CHAPTER 2-3

patient interview

the first and often the most important step in effective di- agnosis and treatment planning.

factors to consider in establishing dentist-patient relationship

Meet and greet the patient at eye level

• Introduce yourself

• pose an open-ended question

demographic informa- tion should be obtained and recorded

Patient’s full name, and how he or she pre- fers to be addressed, for example, Mrs, Ms, first name, etc. If the name is unusual, a phonetic spelling to assist in correct pro- nunciation at the initial interview can be very helpful.

Address and telephone number(s).

Age, sex, and race. Although this informa- tion is routinely included in patient ques- tionnaires, it may be more prudent to house it in the medical history instead of the de- mographic form, emphasizing its need for legitimate patient care purposes.

Occupation.

Marital status.

Party to contact in case of emergency.

Third party involvement, if any, such as private insurance, Government benefit programs, and the like.

Responsible party: when dealing with a minor child, or legally disabled adult, it is critical to ascertain who can give consent for treatment, and who will be responsible for payment of fees. Divorce, remarriage, and all the complications of modern fam- ily life can make this question at once both difficult and absolutely essential to answer before proceeding very far

Corah Dental Anxiety Scale

A standardized instrument used during the course of the initial interview

one tool to measure and confront patient’s fears.

Using the scale: the questionnaire is scored by adding the total score for the four items, responses ‘a’ to ‘e’ valued 1 to 5 respectively.

A score of 20 indicates very high anxiety, whereas a score of 4 would indicate no anxiety.

If the patient scores 12 or less and doesn’t mark ‘e’ on any item, no follow- up is recommended; however, any ‘e’ response even if the total is 12 or less should be noted and followed up verbally, to identify and deal with that concern.

If the patient scores 13 or 14, suggesting an anxious patient, they should be asked about their dental experiences with an emphasis on what you can do to make them most comfortable.

Again, any ‘e’ response should be noted and followed up verbally, to identify and deal with that concern.

A score of 15 or higher suggests a highly anxious patient.

A digression from the interview is indicated to explore the source of the anxiety, encouraging the patient to recount and confront old experiences, to admit fears, and to suggest ways to relieve anxiety about future care.

medical issues that must be addressed in the dental environ- ment

PATIENTíS GENERAL HEALTH

ALLERGIES AND SENSITIVITIES

SYSTEMIC DISEASES

ISSUE OF PAST DISEASES, CONDITIONS, AND TREATMENT

issues may have significant den- tal implications

• Malignant and/or non-malignant tumors.

• Radiation therapy.

• Artificial or prosthetic joints.

• Use/abuse of tobacco, alcohol, narcotics,

  or other illicit drugs.

• Other past medical conditions, especially

  those requiring hospitalization and/or sur-

  gery.

• Pregnancy issues

conditions under endocrine systemic disease

arthritis, diabetes, thyroid problems

conditions under Respiratory systemic disease

asthma, tuberculosis, shortness of breat

conditions under Cardiac systemic disease

heart disease, rheumatic fever, heart murmur, heart valve problems, pacemaker, high blood pressure, chest pains, swollen ankles

conditions under Blood: systemic disease

abnormal bleeding, anemia, transfusions, fatiguability

conditions under Gastrointestinal/genitourinary: systemic disease

jaundice, hepatitis, liver disease, contact with HIV or AIDS virus, sexually transmitted disease, kidney dis- ease

conditions under Central nervous system: systemic disease

epilepsy, fainting spells, nervous disorder/psychiatric care

Radiographs

are indispensable in dental di- agnosis and treatment

Much of the informa- tion obtained with a radiograph is unobtain- able any other way.

Dental radiographs assist in discovering pathology and non-pathologic abnormalities, and in confirming normal healthy conditions.

With current technology and technique, radiographs are a safe and cost-effective tool in dental diagnosis and treatment.

TYPES OF DENTAL RADIOGRAPHS

Intraoral films:

• periapical (PA)

• bite wing

• vertical bite wing

• occlusal film

Extraoral films:

• panoramic films

• Com- puted tomography (CT)

• Magnetic resonance imaging (MRI)

• lateral or frontal cephalometric film

• periapical (PA)

• most common and versatile radiographic tool in dentistry. With it, we can image an entire tooth or several teeth, includ- ing the apex and periapical region. PA films can be used for an emergency as- sessment (usually one or two films), or regional surveys, or a full mouth survey

• bite wing

• the most frequently used radiograph in dentistry. It can clearly dem- onstrate proximal caries and interproximal periodontal bone levels, as well as many other findings of clinical crown and crestal bone

0. vertical bite wing

used to visualize periodontal bone levels in advanced periodontitis, or post-periosurgical patients, which may not be covered by the normal horizontal bite wing

demonstrate the bone level despite significant periodontal bone loss.

occlusal film

offers broader coverage to assess bone trauma and pathology away from teeth such as cysts, stones

panoramic films

useful in screening situations to assess trauma (es- pecially mandibular fractures), demonstrate cysts

locate third molars and other no- table findings or conditions that are not in the usual range of PA films

can be used instead of PAs for patients who do not tolerate intraoral films well.

Defini- tion of detail is not as good, however, and some panoramic formats are non-diagnos- tic in the anterior region

Com- puted tomography (CT)

can produce highly detailed images of bony structures, but both the cost and the radiation dose are high. Soft tissue derangements are not de- monstrable with any of these films

Magnetic resonance imaging (MRI)

can demonstrate both bone and soft tissue joint components

al- though non-invasive, is quite costly, time- consuming, and often difficult to interpret

lateral or frontal cephalometric film

Most common in dentistry

Skull projection films, taken at various an- gles, can demonstrate specific areas

used to diagnose orthodontic problems and to predict growth patterns