DTUK1110

April 26-May 2, 2010United Kingdom Edition EverClear™ a triumph in clarity For details of Carl Zeiss and our wide range of other dental products contact: See what you are missing... Carl Zeiss EyeMag Smart 2.5x loupes Carl Zeiss GTX Carl Zeiss EyeMag Pro prismatic loupes Carl Zeiss OPMI® Pico Nuview Ltd, Vine House, Selsley Road, North Woodchester, Gloucestershire GL5 5NN Tel: 01453 872266 Fax: 01453 872288 E-mail: info@nuview-ltd.com Web: www.voroscopes.co.uk •Floorstand, ceiling or wall mounted •Photoport for digital camera •Five step magnification •Superlux 180 Xenon daylight illumination V2 LED Illumination Many practices take medical histories verbally and if no posi- tive or significant responses are elicited, an entry such as ‘MH – nil’ is made in the records. While better than nothing at all, this approach carries the disad- vantage that it can be difficult or impossible to establish precisely what questions were asked of the patient, in what terms, and what answers were given. Clearly, a well structured medical history questionnaire form, which is completed, signed and dated by the patient, and subsequently up- dated on a regular basis (ideally, during each successive course of treatment), is not only in the patient’s best interest, but is also the best platform for the success- ful defence of cases where failure to elicit or act upon a relevant as- pect of medical history leads to avoidable harm to the patient. In all cases, the taking and confirmation of a medical his- tory is the role of the dental sur- geon and is certainly a key part of a dentist’s duty of care. If in doubt, it may be sensible to defer treatment pending clarification of any areas of uncertainty in a patient’s medical history. Dental history However thoroughly it is carried out, any clinical examination is still only a snapshot of a pa- tient’s dental and oral tissues at a moment in time. While it will provide a lot of useful basic in- formation, the clinician’s under- standing of the patient’s present- ing condition is greatly improved by knowing how the patient reached the present position. • Is the patient a regular or irregular attender? • What treatment has been provided in the last five years? • Is there a history of fractured teeth/fillings? • Are any teeth painful or sensitive? • If so, what causes any such sensitivity? • Do the patient’s gums bleed on tooth brushing or spontaneously? • Is the patient apprehensive about receiving dental care? • If so, do these concerns relate to any particular dental procedure(s) or to the experience in general? • Has the patient experienced any particular problems associated with treatment provided for them in the past? If so, what? Not only will questions like those above help to inform the clinician regarding areas which may or may not need treatment, or which should be kept under review, they will also guide the clinician regarding the success (or failure) of treatment ap- proaches that have been tried in the past. If this knowledge helps the clinician to avoid repeating the previous mistakes of other clinicians, it can also help to avoid claims and complaints that might otherwise have resulted. Social history The social history should include details of employment (and in- terests, hobbies, etc) as well as other social and family related information. The patient’s occu- pation should be included in the consideration of relevant factors affecting diagnosis, treatment planning, consent and treatment, bearing in mind the fact that this is an aspect of a patient’s history that may change as time passes. It is worth establishing a routine of checking the patient’s contact details and employment, when carrying out a periodic update of the patient’s medical history. The ability to attend for ap- pointments could affect the success of complex or exten- sive treatment, eg crown and bridgework, implants, long term periodontal treatment and ortho- dontics. Certain occupations can place severe constraints on a pa- tient’s ability to attend regularly for appointments. Issues relating to a patients employment or recreational in- terests have also been known to have an impact on treatment: For example: • Bruxism in air traffic control- lers, marathon runners and certain other sports players • Aerodontalgia in (pilots and cabin crew) • Stress and its relation to peri- odontal disease (including epi- sodes of pericoronitis involving young adults in the armed forces, or studying for examinations) The outcome of treatment can have a general effect or a more specific effect on a given patient. For example, chronic se- vere pain, which can arise from some form of nerve damage, or TMJ/muscle disturbance asso- ciated with dental procedures, or perhaps a facial paralysis, or permanent loss of sensation in the lip or tongue, would all be likely to reduce the quality of life for most patients. On the other hand, the loss of ability to articulate clearly when speaking or singing, be- cause of a change in anterior tooth shape, position or angula- tion, or perhaps because of lin- gual or inferior alveolar nerve damage, would have a more pro- found affect on an opera singer, lecturer or telephonist than for an agricultural worker who did not depend upon singing for his livelihood. Similarly, there are many jobs in which appearance is important and an adversely al- tered appearance can either lose a patient a job or severely affect a patient’s confidence, particularly if they have to face the public in their working life. Awareness of information such as this is criti- cal when contemplating any aes- thetic/ cosmetic procedures. History of present complaint When a patient attends with a spe- cific problem it is helpful to know how long the problem has existed, when it was first noticed, whether it has ever occurred before, wheth- er any previous treatment has sought to resolve the problem and if so, with what success. If the patient is complaining of pain, for example, it is helpful to know what kind of pain it is (dull ache, or throbbing, or acute bursts of pain), or how long it lasts, and what makes it worse or better and whether it has oc- curred previously and if so un- der what circumstances. Each of these findings needs to be recorded carefully in the notes to demonstrate this im- portant part of the diagnostic process. The significance of this becomes apparent on occasions when a mistaken diagnosis is made. If, however, the diagnosis is supported by the information which was available to the clini- cian at the time, as noted in the records, such situations can of- ten be defended successfully. Summary It will be appreciated that there is very little value in gather- ing information from the above sources if the responses are not collected and recorded in a clear and logical fashion. Hav- ing a structured and systematic approach to history taking and record keeping makes it less likely that critical information will be overlooked, or lost. Later in the treatment plan- ning process, when it becomes a little clearer what treatment possibilities are under consid- eration, it may be necessary to explore some aspects of the his- tory in greater depth, in order to ensure that the patient is aware of any way in which their treat- ment (and its prognosis) might be affected by some aspect of their history. DT Contact Information Dental Protection is the world’s largest specialist provider of dental profession- al indemnity and risk management for the whole dental team. The articles in this series are based upon Dental Pro- tection’s 100 years of experience, cur- rently handling more than 8,000 cases for over 48,000 members in 70 Coun- tries. Email querydent@mps.org.uk or visit www.dentalprotection.org. ‘any clinical exami- nation is still only a snapshot of a patient’s dental and oral tissues at a mo- ment in time’