Ch. 11 Medical, Dental, And Psychiosocial Histories

Question 1

What are the 2 ways to obtain a health history?

Answer 1

Interview
Questionnaire

Question 2

Pre-appointment Information and why it’s important (methods to determine history)

Answer 2

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

Question 3

Limitations of a health history

Answer 3

1. How the questions are worded
2. Difficulty understanding, can’t read or language barrier
3. Location of questionnaire completion (crowded waiting room)
   No privacy and won’t want to correctly answer some questions
4. Pts limited knowledge doesn’t think certain diseases matter for dental treatment
5. Reluctance to discuss health questions
   Embarrassed (hiv, aids)
6. Cognitive ability to understand

Question 4

Advantages of a Questionnaire

Answer 4

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

Question 5

Disadvantages of the questionnaire

Answer 5

(If used alone with out follow up interview)

Impersonal
Inflexible- no additional questions for areas of importance

Question 6

Who will need Antibiotic Prophylaxis ?

Answer 6

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

Question 7

Bacteremia

Answer 7

Introduce bacteria (microorganisms) into bloodstream and then they circulate throughout body

Gives infection to pt

Question 8

Recommended time for pt to take premed before appointment

Answer 8

1 hour (antibiotic)

Question 9

Does a pt still need to take a premed even if on antibiotic for a different condition?

Answer 9

Yes. Most likely will need a higher dose to prevent bacteremia

Question 10

How to decrease frequent exposure of bacteria?

Answer 10

Recommend and push good home care

Question 11

What is the standard antibiotic given?

Answer 11

Amoxicillin
1 hr before appointment
2 grams

Question 12

American Society of Anesthesiology

Answer 12

ASA Classifications 1-6

Question 13

ASA I

Answer 13

Normal health
Without acute or chronic disease and a normal BMI

Question 14

ASA II

Answer 14

Mild systemic disease without functional limitations
Well controlled such as diabetes or hypertension

Question 15

ASA III

Answer 15

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

Question 16

ASA IV

Answer 16

Severe systemic disease that is constant threat to life
Recent stroke or heart attack (<3 months)
Congestive heart failure
Advanced cancer

Question 17

ASA V

Answer 17

Moribund pt not expected to live 24 hrs with out without care
End stage liver disease, malignant hypertension, respiratory failure

Question 18

ASA VI

Answer 18

Declared brain dead and organs being removed

Question 19

When do you review and update pt health history

Answer 19

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

Question 20

System oriented questions

Answer 20

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).

Question 21

Disease oriented questions

Answer 21

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.

Question 22

Symptom oriented

Answer 22

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.

Question 23

Culture oriented questions

Answer 23

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.