An accurate medical and dental history is vital when assessing and diagnosing a patient because it allows for the necessary modifications in our approach to treatment.
For young and healthy patients, a review of medical history is a relatively easy process that may simply consist of evaluating pertinent findings on the history questionnaire. The process is usually more involved with older patients.
Step One: Obtain Thorough History
Obtaining a medical history for older patients is more complex and time consuming as their medical complexity increases. One definition of medical complexity is a when a patient is taking 5 or more medications.
Older patients may not remember the medications they are taking or have recently taken and, in some cases, patients will list “untoward” reactions such as nausea, vomiting or headaches to medications as allergies when they are not allergic reactions. Sometimes, older patients cannot tell us their medical diagnoses.
All of this information, however, is critical since modification of treatment is more likely. So, to make sure we have the necessary information to determine the right treatments for a patient, we go through a medical history review checklist that includes:
- Patient history questionnaire
- Notes from referring dentist
- The most recent assessment from a patient’s primary care physician if the patient is medically complex or if they are a poor medical historian
Sometimes, one can infer a patient’s medical diagnoses and their severity from the medications they are taking. In addition to their medical history, we also ask patients about their exercise tolerance since it is a good indication of a patient’s ability to tolerate stress.
Step Two: Review and Assess
The next step is to review the pertinent information gathered to understand the implications that the information will have on our management and approach to treatment. When dealing with patients who have a variety of medical problems, we need to assess how well those problems are being controlled.
If a disease’s process is not ideally managed or optimized, then referral back to their primary care physician is indicated prior to treatment. Common examples included poorly controlled hypertension, poorly controlled diabetes, asthma and heart disease.
We also assess conditions which may impact healing such as chemotherapy, radiation treatment, diabetes, medications that modify a patient’s immune status, smoking or bisphosphonate use.
Step Three: Modify Treatment
Smoking is the most common modifiable risk factor for poor wound healing and we try to educate patients about their use of cigarettes. We also note which medications a patient may need to refrain from taking the day of the procedure. Among the more common medications are:
- Oral anticoagulants
- Diabetes medications
Medications such as coumadin, Pradaxa, Eliquis and Xarelto often need modification. As a general rule, most other medications should be taken on schedule, although older patients will often not take their medications on the day of the appointment because they do not understand or remember our instructions.
Lastly, there are a few indications for perioperative antibiotics that should be noted. Additionally, when we prescribe new medications, we want to ensure that there are no drug to drug interactions and that the patient understands how to take the new medication.
Oral surgery is not always an easy process for patients, especially older ones. A way to make sure that process is as easy as possible for them is to have a full grasp of their medical history to reduce the likelihood of unexpected complications.
Dr. David W. Todd, DMD, MD, has been active in his profession. He has authored 18 articles in various publications and made numerous presentations at state, regional, and national meetings. For Dr. Todd’s full bio click here.