Dentistry and the Importance of Taking a Full Medical History
The primary focus of any dentist is safety, to optimize the patient experience and achieve the best possible outcomes. This is achieved in a wide variety of ways, from selecting the best ergonomic dental chairs to using PPE like nitrile gloves to protect both patient and dental professionals. Careful choices like the right dental needles for administering oral anaesthesia and using palatable prophy paste further improve the patient experience.
The best dentists will take a holistic approach to the care of their patients. This includes taking and maintaining a complete medical history for every patient they see. Some patients may not fully appreciate the importance of full disclosure in terms of their medical history, but it is imperative.
A Complete Medical History
The dentist is ultimately responsible for the impact the dental care they provide has on the patient as a whole. Conversely, the patient’s overall health can impact their dental treatment.
The human body is a complex array of interactions between different systems, and one thing can have a significant impact on another seemingly unrelated body part.
A complete medical history will include:
- Prior surgery and/or hospitalisations
- Systemic illnesses
- Blood disorders
- Cancer and cancer treatments
- Allergies
- Infectious diseases
- Prostheses
- Current medications (prescribed, OTC, and herbal)
- Illicit drug use
- Tobacco use
- Alcohol consumption
- Mental health conditions (including anxiety and panic disorder)
- Blood pressure and pulse readings
- Pregnancy status
- Emergency contact/next of kin
- Medical doctor contact details
Why is taking a complete medical history so important for a dentist?
- Allergies – many common allergies and sensitivities have significance in the dental setting, due to the products and tools dentists routinely use. These include latex allergy, milk protein allergy, lactose intolerance, dairy allergy, allergy to titanium dioxide (often found in sunscreen; also in some impression products). Some patients have a sensitivity to certain local anaesthetic drugs and can experience an unsettling systemic reaction. Knowing about these sensitivities in advance enables the dentist to accommodate them.
- Medical Conditions – even the most seemingly insignificant condition may be relevant in terms of dental care. Indigestion, heartburn, or reflux disease may cause damage to teeth. Diabetes, even if controlled without drugs, can increase infection and gum disease incidence. Previous cardiac or vascular history often means the patient is taking aspirin, warfarin, or an injectable blood thinner. Some local anaesthetics can stress the heart, and a history of atrial fibrillation or heart attack may indicate that a different drug needs to be used. A patient who has a diagnosed anxiety or panic disorder may be offered additional assistance (e.g. nitrous oxide) for their dental appointments.
It’s also important for the dental clinic staff themselves to be aware of health conditions in their patients to enable enhanced precautions. These conditions include blood-borne diseases like HIV and hepatitis, and active, potentially communicable infections such as shingles.
- Medications –prescription medications, as well as over-the-counter medicines and natural supplements, are potentially significant to dental care. This can include everything from drug interactions of which the patient is unaware of, to the potential of adverse reactions with drugs used in the dental setting. Bleeding is one common example, with an increased bleeding risk associated with everything from aspirin to ibuprofen and even supplements like fish oil and turmeric. Regular use of aspirin, even in a low dose, can increase this risk and using these medicines together further enhances the risks. Certain treatments for osteoporosis can impinge on bone healing in the dental setting, and some mood stabilisers may interact with dental anaesthetics. The more medicines one uses, the greater the potential implications.
- Prior Surgery – it’s crucial to have a complete list of prior surgeries which the patient has undergone. How is this relevant? Certain surgeries, including cardiac surgery and joint replacement, carry an increased risk of infection within six months of the surgery if bacteria enter the bloodstream via the mouth. This can easily occur during a routine scale and clean. Knowing about this increased risk enables the dentist to implement further precautions to mitigate it.
- Radiation Therapy – this form of cancer treatment to the head and neck area has significant implications on dental health and ongoing dental care. Not only is the ability of the area to heal after radiation therapy (and often in the long term) compromised; so too are there consequences for normal function such as the production of saliva. Future radiation exposure via screening x-rays must also be minimized.
Taking a medical history at the first appointment is imperative and updating it to record any changes in health status at subsequent visits is just as important. Patients should be informed of the importance of full disclosure and that all information imparted is treated with the same confidentiality and respect as it would be by their medical doctor.