Chapter 17- Medical history/ Medical problems.

When you go to see your dentist it is very important that you tell them all about your past and your present medical history, which is any past or present medical problems.

Your dentist/ hygienist/ therapist will need to update this at every visit. They may ask you to fill the information in on a tablet/ computer, on a printed form or they may just ask you, write it down and get you to sign it. All of these are perfectly acceptable, all dental health professionals have different systems.

Anyone under 16yrs in the UK has to have this information signed by a parent or legal guardian. A friend, grandparent, childminder, older sibling cannot sign this document.

If you have a very complicated medical history or you can’t remember it all write it down or get someone else to write it down for you. If it is possible this information is better typed for better understanding. If your medical problems are very complicated it is a good idea to carry this list around in your wallet or purse in case you have an accident. In the last 5 years I have picked up 3 people in the street who have tripped over and been confused because they have banged their heads. It is so much easier for ambulance paramedics to look after you if they know all about you. Don’t think it won’t happen because it will, the youngest of these people was in his late 20s, it can happen to anyone at any age. People with certain conditions will be advised to have a medical alert wrist band, always look for this if you happen to be the rescuer.

It is also very important you tell the dental professional any drugs/ medicines you may be on. Carry a list around, a copy of a repeat prescription is sometimes the easiest way to do this. Very important that you get the spellings right, sometimes medicines for widely dissimilar conditions have very similar spellings, it is important that they are correctly noted.

The St Johns Ambulance Brigade and probably other similar organisations have a very handy little system consisting of a box with a sticker on it in which you put one of every tablet you are on [a list would be good as well]  which you then place in your fridge. There is a matching sticker which goes on your front door so if you are taken ill in the night and an ambulance is called the ambulance paramedics know to go straight to the fridge to find all the information they need to know.

Sometimes when I’m asking a patient about their medical history they will withhold information which they do not think is relevant because they think it doesn’t concern their teeth. Your teeth are part of your mouth and that is part of the rest of your body. All good health care professionals practice holistically, they look at whatever is their field of expertise in the context of the whole body.

You do not know what is relevant and what is not, you are not trained to know. Tell the dental professional everything, they will sift out anything they do not need to know.

Here are 2 seemingly innocuous examples;-

The patient may tell me they are allergic to oranges, this may on the surface of it seem to have nothing to do with your teeth but some polishing pastes and solvents are orange flavoured. I don’t want the patient to have an allergic reaction when I am doing something as simple as polishing their teeth. Similarly if the patient tells me they are allergic to avocados, I know they are probably allergic to latex as it is the same plant family and so I know to be doubly careful that no rubber even that used to rub out pencil mistakes gets anywhere near them, lots of things used in dentistry are made of latex; – gloves, bungs in local anaesthetic cartridges, ‘O’ rings on tubing- all sorts.

‘Your eyes are the mirrors of your soul’ so they say. Well your mouth is a mirror of the rest of you. Lots of serious systemic [whole body] diseases can be picked from your mouth and I’m not talking in a ‘reading your palm’ type of way, I’m talking about proper medical signs.

Signs and Symptoms- what’s the difference?

A Symptom is what you tell the clinician about your problem [in medical parlance ‘what the patient is complaining off’] and the history [the story] of that problem [complaint].

A Sign is what the clinician sees when they examine you.

There is a saying in medicine ‘Listen to the patient, they are telling you the diagnosis’. This means that as a clinician you must listen carefully to what the patient says. This relies on the patient telling you everything and answering any questions you might put to them as completely as possible- if you can’t remember write it down.

Here are a few serious conditions that can be picked up, most of which I have picked up over the years on patients from examining their mouths and surrounding areas;- anaemia, leukaemia, heart failure, diabetes, high cholesterol, oral and pharyngeal cancers, Gardeners Syndrome, HIV, Syphilis, Shingles, Pemphigoid, Pemphigus, TB, vitamin and iron deficiencies, Chicken pox, Hand Foot and Mouth, Chron’s disease, Behcet’s disease, Lichen Planus, Sjogren’s syndrome, Acromegaly, Haemophilia, Bell’s Palsy, high cholesterol, bulimia, anorexia. That’s all I can think of for the minute, but hopefully it is enough of a list for you to realise that the dentist’s function is not just teeth.

We all have a ‘duty of care for our fellow human beings’, I have a patient who’s malignant skin cancer on the back of their neck was picked up by their hairdresser’s eagle eye. Not many people’s lives are literally saved by their hair dresser but this persons was.

