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III BDS GENERAL MEDICINE Curriculum - (Final after NMC meeting) - TU BDS Syllabus


General Medicine
Allocation of teaching hours

Unit I
Unit II
Total
Theory
Clinical/Practical
Theory
Clinical/Practical

30
45
30
45
150

Unit I
Learning objectives
Students should be able to:
1.     Learn basics of Medicine, its fundamentals and apply it during clinical practice.
2.     Know common infectious diseases, identify their signs and symptoms, their implication in dental surgery and their management.
3.     Identify different Gastrointestinal disorders their signs and symptoms, their impact in dental surgery and their management.
4.     Have knowledge of common cardiovascular diseases that presents in their daily practice, their impact in dental surgery and impact of dental procedures in the cardiovascular diseases. Identification of cardiovascular disease of dental importance and their effective management, counseling and referral to specialist.
5.     Have knowledge of common respiratory diseases their presentation in daily practice, their impact in dental surgery. Identification of respiratory disease of dental importance and their effective management, counseling and referral to specialist.

Unit I
Introduction to Medicine                                                                              1 hr
·       Aims of Medicine
·       Define signs, symptoms, diagnosis, differential diagnosis, treatment and prognosis
·       Knowledge about history taking, physical examination, diagnosis and management

Infectious Diseases                                                                                        8 hrs
·       Enteric fever    [1hr]
            Introduction, etiology, clinical features, differential diagnosis, complications, diagnosis andmanagement
·       HIV/AIDS         [1hr]
Causative agent, AIDS classification, transmission, clinical features and oral manifestations, diagnosis and treatment
·       Herpes simplex and Herpes zoster     [1hr]
Causative agents, clinical features, diagnosis and treatment
·       Malaria            [1hr]
Introduction, causative agents relevant to region, clinical features, complications, diagnosis and management
·       Viral Hepatitis [1hr]
Causative agents, transmission, clinical features, diagnosis and treatment
·       Tuberculosis   [1hr]
Introduction in general and pulmonary tuberculosis, epidemiology, causative agents, clinical features, diagnosis, complications, MDR/XDR and management introducing DOTS
·       Dengue/Chinkungunya           [30mins]
Causative agents, clinical features, transmission, diagnosis and treatment
·       Tetanus           [30mins]
Causative agent, clinical features and management
·       Influenza A, B  (Bird flu and swine flu)           [1hr]
Causative agents, clinical features, transmission, diagnosis and treatment

Gastro Intestinal System                                                                               6 hrs
·       Stomatitis and gingival hyperplasia   [1hr]
Introduction, causes, clinical features and treatment
·       Dysphagia and Acid Peptic Disease    [1hr]
Introduction, causes, clinical features, diagnosis and treatment
·       Chronic Hepatitis and cirrhosis of liver          [1hr]
Definition, causes specially focusing on alcoholic cirrhosis, clinical features and stigmata of cirrhosis of liver, diagnosis, complications and management
·       Anasarca and Ascites              [1hr]
Definition, causes, pathophysiology of portal hypertension, diagnosis and treatment
·       Acute Gastroenteritis (Diarrhoea, Dysentry) and Helmenths [1hr]
Introduction, causes, clinical features, diagnosis, complication and treatment including emergency management
·       Hepatotoxic Drugs      [1hr]
Common hepatotoxic drugs, drugs used in dental procedures, clinical features, diagnosis and management

Cardiovascular System                                                                                   9 hrs
·       Acute Rheumatic fever and Rheumatic heart disease           [2hr]
Introduction, causative agents, pathophysiology, clinical features, diagnosis and diagnostic criteria, complication and management including secondary prophylaxis. Involvement of Mitral valve (MS and MR) and Aortic Valve (AS)
·       Hypertension  [1hr]
Introduction, pathophysiology,stages, causes and management
·       Ischemic heart disease           [1hr]
Introduction to ACS, IHD, risk factors, clinical features, diagnosis and management
·       Infective endocarditis [1hr]
Causative agents, clinical features, diagnostic criteria, dental implication and prophylaxis and treatment
·       Common Arrhythmias [2hr]
Sinus bradycardia, Sinus tachycardia, Tachy-arrhythmias (AF, VPCs) - Definition, common causes, ECG features, clinical co-relation, treatment
·       Congenital Heart Diseases      [1hr]
Introduction to cyanotic and acyanotic congenital heart disease. Brief elaboration of Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), their clinical features, diagnosis, dental implications and management
·       Congestive Heart Failure        [1hr]
Introduction, causes, clinical features, diagnosis and management

