Evaluating our patient’s health history is extremely important. After all, we know the mouth is connected to the rest of the body. We witness the oral systemic connection on a regular basis. Understanding your patient’s health history not only helps prevent a medical emergency from happening, but helps you as the clinician provide the best care possible. But there are moments when time is limited, or you are in the process of doing a screening and you need to make sure the patient can move forward. The following are five topics I address with my patients health history. By no means is this list exhaustive but these should be addressed to help alleviate the potential of an emergency and limit the exposure to opportunistic infections.
The cardiovascular system is what my mom's cardiologist calls "Big Rent Territory", like Park Place in the game of Monopoly. There are many conditions which fall into this category. Issues such as angina, infarction of the heart or brain, blood pressure and atherosclerosis are some of the most common diseases to be aware of. Not only is it important to inquire about these diseases to help prevent the potential of a medical emergency, but it also helps the oral health care providers ability to properly diagnosis oral health conditions and dispense the appropriate treatment and medications necessary. These issues can have a direct impact on the selection and dosage of local anesthetics and other medication dispensed.
A simple addition to evaluate the patient’s cardiovascular health, which should be standard practice at every dental appointment, is taking the patient’s blood pressure. If your office is providing this valuable service to all of your patients kudos to you! Blood pressure allows the clinician to understand the patient’s ability to tolerate the different types of care we provide. This may be one of the only times your patient has his or her blood pressure checked by a health care provider. Not only does evaluating blood pressure act as screening for cardiac conditions, but now research correlates high BP and sleep apnea.
Immunocompromised or Immunosuppression
Diseases and systemic issues that fall in this category include: diabetes, cancer treatment and rheumatoid arthritis. There is a lot of discussion about the link of oral health and diabetes. We know this disease has a direct impact on periodontal health. It's also important to know that this disease and the medications involved can impact the patient’s treatment and choice of anesthetic. If your patient has diabetes make sure you follow-up with questions such as type of diabetes, the last known A1c level, when the last time medications were taken and if they ate prior to the appointment.
Patients with a current or past history of cancer should have more frequent intra and extra oral evaluations since their risk of head and neck cancers has increased. Also, patients currently undergoing cancer treatment may develop opportunistic infections such as oral candidiasis and have increased risk for decay due to medications and xerostomia.
Allergies to medication may be the first thing to come to mind, but, allergies to metals, latex and other substances as well must be considered. As dentistry progresses the use of items which cause an allergic response has decreased. However, it is important the evaluating clinician identifies potential allergies.
For example, I've worked with a patient who has a severe allergic reaction to shellfish. She also suffers from dry mouth. I received a sample of a mouth rinse which helps reduce the sensation of dry mouth, but also has shell fish by products in it. If she wouldn't have disclosed that information I would have given her that sample of mouth rinse.
Allergies impact the patients ASA status as well. Someone with an allergy is generally a minimum of an ASA level II. Potential harm could result in an allergic reaction which has the potential to be a life-threatening event. I recommend checking out the American Society of Anesthesiologist website regularly to review the ASA category definitions
It's critical to know which medications your patient is taking and why. Ask your patient if they carry a list. Ideally it has the medication name and dosage. If they don't have a list or cannot remember the name ask them to describe the medication like shape and color along with it's use. You can simply google the pill descriptor and get a list of names. It's highly likely that when your patient hears the name of the drug it will jog their memory.
Clinicians should understand why the patient is taking medications and how it effects the body. As we know, the most common side effect of medications is xerostomia, which has tremendous impact on oral health. We also need to make sure there are not any drug interactions with medications we may prescribe or with any other drug therapies, like local anesthetic agents administered. It is highly recommended for dental professionals to use drug reference material. There are several online resources available and are updated on a regular basis.
Really this is a given, right? However, it is amazing how often we forget to ask our patients about past dental experiences or current issues they may have. Perhaps they were traveling and had a dental urgency occur, in which they were treated by a different oral health care provider. Understanding these situations will help guide us on how to approach the patients oral health needs.
Let's not forget to ask our patients if they clench or grind their teeth, have jaw pain or frequent headaches? Perhaps they need to be evaluated for myofacial disfunctions such as a tongue tie. Understand if they've had any temperature sensitivity, it may lead towards recommending desensitizing toothpaste. Even if they've noticed any changes in the way their gum tissues feel or if they notice any bleeding.
There are so many more items to discuss with your patient, but these five items will help open the door to deeper discussions on how you and your office can best support the patients overall health.
Take a moment and evaluate your office’s health history form. Does it address these issues and do you ask the appropriate follow-up questions?