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Understanding a patient’s health history can help you provide the best care possible.
Evaluating your patient’s health history is extremely important. After all we know that 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 will also help you as the clinician provide the best care possible.
The following are some topics you should be addressing with your patient. By no means is this list exhaustive, but these topics should be discussed to help alleviate the potential of an emergency and limit the exposure to opportunistic infections.
The cardiovascular system is big rent territory. There are so many conditions that 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 ask about these diseases to help prevent the potential of a medical emergency, but it will also help you as an oral health care provider 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. 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. One important aspect to remember is high blood pressure is a hallmark precursor to a stroke.
Immunocompromised or immunosuppression
Diseases and systemic issues that fall in this category include diabetes, cancer treatment and rheumatoid arthritis. There has been a lot of discussion about the link of oral health to diabetes. We know this disease has a direct impact on periodontal health. It is 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 the type of diabetes, the last known A1c level, when the last time medications were taken and if he or she 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.
Up next: Questions to ask about joint health...
Arthritis and joint replacement are the big ones in this category. Arthritis will affect how well our patients can implement their oral health care routine and may impact their TMJ. Joint replacement is of greater consideration. The protocols on how to care for these patients in regards to prophylactic antibiotic coverage changes regularly. It is highly recommended to be in contact with the patient’s primary doctor and/or orthopedic surgeon to assess his or her risk for secondary joint infections.
Allergies to medication may be the first thing that comes to mind, but allergies to metals and other substances need to be considered, too. This impacts the patient’s ASA status as well, placing him or her at a minimum of an ASA II. Potential harm could result in an allergic reaction, which has the potential to be a life-threatening event.
Clinicians need to understand why the patient is taking the medication and how it affects the body. As we know, the most common side effect of medications is xerostomia, which has a tremendous impact on oral health. We also need to make sure there aren’t any drug interactions with medications we may prescribe or with any local anesthetic agents administered. It is highly recommended for dental professionals to use drug reference material. There are several online resources available that are updated on a regular basis.
This is a given, right? However, it is amazing how often we forget to ask our patients about past dental experiences and current issues they have.
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? Doing so can help to ensure you are providing your patients with effective care.