RESUMEN

The overall health of the United States' (U.S.) population has been surveyed and reported for several decades in a quest by healthcare professionals to understand the etiology for healthcare disparities and seek to lessen its effects on individuals and, ultimately, eliminate them. Many of these surveys and reports have illuminated disparities, of access to healthcare by focusing on measures to address health literacy deficiencies. A plethora of information concerning patients' health literacy skills and printed information has been made available for dentists and their staff. The printed information is in the format of published patient- centered educational guidelines and readable dental and medical limited reach media (LRM), such as information sheets and prescription drug leaflets. LRM has great potential to enhance access to healthcare information for the reader of interest--your patient--at a readable and comprehensible level. Printed materials are an effective means to enhance health promotion and education for the lay populace. Tailored LRM protocol and the Patient Introduction Form (PIF) are excellent educational instruments for dentists and the dental/medical team (The Team). These instruments are valuable assets for The Team to assist its patients in monitoring and maintaining dental and medical adherence protocols in their daily lives.

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Women's health issues are receiving increased attention, including the differences in their dental needs and experiences. Biological and social factors are strong determinants of physical and dental health along the entire life spectrum. Socio-environmental place also contributes significantly to some of the barriers to quality and quantity of health care received, placing population groups who have less access to care at risk. Considerable disparities exist in who receives dental care and what type of dental treatment is received among different segments of the population. Greater illumination of these issues in all discussions related to healthcare of women and at-risk populations continues to be a needed focus of concern. The plight of women and at-risk populations and problems influencing access to care are addressed.

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Access to and awareness of oral healthcare in the United States have been highlighted in the mass media and discussed among diverse populations. The current surge to provide access to oral healthcare for citizens springs from this quagmire of oral healthcare issues which affects global to local (grassroots) communities. Publications by the World Health Organization's (WHO) Health for All and the United States' Healthy People have set into motion an agenda by which institutions, healthcare professionals and governments can develop action plans to foster and nurture grassroots organizations to address these issues. An initiative has been undertaken by members of the faculty, student doctors and staff of the University of Tennessee Health Science Center, College of Dentistry (UTHSC CoD) and its partners. This cadre of volunteers has implemented grassroots efforts for the citizens of western Tennessee to date as the flagship of Tennessee Smiles: UT Grassroots Oral Health Outreach Initiative (Tennessee Smiles). By participation in health fairs, school programs and other cultural events, these volunteers have made a difference in the lives of thousands of Tennessee citizens who need exposure to information regarding their oral health care needs. The authors discuss the basis for the Tennessee Smiles organization, their successes and challenges. Future plans and the need for support of the organization are emphasized.

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Anticipated demographic changes in the U.S. during the next 20 years will bring increasing numbers of geriatric patients into dental practices. It is expected that these patients will have multiple co-morbid medical conditions and will have to take multiple medications as a result. Dental practitioners must stay informed concerning newly marketed drugs and those commonly prescribed to geriatric patients, and the potential dental implications of those drugs. Specialized training in geriatric dentistry, continuing education, and consultation with medical and pharmacy practitioners can provide valuable tools for managing this special patient population.

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Antiplatelet drugs are used in clinical practice to prevent the adverse sequelae of thromboses in atherosclerotic arteries of the heart, brain, and limbs and in the veins and heart chambers. They have diverse mechanisms of action, half-lives, and pharmacodynamic effects. A major concern among dental health care providers is the potential for excessive bleeding after invasive dental procedures. This article reviews the current antiplatelet agents used for managing cardiovascular and cerebrovascular diseases and suggests how patients taking these agents may be managed when invasive dental procedures are planned.

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The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recently published new guidelines for the management of adult patients at risk for developing hypertension, cardiovascular disease, and associated conditions. These new guidelines include a new risk category (designated as prehypertension) and indicate a lower range for classifying normal blood pressure. This article provides a brief review of recent literature and highlights the pertinent changes from previous guidelines. In consideration of the new hypertension categories, the implications of monitoring blood pressure in the dental office are discussed and the classifications are correlated with specific recommendations for dental management.

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