Respiratory System                                                                            6 hrs
·       Applied anatomy and physiology of Respiratory system       [1hr]
·       Acute Respiratory Tract Infection/ Pneumonia         [1hr]
Introduction to URTI, LRTI and Pneumonia, etiological agents, classifications, clinical features, diagnosis, complications and management
·       Obstructive Airway Disease                [2hr]
Introduction to Chronic Obstructive Pulmonary Disease (COPD) and Bronchial Asthma, clinical features, diagnosis, complications, dental implications and management
·       Pulmonary Embolism [1hr]
Introduction, causes, clinical features, diagnosis and management.
·       Suppurative Lung, Lung Abscess and Aspiration Pneumonia             [1hr]
Definition, causative agents and dental implications, clinical features, diagnosis and treatment





Unit II
Learning objectives
Students should be able to:
1.     Know common haematological manifestation of dental importance, identify their signs and symptoms, their implication in dental surgery and their management.
2.     Deal with Renal diseases of common importance, their signs and symptoms, their implication in dental surgery and their management.
3.     Understand the dental importance of neurological diseases and acknowledgetheir management.
4.     Understand different nutritional deficiencies and their oral manifestation with treatment.
5.     Know Endocrinological diseases, their clinical features, diagnostic evaluations, dental implications, complications and management.
6.     Identify the emergency conditions and perform some basic emergency life saving procedures at the end of the course.


Unit II
Haematology                                                                                     6 hrs
·       Anemia            [2hr]
            Introduction to anemia, classification and severity of anemia,causes of anemia and clinical features
Briefly describe about Iron deficiency anemia and Megaloblastic anemia, causes, diagnosis and management
·       Bleeding and clotting disorders          [2hr]
            Introduction to BT, CT, PT and different common bleeding and clotting disorders
Briefly describe about ITP, Hemophalias, vWD, clinical features, dental implications, diagnosis and management
·       Oral manifestation of hematological disorders         [1hr]
·       Generalized lymphadenopathy          [1hr]
            Clinical and theoretical approach to generalized lymphadenopathy

Renal System                                                                                      3 hrs
·       Nephritic and Nephrotic Syndrome               [1hr]
            Introduction, causes, clinical features, diagnosis, complications and management
·       ARF and CRF                [1hr]
            Definition, causes, clinical features, diagnosis, and management.
·       UTI and Pyelonephritis           [1hr]
            Introduction, causes, clinical features, diagnosis, complications and management



Central Nervous System                                                                                            4 hrs
·       Facial Palsy and Cranial Nerves          [1hr]
            Introduction to different cranial nerves focusing on Facial nerve, clinical examination of commonly examined cranial nerves and their disorders and management
·       Epilepsy           [1hr]
            Introduction to seizure, convulsion and epilepsy, classification, provocation factors, clinical features, diagnosis, status epilepticus and management
·       Headache including migraine and Trigeminal neuralgia        [1hr]
            Introduction, types, clinical features and management
·       Meningitis       [1hr]
            Define, types, causative agents, clinical features, diagnosis, complications and management

Nutrition                                                                                                                     3 hrs
·       Vitamin Deficiencies   [2hr]
Water soluble and water insoluble vitamins, daily requirements, sources, diseases due to their deficiencies and their dental implication, clinical manifestation, diagnosis and treatment
·       Oral manifestations of nutritional deficiencies          [1hr]
           
Endocrine                                                                                                       7 hrs
·       Diabetes Mellitus and Hypoglycemia [3hr]
            Definition, classification, diagnosis, clinical features, acute and chronic complication, management of disease and their complication
·       Thyroid disorders        [2hr]
            Hypothyroidism and Thyrotoxicosis, causes, clinical features, diagnosis, complications and management
·       Acromegaly     [1hr]
            Introduction, causes, clinical features and dental implications, diagnosis and management.
·       Calcium Metabolism and Parathyroids          [1hr]
            Calcium Hemostasis and hormones involved in maintaining it, it’s deficiencies and treatment

Critical Care                                                                                                    3 hrs
·       Syncope and Shock     [1hr]
            Definition, classification, clinical identifying features, immediate response during emergency, diagnosis and management
·       Cardiac arrest and Basic Life Support (BLS) training  [1hr]
            Introduction to cardiac arrest and BLS, theoretical and practical aspect of BLS
·       Allergy and Anaphylaxis         [1hr]
            Causes, clinical features, immediate response during emergency, diagnosis and management

