medical history + patient history

reasons for mhx

duty of care, assist with management of the patient, assist with diagnosis, assist w treatment planning

mhx duty of care

safe and individualised care, must take appropriate precautions to any existing medical conditions, prevent medical emergencies, be prepared to deal with medical emergencies

mhx assist with management of patient

medications/allergies may contraindicate use of certain drugs or dental materials, systemic diseases/cardiac abnormalities = less strenuous procedures/antibiotic cover, potential consultation with gp, precautions for pt w communicable diseases, conditions/medications may incr. caries/perio risk

mhx assist with diagnosis

may allert aetiology of oral problems

7 steps in mhx interpretation

systemic disease and basic pathophysiology, related medications, stability, disability, allergies, predict/prepare for medical emergencies, treatment plan incl. addressing risk factors

reasons for rapport

pt is more likely to make full disclosure, more likely to disclose information relating to their attitudes, motivations, priorities, expectations, pt more receptive to professional judgement/recommendations/advice

ways to establish rapport

eye contact, face at eye level, show interest and concern, reassuring, empathise, no criticising or guilting pt, summarising what i understood from convo

heart disease/hbp/heart murmur/rheumatic fever/pacemaker management

use antibiotics from prevent subacute bacterial endocarditis: rheumatic fever (indigenous Australians), congenital heart disease, prosthetic valve replacement, prosthetic material used to repair cardiac valves
caution with ultrasonic: pacemaker

smoking/tobacco use further investigation

no. cigarettes per day, number of years smoked, other forms of tobacco, situations that trigger smoking, quitting history (longest attempt, most recent), reasons for relapse

alcohol implications

oral trauma, high risk for oral cancer

allergy history

do you have any confirmed/suspected allergies?
if yes: symptoms of reaction, date of reactions, management of reaction (adrenaline, other treatment, ambulance?)

medicine history

medication name, strength, dose, route. frequency, how long pt has been taking medicine, recently ceased/changed medicine, allergy/drug adversions

elements of pt history

presenting concern, dhx, mhx, shx, diet and oral hygiene

pc questions

when did the pain start, it is getting better or worse, painkillers, character of pain, heat/cold associated w pain, pain on chewing/biting, how bad is pain from 1-10

dhx questions - general

history of dental attendance, reasons for attending, previous experience, oral hygiene habits, history of extractions and causes of tooth loss, if problem is hereditary

dhx follow up - bleeding gums

on bleeding/flossing/spontaneous, tenderness/discomfort around gums, pain on biting, puffy/swollen/pimple on gums

dhx follow up - cavities

sensitivity to hot/cold/sweets, pain when chewing or biting, food stuck in specific teeth, spots/holes on teeth, bad taste or bad breath that doesn’t go away

pre procedural precautions: allergies

latex, medications (penicilin), sodium lauryl sulphate, spices (eugenol, mint), food dye

pre-procedural precautions: bleeding risk

• anticoagulants and bleeding abnormalities/dyscriasis

• risk of thromboembolic event vs risk of prolonged bleeding

• patient may need to be taken off anticoagulant to reduce risk of bleeding, factor replacement req., referral to oral maxillofacial surgery or dental unit of hospital

pre-procedural precautions: antibiotic cover

taken one hour before invasive dental procedures with high risk of bacteraemia: manipulation of gingival/periapical tissue, perforation of oral mucosa (extraction, implant placement, biopsy, removal or soft tissue or bone, subgingival root debridement, replanting avulsed teeth)

patients at risk of infective endocarditis

prosthetic heart valve, prosthetic material used for cardiac valve repair, previous IE, rheumatic heart disease in all populations, congenital health disease (involving unrepaired cyanotic defects, repaired defects with residual defects at or adjacent to the site of a prosthetic patch or device)

pre-procedural precautions: steroid cover

preooperative steroid cover for pt taking corticosteriods (prednisolone), may cause adrenal crisis which is life threatening, consider increasing dose, surgery and spesis are major stressors

pre-procedural precautions: osteroradionecrosis (ORN)

bone becomes devitalised by radiotherapy, risk factors: PA lesions, perio, tooth extractions after radiotherapy

pre-procedural precautions: medication related osteonecrosis of the jaw

exposed bone persisting for more than 8 weeks without radiotherapy, risk factors: bone exposure (extractions, implant placement, perio surgery)

pre-procedural precautions: immunosuppressed states

AB or delayed treatment
- e.g. chemotherapy, MBA for rheumatioid arthritis, end stage liver/kidney disease, malignancies

coronary ischemic syndrome (ischaemic heart disease)

defer elective dental procedures for 6 months following myocardial infarction, stent placement, coronary artery bypass surgery

cardiac implanted electronic devices- pacemakers

ultrasonic devices are usually safe but should consult with cardiologist if in doubt

diabetes

if control is poor, consider AB or delaying treatment

shx factors

family responsibilities, language barriers, sources of stress, ethnicity, occupation, socioeconomic status and education levels, family history of perio/hereditable diseases

diet and oral hygiene

cariogenic elements in pt diet, alcohol consumption, frequency of manual/electric brushing, toothpaste, interproximal cleaning, rinses/gels, parent/carer education levels, parent or supervised brushing for children