bds2 medical history taking

Question 1

why is medical history taking important

Answer 1

required for safe and holistic approach to patient care
there can be drug interactions with prescribing
allows risk assessment of the likelihood of emergency in the dental setting

Question 2

describe medical history forms

Answer 2

these are forms completed and signed by the patient
the patient signature does not absolve the responsibility of the dentist and we must check the patient has understood the form correctly

the dentist must also obtain and document a full history using the medical history form as a framework for the discussion

Question 3

what are the stages of medical history taking

Answer 3

introduction
presenting complaint
history of presenting complaint
past medical history
dental history
social history
family history

Question 4

steps to introduction phase

Answer 4

greet patient and introduce everyone present including the full name and job role

Question 5

steps to presenting complaint

Answer 5

this is the reason for the patients attendance
ask the patient to describe their problem using open end questions
document the presenting complaint in the patients own words

Question 6

how do you record the absence of a presenting complaint

Answer 6

C/O: Nil

Question 7

describe the history of presenting complaint

Answer 7

obtain further information about the presenting complaint
use open questions at the beginning then specific questions where it is appropriate to obtain all the relevant information
summarise what the patient has told you and check accuracy

Question 8

how to check pain history

Answer 8

SOCRATES

Question 9

what are the different systems to check in a medical history

Answer 9

cardiovascular
respiratory
gastrointestinal
liver disease
neurological
psychiatric
musculoskeletal
genitourinary
endocrine
haematological
renal
skin
infectious disease

Question 10

what is the systems approach to past medical history

Answer 10

look at the system, the condition or diagnosis, the control and severity of the disease and how it is managed

Question 11

why is hospital treatment an important aspect of past medical histories

Answer 11

need to document any previous hospital admissions, the reason and the dates because this can give the current medical status of the patient and how it may affect the provision of dental care

Question 12

what is important to ask regarding medication in medical history taking

Answer 12

do you take any medication prescribed or otherwise including prescription medicines, over the counter medicines, homeopathic remedies

how are they administered eg topical, oral, inhaled, intravenously

Question 13

what are some drug types with notable implications in the dental setting

Answer 13

anti coagulants
anti platelets
bisphosphonates
steroids
biological therapies

Question 14

describe the relevance of anti coagulants in dentistry

Answer 14

they provide a bleeding risk
warfarin - ask about the date taken and the value of the last INR reading

for direct oral anti coagulants, how many do they take daily

Question 15

what is rivaroxiban

Answer 15

a direct oral anticoagulant

Question 16

what is apixaban

Answer 16

a direct oral anti coagulant

Question 17

why are anti platelet drugs notable in dentistry

Answer 17

they can present a bleeding risk like clopidogrel and aspirin

Question 18

why are biphosphonates relevant in dental settings

Answer 18

they present a medical related osteonecrotic jaw risk

Question 19

examples of biphosphonates

Answer 19

alendrotnic acid and zolendronic acid

Question 20

why should any history of biphosphonate taken be considered

Answer 20

can remain in the system for many years

Question 21

why are steroids that have been taken in the last year important to consider in dentistry

Answer 21

they present an adrenal crisis or infection risk

Question 22

example of steroids

Answer 22

long term prednisolone

Question 23

examples of biological therapies relevant in a dental setting

Answer 23

present an infection risk and delayed wound healing
these are usually given by injection or infusion so ask about the dosing interval

Question 24

questions regarding allergies in a medical history taking

Answer 24

do you have any allergies to medicines, foods or other substances
what happens when you contact this allergy
do you carry an api pen and do you have one with you

Question 25

information that can be provided from dental history examples

Answer 25

attendance
previous experience
dental anxiety
brushing
interdental cleaning
diet
adverse effects to local anaesthetic
risk of bleeding after extraction
denture use
orthodontic treatment
treatment under sedation

Question 26

information obtained from a social history includes what

Answer 26

age
occupation
living situation- where and who with to show how well supported they are
travel arrangements - is it easy for them to access their appointments
mobility
smoking
alcohol
recreational drug use
capacity to consent to treatment

Question 27

information regarding family history should include what

Answer 27

record of relevant health information of patients close relatives
can help identify individuals that are at an increased risk of developing a disease due to shared genes or behaviours
includes cardiac conditions, diabetes, periodontal disease and certain cancers

Question 28

when is a full history required

Answer 28

for a new patient and at the start of each subsequent course of treatment thereafter

Question 29

when can a shortened history be taken

Answer 29

when the patient returns for routine care following initial consultation as long as there is a full history documented in patient records

Question 30

does a full history need to be taken if a patient is regular but has just started a new medication or had a medical intervention since the last visit

Answer 30

yes