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Review of the Medical History

Before 1st Appointment

Questions about allergies

Questions and other information about medical conditions

Questions about an unusual disease

What if the patient checks "no" for every item, or you are otherwise unsure of the patient's answers?

General questions

  • Questions that should be asked of the patient, oral conditions and possible treatment plan modifications for medical conditions can be located in the following three resources:

    • Under Medical Conditions on this web site

    • Textbooks:

      • Little and Falace's Dental Management of the Medically Compromised Patient (available at Clinic Supply)

      • Preventing Medical Emergencies:  Use of the Medical History (required in D2 year)

  • You checked that you currently have or have had ________.

  • Is this a current problem?

  • How long have you had _________?

  • Have you consulted a physician about this symptom?  If yes, do you have a diagnosis?

  • Can you tell me more about this disease?

  • How does this disease affect  you?

  • How long have you had this disease?

  • Are you currently being treated for this disease?

  • What was the reaction to the substance?

  • See Allergies

  • Questions #1, 2, 3, 4, 18

  • The answers to these questions should be checked against the diseases that the patient has reported to insure that all conditions have been reported.

Objectives of the medical history review prior to the 1st appointment:

  • Identify the risks with dental treatment that might be present due to the patient's medical conditions and medications

  • Determine if there are oral conditions related to the medical conditions and medications

  • Compile a list of questions that should be asked of the patient about the medical conditions and medications

  • Identify treatment modifications that might be required to treat the patient

Risks with dental treatment

  • Common risks with dental treatment

    • Increase risk of bleeding with invasive procedures

    • Negative reaction (including allergy) from drugs used or prescribed by the dentist

    • Infectious disease which could be passed on to the dental care provider

    • Increased risk of infection

    • Increased risk of poor or delayed healing

    • Inability to handle stress for dental procedures

    • Infective endocarditis

  • Table with risks for common medical conditions

Questions about symptoms 

  • Remember BEMAD

  • Bleeding

    • Have you had any episodes where it took longer for you to stop bleeding, for example after surgery or after you cut yourself?

  • Exercise

    • What do you do for exercise?

    • Can you climb a flight of stairs with groceries or walk two leverl city blocks without stopping due to chest pain, difficulty breathing or severe fatigue?

  • Medications

    • Are you regularly taking any prescribed or over-the-counter medications, or herbal preparations or nutriceuticals?

  • Allergies

    • Are you allergic to anything?

  • Doctors or Disease

    • Have you seen a doctor or had any medical problems in the past 5 years?

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