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13Practice ManagementApril 26-May 2, 2010United Kingdom Edition B efore providing any treat- ment, it is a clinician’s re- sponsibility to ask the right questions, in the right way, and to listen carefully to the patient’s re- sponses. If an important aspect of a patient’s history does not come to light in the consultation process, and problems arise as a result of this, attention tends to focus upon the clinical records and what they do (and do not) contain. In the ab- sence of any evidence that certain key questions were ever asked, it is extremely difficult to demonstrate at a later date that they were. If, on the other hand, there is a clear answer – perhaps in a medical history questionnaire which has been completed (and preferably, signed and dated) by the patient on a particular day, then there can be no doubt that the clinician asked the relevant question and was entitled to work from the assumption that the answer(s) given were correct. Four specific areas of the pa- tient’s history are worthy of par- ticular consideration in this brief overview: - • Medical history • Dental history • Personal/social history • History of the presenting com- plaint (if any) General observations Creating any history about a pa- tient is essentially an information gathering exercise. Specific tech- niques can usefully be employed to maximise the effectiveness of the process. The experienced cli- nician will choose between the available techniques according to the communication abilities of the individual patient that they are dealing with. Closed questions There are times when you need a definite ‘yes’ or ‘no’ answer to a specific question. The first stage of medical history screen- ing may be one such occasion. Such questions are sometimes called ‘closed’ questions bec- ause there is little or no oppor- tunity to obtain a more detailed reply from the patient. A direct ‘yes’ or ‘no’ is exactly what you are looking for. Closed questions can also be useful when deal- ing with patients whose answers tend to stray from the purpose of the question. Open questions These questions tend to be- gin with… What? Why? When? How? etc and because of this, they require the patient to pro- vide more information for you in their reply. This is often help- ful when dealing with less com- municative patients, or when you are hoping to gather infor- mation of a better quality, and in greater detail. ‘Why’ questions These questions, which are a specific kind of open question, can be extremely useful. They usually require a ‘Because…’ answer, and such answers can provide a useful insight into the patient’s attitudes, priorities, preferences and behaviour. ‘Shopping list’ questions This approach is a little like a multiple-choice test, where you give the patient several possi- ble answers to choose from. For example ‘What makes the pain Getting to know you A detailed history is an essential element in understanding the background to a patient’s oral health and planning effectively for their present and future treatment - Dental Protection page 14DTà 1.1 0.9 0.8 0.7 0.6 0.5 1.0 Plaqueremoved(Turesky) 0 21060 120 Brushing time (seconds) 1801509030 1.1 0.9 0.8 0.7 0.6 0.5 1.0 Plaqueremoved(Turesky) 0 21060 120 Brushing time (seconds) 1801509030 EnamelSMHrecovery(%) 36 33 32 31 30 29 34 35 EnamelSMHrecovery(%) 0 20050 100 Brushing time (seconds) 150 36 33 32 31 30 29 34 35 0 20050 100 Brushing time (seconds) 150 In vivo brushing clinical study2 26% more plaque removal• was observed with brushing for 120 seconds compared with 45 seconds*2 In situ enamel remineralisation clinical study3 1.1 0.9 0.8 0.7 0.6 0.5 1.0 Plaqueremoved(Turesky) 0 21060 120 Brushing time (seconds) 1801509030 1.1 0.9 0.8 0.7 0.6 0.5 1.0 Plaqueremoved(Turesky) 0 21060 120 Brushing time (seconds) 1801509030 EnamelSMHrecovery(%) 36 33 32 31 30 29 34 35 EnamelSMHrecovery(%) 0 20050 100 Brushing time (seconds) 150 36 33 32 31 30 29 34 35 0 20050 100 Brushing time (seconds) 150 Surface microhardness• (SMH) increased in a linear fashion over the period 30–180 seconds*3 References Beals D, Ngo T, Feng Y, et al. Development and laboratory evaluation of a new toothbrush with a novel brush head design.1. Am J Dent 2000; 13: SpIss 5A–13A. Gallagher A, Sowinski J et al. The effect of brushing time and dentifrice on dental plaque removal2. in vivo. [Accepted for publication in J Dent Hyg] Zero DT, Creeth JE et al. The effect of brushing time and dentifrice dose on fluoride delivery3. in vivo and enamel surface microhardness in situ. [Manuscript submitted] AQUAFRESH is a registered trade mark of the GlaxoSmithKline group of companies. * p<0.05 NEW EVIDENCE FOR THE BENEFITS OF INCREASING BRUSHING TIME To motivate behavioural change, it helps if patients understand the benefits of brushing for at least 2 minutes twice a day with fluoride toothpaste, compared to an average brushing time of around 46 seconds.1 New research results from Aquafresh show that increasing brushing time: Recommend a great tasting fluoride dentifrice to encourage your patients to brush for longer, for increased fluoride protection and plaque removal Significantly increases plaque removal Significantly increases fluoride uptake and enamel strengthening SM1274 Compliance Advert - Dental Tribune.indd 1 15/4/09 14:41:00