Chapter 13 - Personal, Dental, and Health histories

Purpose of personal, dental, health history

• Understand concerns, health status, rapport, identify risks, refer, care plan

• Legal documentation

Health history assessment

• Health status is dynamic (constant change)

• Give patients health history questionnaire

  • Identify allergies, disease, medical conditions

Patient centered health history interview

• First step in building rapport w/ patient

• Mutual goal: Patient’s overall well being

Challenges

• Language, culture

• Physical/ mental challenges

• Poor health literacy

• Social determinants of health (willingness/ ability to seek dental care)

Patient centered interviewing process (5 steps)

Establishing private setting

Elicit patient’s chief concerns and set agenda

• What brought u in here today?

Use open ended questions

• Dont ask yes/no questions

Use active listening and response

• Words, tone, facial expression, body language

Summarize interview

• Confirm accuracy, clarify information

2 ethical obligations

1. Honest listening w/o prejudgment

2. Honest response w/o bias

Comprehensive health history

• Gather demographic info

• Social history (marital status, occupation, etc)

  • Why need? Understand circumstances, identify financial barriers

Chief complaint

• Why the patient come in (concerns)

• Don’t assume their complaint

Dental history

• Helps correlate past, current, oral health beahviors and expectations

Review patient history and chief complaint in textbook

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Legal and ethical issues

American Dental hygienist association (ADHA) code of ethics

Health insurance portability and accountability act (HIPAA)

• Protects privacy and security of patient’s info

• Exception — emergency situations

• Informed consent — signing form doesn’t make it informed

American Society of Anesthesiologists Physical Status Classification System (ASA).

The ASA system categorizes patients based on their overall physical health status

• ASA I → Healthy patient

• ASA II → Patient with mild systemic disease

• ASA III → Patient with severe systemic disease

• ASA IV → Patient with severe systemic disease that is a constant threat to life

  • No dental treatment beyond point

• ASA V → Moribund patient who is not expected to survive without the operation

  • Only pallative care

• ASA VI → Brain-dead patient whose organs are being removed for donation

Drug references

• Identify drug actions, side effects, adverse, etc rather than guessing

• Refer to lexicomp/ drug info handbook

Prophylactic antibiotic premedication for prevention of infective endocarditits

• Dental procedure → Bacteria enter bloodstream → infection of heart tissue lining → Infective endocarditits (IE) = life threatening

Antibiotic prophylaxis is used for patients w/ high risk for infective endocardititis undergoing dental procedure

• Not for everyone w/ heart disease

For those with

• Prosthetic cardiac valves, IE, cardiac devices

• Must take prophylactic antibiotic meds 1-1.5 hr before dental procedures

• amoxicillin used

• clindamycin not used anymore → gives c. difficile

Treatments and conditions not requiring prophylactic antibiotic premedication

• Not used for xrays, rubber dams, fluoride treatment, impressions, oral trauma

• Not used for people with prosthetic joints, boob job, penis job, stem cell / organ transplant, catheters, immunocompromised or suppressed = predispose to infections

Medical referral needed if risk for dental care