Medical History Taking Flashcards by Aimee Nimmo

ORDER

introduce
presenting complaint 
history of presenting complaint 
med history 
dental history 
social history 
family history 
conclude

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SOCRATES

site
onset
characteristic 
radiation
associated symptoms 
time 
exacerbating factors 
severity

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MED HISTROY ORDER

heart 
lungs 
stomach 
endocrine 
musco-skeletal
bleeding disorders 
nuero - fits / faints 
meds
hosp/surgery 
allergies

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DRUGS OF NOTE FOR DENTIST

anticoag - warfarin NOACS - for extractions
antiplatelets - clopidogrel / aspirin
bisphosphonates - taken for osteoporosis - link to osteonecrosis of the jaw
steroids - taken if asthmatic - lead to adrenal crisis

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STEPS WHEN SOMEONE HAS ANGINA

make sure they have their GTN spray - encourage them to use it before appointment
manage their stress as this is what can bring on angina attack
jaw pain radiating to neck is jsut their angina
aspirin

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STEPS WHEN PATIENTS HAS PCI /CABG

any stress causes them greater effect as they have reduced cardiac muscle
stent = extra care of mouth as avoid getting perio - push prevention
antiplatelets
aspirin cant be stopped if they are stented

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DENTAL LINK TO ANGIOTENSIN INHIBITORS / B BLOCKERS

lichenoid reaction - whitening around ulceration

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DENTAL LINK TO ANTIPLATELTS / ANTICOAG

extended bleeding time - extractions

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DENTAL LINK TO CALCIUM CHANNEL BLOCKERS

gingival hyperplasia - overgrowth of gum tissue

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STEPS WHEN PATEINT HAS HEART FAILURE

dont use B blockers
dont lie flat as causes shortness of breath
drug absorption issues

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STEPS WHEN PATIENT HAS INFECTIVE ENDOCARDITIS

prevent
avoid piercings
antibiotic prophylaxis before treatment - antibiotic resistance though - need informed consent
mouth bacteria link to infective endocarditis

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STEPS WEHN PATIENT HAS A PACEMAKER

avoid equipment generating electromagnetic feild - induction/ultrasonic scaler

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WHAT IS ANAEMIA

low Hb

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CAUSES OF ANAEMIA

cant make haem 
cant make globin chains 
inflammatory disease
reduced RBC - bone marrow cant make
bleeding such as GIT

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WHAT DO MICROCYTIC RBC INDICATE

small

Fe/thalassemia

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WHAT DO MACROCYTIC RBC INDICATE

large

vit B12 / folate / retics

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WHAT DO NORMOCYTIC RBC INDICATE

normal size but reduced Hb in blood

WHAT DO HYPOCHROMIC RBC INDICATE

paler due to less Hb

HAEMATINICS

needed to make haem
Fe
folate
vit b12

HAEMOGLOBINOPATHIES

failure of globin chain production
thalassemia = genetic mutation of globin
sickle cell anaemia = abnormal globin chains that only work in normal standard O2 enviro

STEPS WHEN PATIENT HAS ANAEMIA

figure out if its caused by sickle cell - as need o2 capacity for general anaesthetic
deficiency cause can =
mucosal atrophy
candidisis
recurrent oral ulceration
sensory changes
if you see a mucosal disease - check their haematinics

WHICH DISEASES REDUCE COAGULATION ABILITY

haemophilia a / b

von willibrands disease

STEPS TO TAKE IF PATIENT IS MILD / CARRIER OF DECREASED COAGULATION

refer to hosp for 
extractions 
surgery 
LA - IDB , lingual infil
review at haemophilia centre every 2 years
observe for 2-3 hours after extraction

STEPS WITH A DENTATE PATIENT WITH DECREASED COAGULATION

treat in hosp for extraction, surgery, lingual infil, IDB

review overnight after extraction

STEPS WITH A EDENTULOUS PATIENT WITH DECREASED COAGULATION

treat in GDP

WHICH PROCEUDRES NEED SPECIAL CARE WHEN A PATIENT HAS AN INHERITED BLEEDING DISORDER

extraction surgery perio surgery biopsy

WHAT IS INR

international normalised rario

STEPS WHEN PATIENT IS ON WARFARIN

don't do treatment there - get INR checked first 72 hours before should be 2-4 local haemostatic measures NSAIDS/antibiotics increase INR

STEPS WHEN PATIENT ON NOACS

treat early in day / week limit inital treatment to asses degree of bleeding high risk procedure = miss morn dose - 1 a day - have after / 2 a day = have only 1 after that day local haemostatic measures NSAIDS prolong action

STEPS WHEN PATIENT IS ON ANTIPLATELET ANTITHROMBINS

aspirin = dont stop, local haemo measures aspirin + 1 / 1 = dont stop, local haemo measures and expect prolonged bleeding 2 = discuss w doc to stop 1 week prior / refer to hosp good post op instruction with emergency contact details

STEPS WHEN SOMEONE HAS COPD

dont lie them flat - obstructs airways might need O2 = interferes they might be using inhaled steroids at high dose = candida risk = rinse / space divider no oxygen

STEPS WHEN SOMEONE HAS COELIAC DISEASE

dont give them meds with gluten

STEPS WHEN SOMEONE HAS CROHNS DISEASE

look out for steroidal meds = cause candida | oral presentaiton

WHICH MEDS CAN CAUSE ORAL INFECTIONS

steroids

STEPS WHEN SOMEONE HAS OROFACIAL GRANULOMATOSIS

odema of mouth and face | check if they have crohns this is a presentation of it

STEPS WHEN SOMEONE HAS LIVER FAILURE

liase with physician - use INR 1.1-1.3 think about which drugs / doses as they have lesser ability of metabolising LA okay as done in plasma paracetamol is safest analgesic reduced plasma proteins = less drug binding (effect)

STEPS WHEN SOMEONE HAS RENAL DISEASE

check drug prescription with physician oppurtunisic infections dry mouth / taste disturbance bleeding tendencies

EFFECTS WHEN SOMEONE HAS CHRONIC RENAL FAILURE

growth in child slow = eruption delayed secondary anaemia effects white patches

STEPS WHEN SOMEONE IS ON RENAL DIALYSIS

treat day after dialysis check drugs with physician - need to be able to be removed dont treat if transplant is near

STEPS WHEN SOMEONE HAS A RENAL TRANSPLANT

be suspicous of oral lesions as they are at a higher cancer risk prednisolone = bad

STEPS TO TAKE WHEN SOMEONE HAS THYROID DYSFUNCTION

goitre detectable hyper = pain anxiety hypo = avoid sedatives

STEPS WEHN SOMEONE HAS DIABETES

be aware of effect of dental treatment on their food intake / their normal routine / glucose alternative if cant eat poor wound healing infection risk hypoglycaemia