Medical History Taking Flashcards
ORDER
introduce presenting complaint history of presenting complaint med history dental history social history family history conclude
SOCRATES
site onset characteristic radiation associated symptoms time exacerbating factors severity
MED HISTROY ORDER
heart lungs stomach endocrine musco-skeletal bleeding disorders nuero - fits / faints meds hosp/surgery allergies
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
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
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
DENTAL LINK TO ANGIOTENSIN INHIBITORS / B BLOCKERS
lichenoid reaction - whitening around ulceration
DENTAL LINK TO ANTIPLATELTS / ANTICOAG
extended bleeding time - extractions
DENTAL LINK TO CALCIUM CHANNEL BLOCKERS
gingival hyperplasia - overgrowth of gum tissue
STEPS WHEN PATEINT HAS HEART FAILURE
dont use B blockers
dont lie flat as causes shortness of breath
drug absorption issues
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
STEPS WEHN PATIENT HAS A PACEMAKER
avoid equipment generating electromagnetic feild - induction/ultrasonic scaler
WHAT IS ANAEMIA
low Hb
CAUSES OF ANAEMIA
cant make haem cant make globin chains inflammatory disease reduced RBC - bone marrow cant make bleeding such as GIT
WHAT DO MICROCYTIC RBC INDICATE
small
Fe/thalassemia
WHAT DO MACROCYTIC RBC INDICATE
large
vit B12 / folate / retics
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
