P!ssed @ pharmacist...

[All4MyDaughter]

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If the dds, md has both licenses, they are full blown dentist and physician. I believe some dds, md do NOT maintain active physician licensure due to costs, ce, and the lack of true benefit due to the dental license.

As an intern I have prescribed tons of stuff outside your definition of dentistry that have already come up on this thread. My attending co-signs, they are majority dds only.

It is interesting that in an inpatient setting, I/my OMFS team could probably prescribe ANYTHING. Yet when I leave the hospital 6 years from now, I will apparently get quite a bit of resistance.

It isn't MY definition of dentistry that matters, it's the state's legal definition. Pharmacy is one of the most highly regulated professions, and community pharmacies are inspected and audited regularly, both by the state board of pharmacy and by insurance companies.

I currently work at a VAMC and really haven't encountered any inpatient orders written by our dental service. But I could see how this could be an issue. If someone is admitted to the hospital, someone has to do the orders to continue home meds, slide scale insulin, stress ulcer prophylaxis, etc... While these might be considered outside of the scope of dentistry in the community, they'd be part of basic inpatient mgmt. So maybe it is different inside the hospital vs. outside... ?

Edit: when my father was admitted to the hospital for surgery by his DPM, his maintenance meds, insulin, etc. were handled by a hospitalist ARNP. The DPM took care of his antibiotics and pain meds. DPMs have a similar scope restriction in this state (foot and ankle) so perhaps that's why the hospital used the ARNP to handle the other stuff.

 

[GTFOOMICT]

It isn't MY definition of dentistry that matters, it's the state's legal definition. Pharmacy is one of the most highly regulated professions, and community pharmacies are inspected and audited regularly, both by the state board of pharmacy and by insurance companies.

I currently work at a VAMC and really haven't encountered any inpatient orders written by our dental service. But I could see how this could be an issue. If someone is admitted to the hospital, someone has to do the orders to continue home meds, slide scale insulin, stress ulcer prophylaxis, etc... While these might be considered outside of the scope of dentistry in the community, they'd be part of basic inpatient mgmt. So maybe it is different inside the hospital vs. outside... ?

Edit: when my father was admitted to the hospital for surgery by his DPM, his maintenance meds, insulin, etc. were handled by a hospitalist ARNP. The DPM took care of his antibiotics and pain meds. DPMs have a similar scope restriction in this state (foot and ankle) so perhaps that's why the hospital used the ARNP to handle the other stuff.

You make a great point. I understand that the hospitalist concept is gaining significant traction in the US finally. At my teaching institution, thankfully, we manage our patients 100% with the prudent consult here and there. I however do see the benefits for practitioner and patient care with having the hospitalist. I also see your profession making an impact more and more as the clinical pharmacist.

But now we are off topic and actually discussing something. Let's get back to useless jabs and power struggles.

 

[aphistis]

I have to admit I don't know very much about OMFS training. Are all OMFS dentists first? And then some go on to earn an MD but some don't. Do those who also complete an MD go through the Steps and residency? Are they dually licensed?

As a pharmacist, if I see an OMFS prescribing birth control or antihypertensives or whatever, would I fill them? Are they within the scope? In this state, MD/DOs have "the human body" as their legally defined scope. Would that also apply to a DMD/MD? Are there any DO OMFS practitioners?

Let's play 20 questions...

Exactly. Oral & maxillofacial surgery is explicitly a dental specialty in the United States. Many OMFS obtain MD degrees during their residency training, but the presence or absence of a medical degree is not correlated to extent or quality of training. As far as I'm aware, all 50 states require you to maintain active medical licensure in order to advertise the degree (meaning USMLE & all that jazz), but I'd rather defer that question to one of the dual-degree residents here in the forum. Active dental licensure, on the other hand, is an absolute prerequisite to OMFS practice.

To my knowledge, there are no DO-granting OMFS training programs.

Particularly as it pertains to the ambulatory anesthesia that most OMFS incorporate extensively into their practice, I can think of numerous drugs well outside the bounds of what you might typically consider "dentistry" that still fall well within the doctor's scope of training and licensure. As a rule of thumb, I personally would consider any drug that could be appropriately found in an operating room or prescribed at a pre-admission testing clinic would fall under that umbrella. Cardiovascular drugs are absolutely appropriate to dispense in that scenario.

As for an MD OMFS who prescribes outside their specialty, I suppose I would view them the same as any physician who does the same--e.g., if you would fill a contraceptive script from a psychiatrist, then I would do the same for the OMFS. If not, then not. I can envision situations where you could make a good argument that it's medically appropriate, but I can also see from a medicolegal standpoint that a pharmacist might have a good-faith disagreement.

 

[aphistis]

It isn't MY definition of dentistry that matters, it's the state's legal definition. Pharmacy is one of the most highly regulated professions, and community pharmacies are inspected and audited regularly, both by the state board of pharmacy and by insurance companies.

I currently work at a VAMC and really haven't encountered any inpatient orders written by our dental service. But I could see how this could be an issue. If someone is admitted to the hospital, someone has to do the orders to continue home meds, slide scale insulin, stress ulcer prophylaxis, etc... While these might be considered outside of the scope of dentistry in the community, they'd be part of basic inpatient mgmt. So maybe it is different inside the hospital vs. outside... ?

Edit: when my father was admitted to the hospital for surgery by his DPM, his maintenance meds, insulin, etc. were handled by a hospitalist ARNP. The DPM took care of his antibiotics and pain meds. DPMs have a similar scope restriction in this state (foot and ankle) so perhaps that's why the hospital used the ARNP to handle the other stuff.