Miscellaneous                                                                                                4 hrs
·       Adverse drug reaction and drug interactions [1hr]
            Definition, common drug reactions and interactions and their management
·       Emergency drugs        [1hr]
            Few emergency drugs like Adrenaline, Atropine, Hydrocortisone, Bronchodilators, and Dextrose. Their doses, uses and indications
·       Antiplatelets and Anticoagulants       [1hr]
            Classification of Antithrombotics, Aspirin, Clopidogreland Warfarin uses, mode of action, side effects, dental implications and management of complications
·       Tobacco and Alcohol related disorders          [1hr]
            Oral manifestation of tobacco and alcohol. Other complication of their misuse and their management



Hematologic Diseases ( Must Know Points)

Disease
Oral manifestation
Dental consideration
Anemia (most of them)
Petechiae, Spontaneous gingival bleeding, herpetic infection, glossitis, stomatitis, angular cheilitis, pale oral mucosa, oral candidiasis, RAS, erythematous mucositis, burning mouth.

·        Goal: establish and maintain good oral health, thus reducing the risk of an oral infection.
·        For patients who are severely neutropenic (neutrophil count <200/micro lit), prophylactic antibiotic and antifungal should be used and foods that may be contaminated with bacteria or fungal pathogens avoided.
·        Attention to details of oral hygiene and hand washing and avoidance of minor injuries and exposure to infectious agents can reduce risk of serious complications

Polycythemia vera
PV can manifest intraorally with erythema (red-purple color) of mucosa, glossitis, and erythematous, edematous gingiva.
Spontaneous gingival bleeding can occur because the principal sites for hemorrhage, although rare, are reported to be the skin, mucous membranes, and gastrointestinal tract.

·        Control of hemorrhage after dental surgery should be considered
·        Clinically significant bleeding may require platelet transfusion and a role for e-aminocaproic acid and tranexamic acid has been suggested by some. Other measures to consider in preparing the patient with PV for routine dental surgery include obtaining better control of blood counts by phlebotomy or drug therapy and adjustment of any concomitant antiplatelet and/or anticoagulant therapy.
Sickle cell disease
Higher risk of osteomyelitis (Salmonella and Staphylococcous Aureus.
Radiographic findings in patients with SCA include a “stepladder” trabeculae pattern (70%), enamel hypomineralization (24%), calcified canals (5%), increased overbite (30–80%), and increased overjet (56%). Patients may also have pallor of the oral mucosa and delayed eruption of the teeth.

The need for antibiotic prophylaxis is controversial.
Other management considerations for patients with SCA include maintaining good oral hygiene, routine care during noncrisis periods, aggressive treatment of oral infection, avoidance of use of aspirin, caution with respiratory-depressing conscious sedation, and avoidance of long, stressful dental visits. Use of nitrous oxide–oxygen for anxiolysis is safe, with maintenance of adequate flow rates.


Hematologic Diseases
(Few must know aspects)


Thalassemia
Radiographic features of jaws and teeth among people with thalassemia major include the appearance of spiky-shaped and short roots, taurodontism, attenuated lamina dura, enlarged bone marrow spaces, small maxillary sinuses, absence of inferior alveolar canal, and thin cortex of the mandible.
“chipmunk faces”
Dental arch morphologic changes include a narrower maxilla and smaller incisor widths for the maxillary and mandibular arches.64 Consistent with gen- eral growth retardation, dental development of patients with b-thalassemia major was found to be delayed by a mean of 1.01 years, increased with age, and was higher for boys than girls compared with unaffected children.
higher dental caries experience
The primary concern is the level of anemia; however, it is rarely of clinical significance.

White blood cell disorder
Enlarged gingiva, oral ulcers, oral infection due to immune suppression from disease or therapy
recurrent gingivitis, severe periodontitis, alveolar bone loss, and ulceration.

·        Measures to decrease sources of infection.
·        Prophylactic antibiotics have historically been recommended by some for patients with a hematologic malignancy–caused ANC <1,000 cells/mm3 prior to dental extractions.
·        Typically in the dental setting, the drugs and regimens supported by the most recent American Heart Association guidelines for infective endocarditis prevention are used prior to invasive dental procedures.
Refer your seminars for leukemia, lymphoma, chediak higashi syndrome and additional essential readings, especially hematologic investigations and bleeding and clotting disorders.