C.1 : History And Examination

Question 1

What is the aim of the presenting complaint in the patient’s history?

Answer 1

The aim is to establish provisional differential diagnoses even before examining the patient.

Source: Adapted from medical guidelines

Question 2

What are some suggested questions to ask when a patient is complaining of symptoms?

Answer 2

Ask about the onset and pattern, frequency, exacerbating and relieving factors, origin and radiation, character and intensity, and associations.

Source: Adapted from medical guidelines

Question 3

Why is it important to ask about the character and intensity of pain?

Answer 3

To understand how the patient describes the pain, which can help in determining the nature of the problem.

Source: Adapted from medical guidelines

Question 4

How can dental problems be quickly narrowed down?

Answer 4

By asking a series of questions related to onset, frequency, exacerbating and relieving factors, character and intensity of pain, and associations.

Source: Adapted from medical guidelines

Question 5

What can the patient’s social history reveal?

Answer 5

The patient’s social history can give a lot of information about their lifestyle and risk factors for diseases such as periodontal disease and oral cancer. It is important not to be judgemental at this stage; however, these questions can be helpful in getting to know patients and in Rx planning.

Source: THE SOCIAL HISTORY

Question 6

What questions can be asked regarding smoking in the social history?

Answer 6

What do they smoke? How long have they smoked for? If they have stopped smoking, when did they stop?

Source: THE SOCIAL HISTORY

Question 7

What is the recommended limit for alcohol intake according to the Chief Medical Officer’s guidelines?

Answer 7

The Chief Medical Officer’s guidelines now advise no more than 14 units of alcohol per week for both men and women to keep health risks from alcohol to a low level. It is useful to clarify what the patient drinks (spirits, lager, or wine, for example) and often they will need help in calculating the number of units they consume.

Source: THE SOCIAL HISTORY

Question 8

Why is it important to consider the patient’s occupation in oral health advice?

Answer 8

Certain occupations may affect both routine and diet so should be considered when delivering oral health advice and motivating patients.

Source: THE SOCIAL HISTORY

Question 9

How can information about a patient’s diet be gathered effectively?

Answer 9

General information can be gathered regarding a patient’s diet; however, a more formal approach is to use a diet sheet. Ideally, this should be completed across a mixture of both working days and non-working days to get an idea what the patient’s frequency of sugar intake is. They should include drink as well as food and record if sugar is added to these. It is tempting for patients to change their diet once they know it is being analysed, or to avoid recording things they feel they shouldn’t have eaten. It is important to educate patients about hidden sugars and the impact of diet on their dental health regardless of what is recorded, in case there have been any omissions on their completed diet sheets!

Source: THE SOCIAL HISTORY

Question 10

Why is it useful to know if patients are using substances like gutka, betel nut, or paan?

Answer 10

It is useful to know whether patients are using other substances such as gutka, betel nut, or paan (with or without tobacco) as these can lead to staining of teeth and gingival tissues as well as an increased risk of oral cancer.

Source: THE SOCIAL HISTORY

Question 11

How often do you go to the dentist?

Answer 11

This gives information on motivation, likely attendance patterns, and may indicate patients who change their general dental practitioner (GDP) frequently.

Example sentence: The patient mentioned that they go to the dentist every 6 months.

Question 12

When did you last see a dentist and what did they do?

Answer 12

This may give clues as to the diagnosis of the presenting complaint, e.g. a recent root canal treatment (RCT).

Example sentence: The patient stated that they last saw a dentist 3 months ago for a filling.

Question 13

How often do you brush your teeth and how long for? Do you use mouthwash, floss, or interdental brushes?

Answer 13

This gives information on motivation and likely gingival condition.

Example sentence: The patient brushes their teeth twice a day for 2 minutes each time and uses floss daily.

Question 14

Are you aware that you grind your teeth or bite your nails?

Answer 14

This may provide information on temporomandibular disorder (TMD) and personality.

Example sentence: The patient was not aware that they grind their teeth at night.

Question 15

How do you feel about dental treatment?

Answer 15

This helps in explaining any dental anxiety.

Example sentence: The patient expressed feeling nervous about getting a filling.