I did my general practice residency at the local big VAMC, and the number of inpatient consults we did generated a ton of nursing & pharmacy orders. I can't think of a single time we ever got any static about them. What you're describing is governed by hospital bylaws as much as by statutory law. The hospital can exceed the strictness of applicable state/federal law by as much as they wish--i.e. if state law says non-physicians can admit patients, for example, the hospital can still restrict admitting privileges to physicians only; but if the law says only physicians can admit, the hospital can't allow me or a podiatrist to do it. This is generally more visible at federal facilities like VA centers, since there's no intermediate layer of state laws present to augment federal requirements.

 

[fahimaz7]

Hate to see such a harsh response, but you speak the truth. Ideally, you'd see the same type of restrictions placed on psychiatrists prescribing something "out of scope" like simvastatin, but from what I gather, as an MD of any type, all of your Rx's will be filled by pharmacists nationwide.

Psychiatrists had to pass the US licensing exam, which went into great detail on treating hyperlipidemia. Why shouldn't he be allowed to prescribe a drug that he was trained to give? Do dentists have the same training and exams?

You're missing my point. I repeat,

"The link between statins and periodontal disease is well documented in the literature and I wouldn't be surprised if it becomes one of the many weapons in the arsenal of treating perio disease in the future. Obviously, any treatment plan using a statin for that purpose would be done in collaboration with the patient's physician."

Never did I say that statins are being utilized now to treat periodontal disease in the population (research is still being done obviously). In the near future, though, it is likely that they will be used. We very well then may see the role of the dentist expand to reflect that of the important relationship between oral and systemic health. Despite what you think, not all dentists are interested in just drilling and filling.

In response to your statement that dentists wouldn't want to "deal" with monitoring statins, well, that is why I said that any sort of treatment plan would be carried out in collaboration with the patient's physician.

Are you at MCG? What year?

There's been a few papers that suggested people on statins have a lower incident of periodontal disease. But, I haven't been able to locate a paper published showing the effects of treating perio disease with a statin (systemic), that's not a retrospective study. There was a recent publication that used SMV in a gel, applied locally, to help treat periodontal disease... Is that what you are referring to?

This is very different than prescribing a systemic statin for a patient (or for the dentist himself). Are dentists, at any part of their education, trained to manage a patient's hyperlipidemia?

Clinical Effect of Subgingivally Delivered Simvastatin in the Treatment of Patients With Chronic Periodontitis: A Randomized Clinical Trial
Avani R. Pradeep, Manojkumar S. Thorat
Journal of Periodontology, February 2010, Vol. 81, No. 2, Pages 214-222

 

[fahimaz7]

.

 

[Doc Smile]

Psychiatrists had to pass the US licensing exam, which went into great detail on treating hyperlipidemia. Why shouldn't he be allowed to prescribe a drug that he was trained to give? Do dentists have the same training and exams?



Are you at MCG? What year?

There's been a few papers that suggested people on statins have a lower incident of periodontal disease. But, I haven't been able to locate a paper published showing the effects of treating perio disease with a statin (systemic), that's not a retrospective study. There was a recent publication that used SMV in a gel, applied locally, to help treat periodontal disease... Is that what you are referring to?

This is very different than prescribing a systemic statin for a patient (or for the dentist himself). Are dentists, at any part of their education, trained to manage a patient's hyperlipidemia?

Clinical Effect of Subgingivally Delivered Simvastatin in the Treatment of Patients With Chronic Periodontitis: A Randomized Clinical Trial
Avani R. Pradeep, Manojkumar S. Thorat
Journal of Periodontology, February 2010, Vol. 81, No. 2, Pages 214-222

This thread was dead until you resurrected it. . .leave it alooooooooone

 

[fahimaz7]

This thread was dead until you resurrected it. . .leave it alooooooooone

It's been dead for a week. I wouldn't really call it a resurrection. I had a test this week and wasn't able to read any SDN.

 

[rphnva]

Issue: Fall/Winter 1998/1999

U. S. Territories
A prescription from a U. S. Territory should be treated the same as an out-of-state prescription. U. S. Territories include Puerto Rico, U. S. Virgin Islands, and Guam.
Physicians Prescribing for Themselves or Their Family Members
As long as the physician issues a prescription for a legitimate medical purpose, the physician may prescribe for himself, his family, or any other patient. However, a pharmacist may not fill a prescription unless they know that the prescription is written for a legitimate medical purpose. Pharmacists should take whatever steps are necessary to ensure that there is a true physician-patient relationship.

Prescribing NOT in their related field of practice would raise some eyebrows, tho..especially mine.

From the archived compliance newsletters Texas Board of Pharmacy. I just took the MPJE, and had a question on the subject. I answered know, then i read this? 😕

 

[Daurang]

Issue: Fall/Winter 1998/1999

U. S. Territories
A prescription from a U. S. Territory should be treated the same as an out-of-state prescription. U. S. Territories include Puerto Rico, U. S. Virgin Islands, and Guam.
Physicians Prescribing for Themselves or Their Family Members
As long as the physician issues a prescription for a legitimate medical purpose, the physician may prescribe for himself, his family, or any other patient. However, a pharmacist may not fill a prescription unless they know that the prescription is written for a legitimate medical purpose. Pharmacists should take whatever steps are necessary to ensure that there is a true physician-patient relationship.

Prescribing NOT in their related field of practice would raise some eyebrows, tho..especially mine.

From the archived compliance newsletters Texas Board of Pharmacy. I just took the MPJE, and had a question on the subject. I answered know, then i read this? 😕

Must be a slow news cycle day. Thanks anyhow.