Dentists are permitted to obtain, supply, possess, administer, and prescribe medicines for the management of their patients’ oral health. In Australia, dental prescribing and provision of medicines are regulated by individual state and territory drug legislation, as well as through national rules and regulation through the Dental Board of Australia, the Pharmaceutical Benefits Scheme (PBS) and Therapeutic Goods Administration (TGA). In Aotearoa New Zealand, subsidisation of medicines is determined through the Pharmaceutical Management Agency (PHARMAC) and categorisation of medicines and legalities around their availability is determined by the Medicines Act 1981, with listing of approved medicines on the Pharmaceutical Schedule.

An adverse drug reaction (ADR) is defined as a response to a medicine that is noxious and unintended, and occurs at doses normally used or tested in humans’ (1). ADRs that manifest in the orofacial region are common, being associated with at least 43 of the top 100 drugs dispensed on the Pharmaceutical Benefits Scheme (PBS) in Australia (2). ADRs are becoming more relevant in dentistry with increasing awareness of oral ADRs amongst dental professionals, increasing number of people taking medications, polypharmacy becoming more common especially with increasing age, and the elderly being more prone to adverse effects. In Australia, 87.1% of the population aged 50 years or more takes at least one medicine regularly (3). ADRs are a major public health problem because they occur frequently and contribute significantly to human suffering and economic expense. The Medication Safety Report from the Pharmaceutical Society of Australia in 2019 stated that 250,000 Australian hospitalisations per year are caused by adverse drug events, most of which are due to ADRs, at a cost of approximately AU$1.4 billion (4).

Despite recent advances in development and regulation of medicines for children, unavoidable factors specific to the care of this age group will always make prescribing for infants and children challenging. These factors (see Figure 12.1) include: • the changes in anatomy and physiology that occur during child development that impact on drug pharmacokinetics and pharmacodynamics. • the general lack of research on drug safety and efficacy in children due to practical and ethical reasons • the need to individualise drug dosage based on parameters such as the child’s age, weight or surface area • the limited availability of medicinal products specifically formulated for children • the vagaries of administering medicines to infants and children • the general difficulties of communicating with children • the challenge of diagnosing and recognising adverse reactions in children • the higher risk for medication error in paediatrics • the frequency of off-label prescribing in paediatrics and associated medicolegal issues, and • recognition that treatment of infants and children involves managing their parents and/or carers as well.

Managing oral pain is a daily task for dental practitioners. Understanding the type of pain, accurately diagnosing the cause and being able to choose the most appropriate drug regimen (if required) is a fundamental skill for all dentists. This chapter describes the medicines commonly used for pain management in dentistry, their mechanism of action, appropriate doses, adverse effects, common drug interactions and their place in therapy.

Dental practitioners are often faced with questions about the safety of dental interventions during pregnancy and breastfeeding. Questions often focus on the safety of the drugs involved such as local anaesthetics, sedatives, analgesics fluoride and antibiotics. Despite the general wisdom that it is best to avoid all drugs during pregnancy and lactation, situations do arise where drug treatment is unavoidable. Therefore, it is necessary that dental professionals competently address these queries with up-to-date, accurate and evidence-based advice or appropriately referral to expert resources. This chapter addresses the common areas of concern for pregnant and breastfeeding women relating to drugs used in dental practice.

Antithrombotic drugs are those used to slow down blood clot formation, including antiplatelet agents and anticoagulants. Dentists commonly encounter patients who are on antithrombotic drugs, as these drugs are used to manage common conditions. For example, the direct oral anticoagulant drugs (DOACs) are frequently prescribed for management of atrial fibrillation, which affects approximately 5% of the Australian population aged 55 and over (1). As a result, the DOACs were within the top 100 drugs dispensed on the PBS in 2018 in Australia (2). Increased risk of oral bleeding is thus a common complication dentists may have to manage. The risk of post-extraction bleeding is increased three-fold in patients taking anticoagulants compared with those not taking these drugs (3, 4). Understanding the principles of haemostasis, how to balance the risk of bleeding against the risk of clotting, and how to manage these patients is thus an integral part of dentistry.

