By Judy ValdezPATIENT HEALTH & MEDICAL HISTORY

Provide information pertinent to the etiology and diagnosis of oral conditions and the total patient care plan.

Reveal conditions that necessitate precautions, or adaptions during appointments to ensure that dental and dental hygiene procedures will not harm the patient and that emergency situations will be prevented.

Aid in the identifi cation of possible unrecognized conditions for which the patient will be referred for further diagnosis and treatment.

Permit appraisal of general health and nutritional status, which in turn, contribute to the prognosis of success in patient care and instruction.

Give insight into emotional and psychological factors, attributes that may aff ect present and future care.

Identify cultural beliefs and practices that aff ect risk for oral disease

PURPOSES OF THE HISTORY

Information directly related to patient careAge group would influence materials selected

for careManifestations of systemic disease and

medications influence care decisions

ITEMS INCLUDED IN THE HISTORY

Personal History Data collection for planning care Need for informed consent Need for physician consultation Culturally appropriate communication

determination

Dental History Chief complaint Previous dental and preventive care Patient attitude toward oral health Personal daily care Patient’s current health beliefs

PATIENT INFORMATION

Medical History Conditions that complicate dental care Disease requiring special precautions or

premedication Conditions requiring medicating drugs Gender or ethic/racial influences Increased risk for systemic diseases Allergic or untoward reactions Diseases/drugs with oral manifestations Communicable diseases Physiologic status of patient

Influence care Contraindicate care

PATIENT INFORMATION (CONT.)

Care planning influencesEvaluation before clinical assessmentEssential for preparation of care plan

IMMEDIATE APPLICATIONS OF HISTORY

Telephone or personal contactWritten requestReferrals

MEDICAL CONSULTATION

Recent therapyPhysician consultationRationale for radiographs

RADIATION

Risk for infectious endocarditisRisk factors with invasive proceduresRoutine use of antibiotics not indicatedTiming of ingestion of oral antibioticsRecommendation for class of antibiotics

PROPHYLACTIC PREMEDICATION

Risk in general population of infective endocarditis is low

Prophylaxis only for patients with underlying cardiac conditions

Used only for certain procedures

PRINCIPLES OF PRETREATMENT ANTIBIOTIC PROPHYLAXIS

Prosthetic cardiac valvePrevious endocarditisCongenital heart diseaseCardiac transplantation recipients with

cardiac valvular disease

MEDICAL CONDITIONS REQUIRING ANTIBIOTIC PREMEDICATION

Dental & dental hygiene procedures involving:

Manipulation of gingival tissueThe periapical region of teethPerforation of the oral mucosa

PROCEDURES REQUIRING IE PROPHYLAXIS FOR AT-RISK

PATIENTS

Routine anesthetic injectionsTaking dental radiographsPlacement of removable appliancesAdjustment of orthodontic appliancesPlacement of orthodontic bracketsShedding of primary teethBleeding from trauma to lips or oral mucosa

PROCEDURES NOT REQUIRING IE PROPHYLAXIS FOR AT-RISK

PATIENTS

ASA Physical Status Classification SystemCategories I to VIOverall estimate of medical risk

ASA DETERMINATION

Update at each appointmentChanges in health status with consideration

for care planInterim illnessVisits to physicianLab test and resultsChanges in medicationChanges in oral soft tissues and teeth

REVIEW AND UPDATE OF HISTORY

Date all entriesPermanent written records in inkPatient signature for informed consentPrivacy of patient informationCoded tabs for health alertsPlan for periodic revision of forms

DOCUMENTATION

A person’s health is not static; therefore, a health

history must be updated when or how often?

A) AnnuallyB) At every recall appointmentC) At each and every appointmentD) At the initial appointment

QUESTION

C) At each and every appointment is the correct answer.

Updating the patient’s health history at each appointment is essential for current information concerning the patient. The state of the patient’s health is constantly changing. Therefore, the history represents only the period in the patient’s life during which the history was made.

ANSWER

Which type of patient would require antibiotic coverage during treatment?

A) A patient on antihypertensive drugsB) A patient with latex allergyC) A patient of Native American descentD) A patient at risk for infective endocarditis

QUESTION

D) A patient at risk for infective endocarditis is the correct answer.

Patients at risk for infective endocarditis must have antibiotic premedication prior to any tissue manipulation that could create a bacteremia.

ANSWER

Indications for oxygen administration include all of the following except:

A)SyncopeB)Cardiac problemsC)Respiratory diffi cultiesD)Hyperventilation

QUESTION

D) Hyperventilation

ANSWER

What is the most common medical emergency that occurs in a dental offi ce?

A)Heart attackB)Asthma attackC)SyncopeD)Anaphylaxis

QUESTION

C) Syncope

ANSWER

Syncope(Fainting)Severe Anaphylactic ReactionCardiac ArrestMyocardial Infarction(Heart Attack)

IDENTIFY THE MOST COMMON MEDICAL EMERGENCIES IN A

DENTAL OFFICE