take a comprehensive medical/dental history and keep complete and accurate records. They must provide this service at a minimum standard as would be expected by the average well-trained practitioner and as decided by the relevant medical or dental board. In the case of a medical practitioner, he/she would be expected to know the basic structures of the oral cavity, how normal (healthy) structures should appear, and to recognize abnormality. If the abnormality is of the dentition (teeth) or periodontium (gums), then immediate referral to a GP dentist is appropriate. If the abnormality is with the soft tissues (including tongue and cheeks), then a specialist oral surgeon or oral pathologist should be consulted. A doctor must be aware of and warn the patient of any oral side effects of a diagnosed systemic condition (e.g., diabetes) or medications prescribed (e.g., antidepressants). A dentist must take a thorough medical history (including all medications) and refer to or consult with an appropriate medical practitioner, particularly where he/she suspects oral side effects of medical treatments or medications. A dentist must be aware of the oral signs of common systemic medical conditions and refer to the patient’s managing GP with an appropriate covering letter of referral. The dentist has a duty of care to follow up the patient’s medical management after referral. The dentist has a duty of care to refer all oral pathology where diagnosis or treatment is not within his/her capability/training, to the appropriate dental specialist. A dentist must keep sufficient records (including OPG X-ray) to enable forensic or criminal identification. All healthcare professionals may be called upon to provide a medicolegal report and need to be familiar with the process.