Question 16

What do you think about the appearance of your teeth?

Answer 16

This provides clues about motivation and possible need for orthodontic Rx.

Example sentence: The patient mentioned wanting to straighten their teeth.

Question 17

What is your job?

Answer 17

This can give indications about socio-economic status, education, availability for attending appointments, possible snacking habits, and frequently changing routines (e.g. night shifts or long-distance driving), that may affect diet (e.g. high-sugar/ energy drinks if an athlete).

Example sentence: The patient works as a teacher and has a consistent schedule.

Question 18

Where do you live?

Answer 18

This gives information on fluoride intake and travelling time to surgery. This question may seem invasive to the patient, so the information can be obtained from their records. Confirm these are up to date and accurate.

Example sentence: The patient lives in a rural area with limited access to fluoride in the water.

Question 19

What types of dental treatment have you had previously?

Answer 19

For example, previous extractions, problems with local anaesthesia (LA) or general anaesthesia (GA), orthodontics, and periodontal Rx.

Example sentence: The patient had a previous extraction due to a decayed tooth.

Question 20

What are your snacking habits like?

Answer 20

For example, types of foods/ drinks and frequency. This can give indications about hidden sugars, caries rate, and erosion. It is worth including specific questions as to whether or not they use tobacco, alcohol, or other recreational drugs.

Example sentence: The patient snacks on sugary treats throughout the day.

Question 21

How often do you go to the dentist?

Answer 21

This gives information on motivation, likely attendance patterns, and may indicate patients who change their general dental practitioner (GDP) frequently.

Example sentence: The patient mentioned that they go to the dentist every 6 months.

Question 22

When did you last see a dentist and what did they do?

Answer 22

This may give clues as to the diagnosis of the presenting complaint, e.g. a recent root canal treatment (RCT).

Example sentence: The patient stated that they last saw a dentist 3 months ago for a filling.

Question 23

How often do you brush your teeth and how long for? Do you use mouthwash, floss, or interdental brushes?

Answer 23

This gives information on motivation and likely gingival condition.

Example sentence: The patient brushes their teeth twice a day for 2 minutes each time and uses floss daily.

Question 24

Are you aware that you grind your teeth or bite your nails?

Answer 24

This may provide information on temporomandibular disorder (TMD) and personality.

Example sentence: The patient was not aware that they grind their teeth at night.

Question 25

How do you feel about dental treatment?

Answer 25

This helps in explaining any dental anxiety. ## Footnote Example sentence: The patient expressed feeling nervous about getting a filling.

Question 26

What do you think about the appearance of your teeth?

Answer 26

This provides clues about motivation and possible need for orthodontic Rx. ## Footnote Example sentence: The patient mentioned wanting to straighten their teeth.

Question 27

What is your job?

Answer 27

This can give indications about socio-economic status, education, availability for attending appointments, possible snacking habits, and frequently changing routines (e.g. night shifts or long-distance driving), that may affect diet (e.g. high-sugar/ energy drinks if an athlete). ## Footnote Example sentence: The patient works as a teacher and has a consistent schedule.

Question 28

Where do you live?

Answer 28

This gives information on fluoride intake and travelling time to surgery. This question may seem invasive to the patient, so the information can be obtained from their records. Confirm these are up to date and accurate. ## Footnote Example sentence: The patient lives in a rural area with limited access to fluoride in the water.

Question 29

What types of dental treatment have you had previously?

Answer 29

For example, previous extractions, problems with local anaesthesia (LA) or general anaesthesia (GA), orthodontics, and periodontal Rx. ## Footnote Example sentence: The patient had a previous extraction due to a decayed tooth.

Question 30

What are your snacking habits like?

Answer 30

For example, types of foods/ drinks and frequency. This can give indications about hidden sugars, caries rate, and erosion. It is worth including specific questions as to whether or not they use tobacco, alcohol, or other recreational drugs. ## Footnote Example sentence: The patient snacks on sugary treats throughout the day.

Question 31

Are you fit and well?

Answer 31

YES/NO ## Footnote Example of a medical questionnaire

Question 32

Are you seeing a doctor for anything?

