Medical History

In a published report by the World Health Organization, Application of the International Classification of Diseases to Dentistry and Stomatology, oral implications are associated with over 120 chronic diseases. Approximately 45% of the American population has been shown to have at least one chronic illness which can either have its own oral effects or create oral changes as a consequence of the medications used to treat the illness.6

Obtaining an accurate health history to assess a patient’s current health and anticipating possible future needs will enable the clinician to determine a timeline for treatment. It is necessary all oral health team members be educated on the medical-dental connections and trained to inquire at every visit about the patient’s current health status. Educating patients about the importance of updating their medical history, since many do not make the connection between their dental health and their overall health, must be addressed as well.

The health history will allow oral health providers insight into issues a person can expect from their health situation and will allow practitioners to address dental hygiene needs that may arise as the result of those conditions. This will also determine if a medical clearance for a specific medical condition is needed before treatment begins.

As the advancements in medicine continue, individuals are experiencing longer life expectancies and are living longer with chronic illnesses.7 The diseases we become afflicted with and the medications we take for those illness are known to have effects on the oral cavity (Table 1).

Table 1. Oral Change Caused Either by the Disease or Medication Used to Treat Disease.
Xerostomia
(dry mouth)
Gingival OvergrowthOral MucositisIncreased BleedingVomiting
Heart DiseaseXX X
High Blood PressureXX
CancerX X X
StrokeX X
Alzheimer’s DiseaseX X
DiabetesX X
Parkinson’s DiseaseX X

Xerostomia is reported to be the primary oral side effect of medications. Xerostomia is the patient’s perception of dryness in the mouth which may be associated with diminished salivary function. Having a dry mouth causes loss of lubrication, speech difficulties, complications with the fit of dentures, and an increase in carious lesions due to the lowered buffering capabilities.

Dental professionals can provide additional options for treating the symptoms of xerostomia and other side effects of diseases and medications, such as gingival overgrowth, enamel erosion, grinding and mobility issues. Interventions may include recommendations for dietary changes and home care modifications or implementing professional treatments based on the information provided in the patient’s medical health history.

Many medical and medication effects can be minimized with meticulous self-care, diet and adjunctive therapy provided by oral health professionals. It is during periodic preventive care visits the oral hygiene status will be evaluated and adjusted to meet the patient’s needs. Maintaining a dialogue with a patient’s primary care physician as a patient’s health changes and increasing the monitoring of oral conditions may be required as the health of the individual changes.

Initiating a conversation with the patient about their dental desires and the dental services that are available is easily started utilizing a Patient Dental Questionnaire (Figure 1). It is with this questionnaire the clinician will be able to determine the patient’s intention to maintain their dentition for life or their plan to use a prosthetic to gain function if teeth are lost. The patient’s cosmetic desires will be assessed at this time as well. Once the patient determines their dental goals, the examination and treatment planning can begin.

Figure 1. Patient Dental Questionnaire.
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