Medical emergencies occur rarely in dental practice. When they do occur, however, they can be both dangerous for the patient and unnerving for the clinician. If these events have been planned for, staff will be adequately trained, the correct medications on hand and their method of use easily recalled, so these rare and disturbing events can be managed with good outcomes. It has been reported that only one resuscitation event occurs for every 250 years of dental practice (1). Although this may seem rare, when it does occur, the event can be life threatening. Therefore, staff training in cardiopulmonary resuscitation (CPR) with regular updates is mandatory. Previous studies have reported very high uptake of CPR training, yet about 20% of dentists felt inadequately prepared and were less likely to have the necessary drugs and equipment in their practice (2). The single most important factor for prevention of medical emergencies in dental practice is the taking of a thorough medical history for each patient.

Dental fear and phobia are common with a prevalence of around 1 in 6 Australian adults (1). Fear of dental care can lead to significant stress and avoidance resulting in neglect and deterioration of oral health (2). The aim of anxiolysis is to improve patient comfort in order to complete dental examination, investigations and procedures (3). This chapter will focus on the pharmacological measures used for anxiolysis in community dentistry.

Introduction

Physicians often tend to be seen as holding the top position in the hierarchy of health practitioners. In prior research, they often come across as aloof, high-status figures, who in the eighteenth-century paired up with the state to regulate, oversee, and improve the activities of all other health practitioners. This chapter argues that Swedish physicians’ connection to the state remained tenuous throughout the eighteenth century. I contend that physicians were not particularly important to the state, except as one of many groups of actors on a medical market. They were, to put it bluntly, neither considered nor treated as an important part of the machine of governance. That is not to say that they were completely unimportant, but neither were hatters, cobblers, or indeed barber-surgeons or midwives inconsequential. This, of course, is a position that runs contrary to earlier historiography, which has tended to portray eighteenth-century physicians, and in particular their main organisation the Collegium Medicum, as forerunners to nineteenth- and twentieth-century branches of the state that are concerned with social medicine, hygiene, and general improvement of the health of the population. By giving examples of how physicians negotiated with other groups and operated in different roles on the Swedish medical market and in relation to the state, this chapter instead points to the sprawling complexity and open-ended nature of early modern health practices. To create a more complex, and hopefully also more truthful, description of the role of physicians in eighteenth-century Swedish society, I take as my point of departure two propositions, which underlie the argument of the present chapter.

Introduction

This chapter examines the connections between haircare, medicine, gender, and health in Sweden between the years 1740 and 1840. The periodisation covers a drastic change in hair fashions, particularly for elite men who went from wearing powdered hairstyles and wigs in the eighteenth century to more moderate styles in the early nineteenth century. It also covers the growth of a type of literature about haircare and cosmetics, a genre that was separate from but which still drew on household recipes and medical texts. Advice literature, newspapers, and journals of this period created a discursive framework in which beauty tips were combined with popular conceptions of medical science. In these diverse texts, hair was a part of the body and thus a signifier of a body's health, vitality, and morality. At the same time, hair was something separate, easy to alter, remove, and transform into a commodity. Moreover, it was paradoxically both gendered and not gendered. By comparing different genres of writing, this chapter shows that there was a tension between the various ways hair was conceptualised during this period. One continuous strand in the discussions of hair and haircare throughout the period is the connection drawn between healthy hair and health of the body.

The chapter includes an overview of the way haircare appeared in economic texts, medical writing, popular journals, and haircare manuals. The study additionally examines the growth of a new genre of advice literature in Sweden, and how it carried with it traditions from older genres.

Introduction

The chapter examines mental health care in early modern Swedish local communities, and in particular the religious activities that were aimed at finding cures for or alleviating madness and mental disturbances. After briefly providing background about the role of religion in medicine and healing in the early modern culture, the chapter discusses the spiritual healing practices carried out at the local level, in particular by local clergy and the rural lay communities, in early modern Sweden (including Finland) during the seventeenth and early eighteenth centuries (c. 1600s–1730s). This time frame covers the era when the Swedish Realm was at its largest and the period of Lutheran Orthodoxy. This period is characterised as a time when religion was an integral part of medicine. Moreover, this is a time when many new natural-scientific and medical ideas, and the professionalisation and ‘secularisation’ of medicine, were only slowly contributing to the healing practices in the northern periphery of Europe.

