Ch. 11 Medical, Dental, And Psychiosocial Histories Flashcards
What are the 2 ways to obtain a health history?
Interview
Questionnaire
Pre-appointment Information and why it’s important (methods to determine history)
Basic info gathered before initial assessment
Saves time and facilitates the process
Helps determine potential problems like need for premed or primary care provider
Ex: diabetes, hemoglobin levels (HBA1C)
Or if on blood thinner
Limitations of a health history
- How the questions are worded
- Difficulty understanding, can’t read or language barrier
- Location of questionnaire completion (crowded waiting room)
No privacy and won’t want to correctly answer some questions - Pts limited knowledge doesn’t think certain diseases matter for dental treatment
- Reluctance to discuss health questions
Embarrassed (hiv, aids) - Cognitive ability to understand
Advantages of a Questionnaire
Broad in scope-leads to pos. Answers needing additional clarification
Time saving
Consistent (Systemic in gathering info) same form every time
Pt has time to think over answers-not under pressure from interview
Pt may write info not directly expressed in interview
Legal aspects-pt wrote it out and signed
Disadvantages of the questionnaire
(If used alone with out follow up interview)
Impersonal
Inflexible- no additional questions for areas of importance
Who will need Antibiotic Prophylaxis ?
Pts with or at risk for IE (Infective Endocarditis-infection of heart) need a premed before any oral tissue manipulation!
Ex: prosthetic heart valves, history of IE, heart transplant, and some congenital heart conditions
Probing or scaling could lead to bacteremia
Bacteremia
Introduce bacteria (microorganisms) into bloodstream and then they circulate throughout body
Gives infection to pt
Recommended time for pt to take premed before appointment
1 hour (antibiotic)
Does a pt still need to take a premed even if on antibiotic for a different condition?
Yes. Most likely will need a higher dose to prevent bacteremia
How to decrease frequent exposure of bacteria?
Recommend and push good home care
What is the standard antibiotic given?
Amoxicillin
1 hr before appointment
2 grams
American Society of Anesthesiology
ASA Classifications 1-6
ASA I
Normal health
Without acute or chronic disease and a normal BMI
ASA II
Mild systemic disease without functional limitations
Well controlled such as diabetes or hypertension
ASA III
One or more moderate to severe systemic diseases
Significant functional limitations
Ex: Renal failure with dialysis
Unstable asthma or epilepsy
Poorly controlled diabetes or hypertension
Substance use
History of stroke or heart attack (>3 months)
Morbid obesity
ASA IV
Severe systemic disease that is constant threat to life
Recent stroke or heart attack (<3 months)
Congestive heart failure
Advanced cancer
ASA V
Moribund pt not expected to live 24 hrs with out without care
End stage liver disease, malignant hypertension, respiratory failure
ASA VI
Declared brain dead and organs being removed
When do you review and update pt health history
At every appointment
Ask questions to compare present condition with previous one
Changes in health
Visits to physician (reason and results)
Lab tests and results (blood, urine, other)
Current meds
Changes in oral soft tissue and teeth
System oriented questions
Direct questions to determine if the patient has had a disease. Often the questions are organized as a review of body systems (e.g., the digestive system, respiratory system, or urinary system).
The questions may contain references to specific organs (e.g., the stomach, lungs, or kidneys).
Disease oriented questions
A typical set of questions may start with “Do you have, or have you had, any of the following diseases or problems?”
A listing under that question contains items such as diabetes, asthma, or hypertension arranged alphabetically or grouped by systems or body organs.
Follow-up questions can determine dates of illness, severity, and outcome.
Symptom oriented
suspicion of a condition, which, in turn, can provide an opportunity to recommend and refer the patient to schedule an examination with a PCP.
Examples of the symptom-oriented questions are “Are you thirsty much of the time?” “Have you lost weight without trying?” or “Do you have to urinate frequently during the day and/or at night?”
Positive answers could lead to tests for diagnosis of diabetes.
Culture oriented questions
Identify ethnic or gender-related increase in risk for systemic or oral disease.
Determine traditional, culturally related health beliefs that may influence dental hygiene interventions or recommendations.
Identify herbal preparations or other traditional medications used by the patient that may affect oral care or risk for disease.
