L121: Making a Diagnosis

Question 1

What are the five stages of taking a medical history?

Answer 1

• C/O: Complaining of;
• HPC: History of present complaint;
• PMH: Past medical history;
• PDH: Past dental history;
• SH: Social history.

Question 2

In summary, what is noted for C/O?

Answer 2

• Symptoms of the disease in the patient’s own words;
• Type of pain? Sharp or dull?;
• Level of pain 0-10.

Question 3

In summary, what is noted for HPC?

Answer 3

• Duration of pain;
• Changes to pain;
• Exacerbating or relieving factors.

Question 4

In summary, what is noted for PMH?

Answer 4

• Structured Qs!
• Diabetes;
• Allergy;
• Epilepsy;
• Drug history;
• Antidepressants (tricyclic);
• Aspirin;
• Drug-induced hyperplasia;
• Anticoagulants.

Question 5

How may treatment for a patient suffering from diabetes be effected?

Answer 5

• Meal times: avoid appointments that interrupt eating routine to avoid hypos;
• Healing: slower healing;
• Infections: more prone to infections so antibiotic cover (AB) may be required.

Question 6

Why is it important to note any allergies the patient suffers from?

Answer 6

• To avoid any drugs that they might be allergic to;

- To avoid any materials that they might be allergic to (e.g. latex).

Question 7

How may treatment for a patient suffering from epilepsy be effected?

Answer 7

• Patient could be sensitive to dental chair light being used;
• Removable appliances should be avoided (to prevent choking in a seizure).

Question 8

Why is it important to note any drugs the patient takes?

Answer 8

• To avoid unwanted interactions of drugs that the dentist might prescribe;
• To be aware of how the treatment might need to be altered (e.g. do they suffer from any blood disorders that prevent clotting etc.).

Question 9

What effect do tricyclic antidepressants have on the oral cavity?

Answer 9

• Xerostomia, therefore predisposition to tissue damage, caries, denture retention.

Question 10

What drug can cause ulceration if directly applied to the gingiva or soft tissues?

Answer 10

Aspirin, ‘aspirin-burn’ (salicylic acid)

Question 11

What drugs can cause gingival hyperplasia?

Answer 11

• Epanutin-dilatin (epilepsy);

- Cyclosporin (immunosuppressant).

Question 12

In summary, what is noted for PDH?

Answer 12

• How regular the patient attends a dental practice;

- Past experience (good, bad, traumatic).

Question 13

In summary, what is noted for SH?

Answer 13

• Employment status;
• Full time or part time;
• Ease of attending clinic;
• Alcohol and tobacco use;
• Are they providing care for anyone?;
• Wind instruments?

Question 14

After examination, patients might require ‘special testing’, give examples of these tests.

Answer 14

• Mobility tests (can teeth move >1mm?);
• Radiographs;
• Plaque score;
• Biopsy;
• Sensitivity test.

Question 15

What are the most common dental diagnoses?

Answer 15

• Caries;
• Gingivitis;
• Pulpitis;
• Periodontitis;
• Tooth wear;
• Failure of restoration(s);
• Recurrent oral ulceration (ROU).