You may have wondered why the dentist has so many questions on the health history sheet. And why does the dental staff insist on updating the medical history every time you visit the dental office?
Each of the questions asked on the medical history sheet have specific items that can easily have an effect on the delivery of dental treatment. The body is all connected. That medication you take for some other part of the body can be important for today’s filling or extraction or even cleaning plans.
It may be helpful to briefly discuss some of the more common items that show up on medical history forms. Diabetes has become very common in this community. Diabetes might seem pretty disconnected from the teeth. Although diabetes doesn’t usually affect placing a filling very much, it has some real implications on the gums. People with diabetes are more likely to have periodontal problems. The gums become inflamed easier and stay that way more easily than on people without diabetes. This prompts a referral to a periodontist (bone and gum specialist) when problems might not be as severe as if a person did not have diabetes. If a person is getting a tooth out, healing often takes longer on a person with diabetes. This means the extraction should be done with an absolute minimum of time spent during the extraction and bony removal should be similarly minimized. Again, diabetes may signal referral to a specialist (oral surgeon) for a particular tooth that the dentist would normally extract himself if the patient did not have diabetes.
Many people have had a knee or hip replaced with an artificial joint. It is widely thought that entrance into the blood system of certain types of bacteria commonly found in the mouth can put these artificial joints at risk of failure in the first two years after they are placed. Because of this, antibiotics are usually prescribed for use an hour before the patient arrives for most dental procedures or a cleaning. It may seem like the knee is a long way from the teeth so there is no need to tell the dentist or dental hygienist about a new knee. However, the knee or hip came at considerable cost, usually after a rather long wait, and with a fair amount of uncomfortable physiotherapy. It would be an unnecessary shame for a new knee or hip to be lost and have to be replaced because the patient decided to not mention its replacement to the dentist. This can all be avoided by telling the dentist about the new knee or hip on the medical history sheet.
Allergies are always a concern, especially medication allergies. An allergy to aspirin makes a prescription for Naprosyn or Ibuprofen (which are in the same medication group as aspirin) impossible. An allergy to Penicillin makes prescription of a whole list of medications impossible. Metal allergies have to be checked out to see precisely which metals are involved in the allergy. A crown or a partial denture placed when a person has an allergy to one of the metals composing the alloy used will certainly be costly and uncomfortable, and could cause more serious problems.
Autoimmune problems (like lupus or other problems) can cause some unusual signs and symptoms in the mouth that can look like problems that normally require expensive treatment or a specialist visit. If the dentist knows the patient has an autoimmune disorder, it can change what the course of action is on some problems.
As you can see, treatment is complicated in many ways by a medical history that is not complete or is in some other way not accurate. Not knowing a medical history can cause unnecessary visits to the specialist and/or unnecessary risks to the patient. No one benefits if the dentist does not know the patient’s current medical status or medical history. If the dentist has a question on the medical history that seems strange, you might want to ask why an answer to that question is needed. From a professional standpoint, the dentist is regulated strictly by law regarding disclosure of any item on a medical history without your consent. Ask your dentist if you have a question or concern about a medical question he or she has asked you to answer.
- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)