A court record from southwestern Finland from 1700 offers a starting point and a good example about the ways religion, and churchmen, were involved in healthcare. Around the year 1680 Brita, a soldier's widow in her late fifties, lost her mind, or started suffering from an undetermined ‘weakness in the head’ (Swe. hufwud swaghet).

Introduction

Today, as in the early modern era, great value is placed on the possession of health. This volume has uncovered health as a signifier of the good life in early modern society, understood in terms of happiness, tranquility, virtue, and prosperity. In this commentary chapter, I will move the discussion closer to our present time, focusing on the era from c. 1970 up until ‘today,’ sometimes referred to as ‘late modernity.’ How can the high premium placed on achieving and maintaining health today be understood from the historian's perspective? Can health and wellness ‘of body and soul’ be likened – as has sometimes been suggested – to a secular religion, manifesting the virtuous (Swe. dygdigt) life, with places like the gym, the yoga studio, or the running track as temples of worship? Reflecting on the historically contingent nature of health, I will discuss the comparisons, analogies, and contrasts between the early modern and the late modern eras.

The chapters of this volume have demonstrated a great variance regarding the meaning and significance of ‘health,’ how it has been interpreted and imagined to be achieved and maintained. They have delineated the breadth of definitions of health, including mental, spiritual, and emotional dimensions, in the early modern era. Hence, this volume underlines the importance of historising and contextualising the conceptions and practices of health and illness as integrated in social relations, institutions, and the everyday lives of people from all social standings.

Introduction

This chapter is an attempt to elucidate how Katerina Lemmel, a newly widowed former spice merchant, who entered a Birgittine nunnary in 1516, perceived sickness and health. I aim to capture her beliefs and experiences, conceptions and comprehensions, of what people in those days called bodily and spiritual health. Furthermore, I examine by what means and methods what we call physical and mental ailments were prevented or combated in the female convent at Maria Mai in Maihingen, Germany. The two key questions I consider are: Were humoral pathological methods combined with religious ones? And how was God's impact on healing perceived?

I examine the ways in which Katerina contributed to the well-being of her sisters in the female convent, especially how she introduced luxury products such as spices, salutary drinks, and wine as healing products. I also study her view of the impact of faith on sickness, recovery, and death. Katerina's views and beliefs can be identified by reading her letters to her cousin, one of her former associates in the spice trading company that she had been a part of before entering the monastery Maria Mai in Maihingen in 1516. An analysis of her letters gives us, for the first time, an idea of how a nun – specifically a nun from the Swedish Birgittine order – experienced health and healing. She was not herself a healer, but a representative of the enlightened urban population. Throughout her professional life, she lived according to humoral pathological ideas, with the help of the family's own pharmacist.

Introduction

At a 1692 court session in Snevringe, a small village outside of the town Vasteras, farmer Anders Larsson sued farmhand Olof Nilsson for having breached their employment contract. According to their agreement, Olof was supposed to work for Anders for about four months. However, Olof had only fulfilled his duties for six weeks. In his defense, Olof explained that he had fallen ill and thus had been too weak to perform the tasks expected of him. Anders reproached Olof and stated that he had not demanded Olof to exceed his abilities when working for him. Anders added that Olof, despite his current, frail condition, should at least have been able to thresh grain. The court verdict was that Olof should either return his salary in lieu of unfulfilled weeks of work to Anders, or return to work for him for the remaining nine weeks, as stipulated in the original agreement.

The case referred to above offers insights into a typical breach of contract negotiations between a farmer and a farmhand in seventeenth-century Sweden, such as it might unfold in a case of a breach of contract. But it also informs us about how ordinary people in early modern Sweden could use concepts of illness, impairment, and bodily ability in everyday contexts, and more importantly, what meanings were given to these concepts.