1. Intro To Human Disease

Question 1

LOs

Answer 1

• Understand the principles of history taking relevant to dental treatment
• Learn to take a medical history that explores the full extent of the problem based upon your understanding of the complications of each diagnosis
• Appreciate the contribution of history, examination and investigations to the overall diagnosis and subsequent management
• Understand that patients have their own ideas, interpretations, concerns and expectations

Question 2

Symptom vs sign?

Answer 2

SYMPTOM
↳ subjective feeling reported by patient
↳ WHAT THEY FEEL

↳eg.
→ pain
→dry mouth

SIGN
↳ objective change, is observable
↳ WHAT CLINICIAN SEES

↳ eg.
→ swelling
→ ulcers
→ erythema (redness)

Question 3

Acronym to help with history taking?

Answer 3

SOCRATES

Site. Where is pain?
Onset. Sudden or gradual?
Character. McGill pain …………………….. questionnaire
Radiation. Does the pain spread?
Associated factors. Eg. headache, fever, etc
Timing. Constant or intermittent
Exacerbating/ relieving factors. Eg, OTC analgesics
Severity Eg. ?/10

Question 4

What do we want to know when taking patient history?

Answer 4

• Age, name, occupation, reason for referral

① presenting complaint (PC)

② history of presenting complaint (HPC)

③ past medical history (PMH)

④ previous dental history (PDH)

⑤ review of systems

⑥ medication/ allergies

⑦ family history (FH)

⑧ social history (SH)

⑨ examination

Question 5

① presenting complaint features?

Answer 5

↳ should be written in patients own words

Question 6

② history of presenting complaint (HPC) features?

Answer 6

↳ details of problem & symptoms → write in chronological order
↳ start?
↳ what observed?
↳ happened before?
↳ pain?

Question 7

③ past medical history (PMH) features

Answer 7

↳ ever in hospital
↳ illness
↳ operations
↳ diabetes?
↳ asthma
↳ bronchitis TB
↳ jaundice
↳ rheumatic fever
↳ bp
↳ heart disease
↳ stroke
↳anaesthetic problems
↳ epilepsy

Question 8

④ previous dental history (PDH) features

Answer 8

↳ regular?
↳ treatments?
↳ LA /IV sedation / GA

Question 9

⑤ review of systems features

Answer 9

↳ eyes/ nose/ ears/ mouth/ throat (ENT)
↳ CVS
↳ resp
↳ GI
↳ musculoskeletal
↳ endocrine
↳ haematological
↳ neurological
↳ psychiatric

Question 10

⑥ medication/ allergies features

Answer 10

↳ allergen + reaction, particularly to antibodies
↳ tablets / injections (dose, how many times a day?)
↳ herbal remedies
↳ as required med
↳ relevant previous med

Question 11

⑦ family history (FH)

Answer 11

↳who else at home + occupation
↳ marital status, spouse health
↳ family illnesses

Question 12

⑧ social history (SH)

Answer 12

↳ smoking
- cigarettes/ filtered/ no filter/ tobacco
- number (/day)
- duration

↳ alcohol
- frequency (units/ week)

↳ illicit substances (if relevant)
↳ social network
↳ relationship status

Question 13

⑨ examination features

Answer 13

↳assess patient as enter

↳general appearance
- pale
- habitus / gait
- dishevelled
- wheezing
- skin

↳ extra oral
- hands
- bony symmetry
- ears
- nose
- soft tissues
- salivary glands
- speech affect
- neck
- soft tissues (lacerations)
- lips (contour)
- lymph nodes

↳ lymph nodes
- submental
- submandibular
- preauricular
- postauricular
- occipital
- cervical
- supraclavicular

↳ salivary glands
- parotid
- submandibular
- sublingual

↳ general
- temp
- pulse
- bp
- resp rate

↳ cranial nerves
- competent to examine all cranial nerves

↳ swelling
- site
- shape
- size
- colour
- consistency
- hard
- soft
- fixed
- mobile
- outline
- surrounding tissues
- transillumination

↳ intra oral
- mucous membranes (buccal mucosa/ labial mucosa/ palate/ floor of mouth/ oraphynx/ retromolar fossa)
- tongue
- salivary gland ducts

↳ tonsillar tissue

↳ periodontal tissue

↳ teeth

↳ edentulous ridges

↳ occlusion

↳ dentures

Question 14

investigations

Answer 14

dental
↳ vitality tests (thermal/ electric)
↳ diagnostic LA
↳ studying models

imaging
↳ radiographs
↳ ultrasound
↳ CT scan
↳ MRI scan
↳ photography

visualisation
↳ endoscopy
↳ arthroscopy

blood
↳ haematology
↳ biochem
↳ microbiology
↳ serology
↳ immunology

body fluid
↳ microscopy
↳ culture
↳ sensitivity
↳ saliva
↳ urine
↳ purulent discharge
↳ aspirate
↳ CSF

biopsy
↳ incisional
↳ excisional
↳ FNA

Question 15

management plan

Answer 15

• explanation + patient factors considered
• agreed management plan
• lifestyle advice
• short/ medium/ long term
• medical/ surgery
• referral for specialist opinion/ management

Question 16

treatment

Answer 16

• treatment is tailored to patient needs
• many factors must be considered
  ↳ patient factors
  ↳ prognosis
  ↳ ETC