I’ve had peoples medical practioners be pretty snotty to me over things I have noticed on patients ‘tell her to stick to dentistry’ was one comment relayed to me by a patient. It doesn’t matter if it’s me, your hairdresser, or a concerned friend or relative. Better to flag something up that turns out to be nothing than not bother when something could have been picked up early. Don’t ignore it go and find out!

The thing is people go to the doctors when they are ill but hopefully they go to the dentist on a more regular basis as a preventative measure. This is a golden opportunity for a well-informed clinician to pick up other conditions in a timely manner. 

Below are some of the major conditions that affect your treatment at the dentist. The list is by no means exhaustive, these are the commonest things that I can think of.

Diabetes.

There are several types of diabetes, the commonest ones are Type 1 and Type 2. Type 1 is where for some reason your pancreas does not produce insulin and so you cannot metabolise the sugar in your blood so your cells are starved of fuel, this condition is usually picked up in your early teens often because you fall asleep in class or have no energy and are tired all the time [the other symptoms are excessive thirst, excess urine production, weight loss, tingling and numbness in your fingers and toes]. This is treated with insulin. Type 2 [used to be called late onset but younger and younger people are being diagnosed] is where you produce insulin but for some reason your cells are blind to it. Obesity is the main factor that generates medical intervention, this condition is treated with diet, drugs and sometimes insulin as well [it is by no means as simple as this but this will do for now].

As far as the dentist is concerned it is very important that whatever your visit is for unless you are told otherwise that you take the medication you normally take, at the time you have been told to take it and you eat as you have been advised to. Always carry emergency sugar/ sweets/ bananas with you. If you are rushing to the dentist from work and you haven’t had time to eat as normal tell the dentist, I would much rather run 10 minutes late while the patient eats a banana than have them go into a coma on me.

It is important that you visit the dentist at a time of day when you are most stable.

Diabetics are more prone to infection and are slower to heal than others. It is very important that you follow ‘post-operative instructions’ after an extraction to the letter and that your oral hygiene is tip top as diabetes is one of the factors in gum disease [periodontal disease].

Asthma.

This is a condition where the patients breathing is compromised by constriction of their airways making breathing out especially difficult. It can be brought on by lots of things; – hypersensitivity to inhaled particles, as a response to exercise or cold and as a result of anxiety. For a lot of people visiting the dentist can make them very anxious. Asthma is known as a step disease, the more drugs the patient is on the more serious the condition. If you are an asthma sufferer find a dentist you like, go and see them regularly, the more familiar the environment the less likely you are to suffer an attack whatever the procedure. Always carry your inhalers with you, I get my patients to put them on the work surface at the ready, just in case- you never know, no good having to rummage around in the bottom of your handbag in a crisis.

Allergies.

If you are a person who suffers from multiple/ severe allergies to anything [foods, household dust/ mites, drugs etc] make sure you tell the dentist. If you need to carry an epipen put it on the work surface so it is close at hand just in case. I have had a bee fly in the window just as I was treating a patient with a severe allergy to them. How vulnerable must someone feel flat on their back with a bee circling overhead, it was frightening for me and the patient. Her condition had only just been diagnosed, she had only just told me. Now I always close the windows in advance. ‘Always expect the unexpected’.

Heart conditions, strokes, TIAs [transient ischaemic attack], clots, other respiratory [breathing] conditions, cancer treatment, transplants, new hips/ knees anything else in the way of severe illnesses/ conditions.

The list is too numerous to mention, make sure you tell the dentist.

Epilepsy.

If you are a person who suffers from epilepsy, however mild, however long ago your last fit make sure you tell the dentist. ‘Fore warned is fore armed’, ‘always expected the unexpected’. Fits can sometimes be brought on by stress [at the dentist] and flickering light [a florescent tube on its way out/ the charger on a curing light].

Pregnancy.

Always tell the dentist if there is even the remotest chance you might be pregnant. Some local anaesthetics, antibiotics and pain killers should not be given to pregnant women. A pregnant woman should not have radiographs [x rays] even though the dose of radiation is very small- just as a precaution.

HIV.

If you think you may possibly be HIV positive, please tell the dentist. There is not and there never was anything to be ashamed off. Just because something is transmitted by sex rather than coughing and sneezing does not make it different to any other disease. It is just how those particular nasty little organisms travel from one person [host] to another. They want to infect as many people as possible that is their remit, you are just unlucky enough to have been chosen! Practice safe sex- don’t give them a chance. Further info on www.SH24hrs [sexual health 24 hours a day including self-testing kits].

Nothing you ever tell your dental or medical clinician will ever be repeated outside of the surgery.

The next chapter is on drugs and the dentist so I won’t go into that now. Suffice it to say tell the dental professional everything even if you don’t think it’s relevant, let them decide.

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