Answer 32

YES/NO ## Footnote Example of a medical questionnaire

Question 33

Have you ever been admitted to hospital?

Answer 33

YES/NO ## Footnote Example of a medical questionnaire

Question 34

Have you ever had an operation?

Answer 34

If so, were there any problems? ## Footnote Example of a medical questionnaire

Question 35

Have you ever had any heart trouble or high blood pressure?

Answer 35

YES/NO ## Footnote Example of a medical questionnaire

Question 36

Have you ever had any chest trouble?

Answer 36

YES/NO ## Footnote Example of a medical questionnaire

Question 37

Have you ever had any problems with bleeding? Do you bruise easily?

Answer 37

YES/NO ## Footnote Example of a medical questionnaire

Question 38

Have you ever had asthma, eczema, or hayfever?

Answer 38

YES/NO ## Footnote Example of a medical questionnaire

Question 39

Do you have fits, faints, or headaches?

Answer 39

YES/NO ## Footnote Example of a medical questionnaire

Question 40

Do you have any known allergies such as penicillin, latex, or Elastoplast?

Answer 40

YES/NO ## Footnote Example of a medical questionnaire

Question 41

Are you allergic to any other drug or substance?

Answer 41

YES/NO ## Footnote Example of a medical questionnaire

Question 42

Do you have or ever had: Arthritis? Diabetes? Epilepsy? Tuberculosis? Jaundice? Hepatitis especially B or C? Other infectious disease, HIV in particular?

Answer 42

YES/NO ## Footnote Example of a medical questionnaire

Question 43

Are you pregnant or breastfeeding?

Answer 43

YES/NO ## Footnote Example of a medical questionnaire

Question 44

Are you taking any drugs, medications, or pills?

Answer 44

YES/NO ## Footnote Example of a medical questionnaire

Question 45

Who is your GMP?

Answer 45

Check the medical history at each recall. ## Footnote Example of a medical questionnaire

Question 46

If a patient cannot recall their regular medications, ask them to bring their prescription to their next appointment or contact their General Medical Practitioner (GMP).

Answer 46

Check the medical history at each recall. ## Footnote Example of a medical questionnaire

Question 47

If in any doubt, contact the patient's GMP, or the specialist they are attending, before proceeding.

Answer 47

Check the medical history at each recall. ## Footnote Example of a medical questionnaire

Question 48

What is the importance of screening for medical problems in dental practice?

Answer 48

Screening for medical problems in dental practice is important because certain conditions are so commonplace and of such significance that screening is justifiable. Whether or not it is appropriate to use the dental practice environment to screen for hypertension, smoking, or drug and alcohol abuse is a cultural, personal, and pragmatic decision for the dentist. ## Footnote Source: THE MEDICAL HISTORY

Question 49

What should be considered when screening for hypertension in a dental practice?

Answer 49

When screening for hypertension in a dental practice, it is important to ensure that you are adequately trained in the technique, are aware of and avoid the risk of inducing disease, and act on significant results in a meaningful way. Generating a cohort of 'worried well' who then overload their GP is hardly helpful, whereas detecting significant hypertension in an unsuspecting middle-aged man who then has this corrected could be. ## Footnote Source: THE MEDICAL HISTORY

Question 50

What is the purpose of asking patients to complete a medical history questionnaire?

Answer 50

To encourage more accurate responses to sensitive questions. ## Footnote It is important to use this as a starting point and clarify any uncertainties.

Question 51

Give an example of a medical questionnaire question.

Answer 51

Are you fit and well? ## Footnote Example of a question from a medical questionnaire.

Question 52

When should the medical history be checked?

Answer 52

At each recall. ## Footnote It is important to check the medical history regularly.

Question 53

What is crucial when choosing to implement a screening policy in dental practice?

Answer 53

Ensuring proper training in the technique and acting on significant results. ## Footnote It is important to be adequately trained and take appropriate action based on screening results.

Question 54

What is 'white coat hypertension'?

Answer 54

A condition where a patient gets anxious at the dentist, leading to falsely elevated blood pressure readings. ## Footnote White coat hypertension can result in inaccurate blood pressure readings.