Dentistry 101: Meet and Greet - Part-2
• Dentistry 101 • 6 minutes to read
It isn’t enough to just know how to treat a patient at the first visit, it is equally important to know what and how to ask. When I was first introduced to the Universe of Medicine, I was rostered with an Internal and Family Medicine specialist who drew this whole big chart and explained the art of ‘history taking’. While you can find most of these points listed out on a variety of websites, I have tried to break things down into a sequence that helps you understand why you need to get through each step and why is it important for us, as Dentists, to know every teeny tiny detail about the patient’s (and even their family’s!) life and history.
Listed out are the basic steps to follow when taking a patient’s history –
Introduce yourself and gain consent (So they find you more approachable) - Confirm the patient’s identity and take note of who is accompanying them, their age, mental capacity to understand the conversation and to answer your questions regarding their medical history.
Chief complaint - this is the main reason for them to be sitting in front of you (Not just your cool personality 🤯). There could be a variety of reasons – cosmetic, functional, pain, or paranoia.
History of Presenting Illness (HPI) – this step is needed to elaborate the chief complaint of the patient. Assess the type of pain they are experiencing. This allows us to formulate a provisional diagnosis (Tentative diagnosis made prior to any confirming tests performed. Eg. Someone comes to you and says they have lost their sense of smell and taste. You immediately suspect COVID19, this is your “provisional diagnosis”, but you still need to wait for test results, to confirm and express your “final diagnosis”). You could either have your own list of questions or use this simple acronym to prevent missing out of any details.
“SOCRATES” [1] –
- Site (where is the pain) – pain from a tooth, from the jaw, from the ear, from the inside of the cheek, etc.
- Onset (when did it start) – right after eating hot pizza, spontaneously in the middle of the night, ever since I finished that bag of Doritos.
- Character (description of the pain) – dull, throbbing, pulsating, etc.
- Radiation (is the pain radiating elsewhere) – head, ear, etc.
- Associations - nausea, fever
- Time - how long does the pain last, does it keep you up at night
- Exacerbating/ relieving factors - are they taking any painkillers, do cold/warm compresses help
- Severity - rate the pain on a scale of 1-10 (you can also use smileys!)
Medical History – knowing any existing conditions is one of the most important aspects of taking history. Medical history is not just taken at the first appointment and then forgotten about. It is mandatory to check in with the patient periodically (6 months to 1 year or anytime you feel there is a significant change in a patient’s health – eg. Davis was 102 kgs when he saw you 3 months ago, he returned today to complete his fillings and he looks significantly slimmer, and he informs you that he now weighs 70kgs). For female patients of child-bearing age, it is important to ask if they are pregnant (or even if they suspect that they might be).
Drug history – it is necessary for any medical practitioner, especially Dentists, to know if the patient is on any medication that could require a change in protocol during any dental procedure (right in the middle of an implant surgery is not the best time to get surprised by your patient 🙃).
For example, if a patient is taking blood thinners and you think they need an extraction, it is best to refer the patient to an oral and maxillofacial surgeon, rather than attempt the surgery and have them bleed non-stop in your dental chair. Oral and maxillofacial surgeons are better equipped to deal with such a medical emergency. You also need to know if the patient has faced an allergic reaction to any drug.
Dental history – ask the patients how often they visit a Dentist, ask about their experience, the treatment they’ve had before. It is necessary to determine whether the patient is aware of their dental needs and educate them appropriately if they aren’t. If someone had a bad dental experience in their childhood, you must proceed with caution and care to make them feel as comfortable as possible.
Also, ask the patient what their expectations are from you (usually it is to fix their teeth, duh 🤷♀️, but in some circumstances, their expectations are not so obvious), the treatment they are seeking and the outcome they are expecting. You can do so by asking them to rank their current dentition on a scale of 1-10. Where they are now and where would they like to be once the treatment is completed.
Review of systems – prompt the patient and ask them questions regarding all the body systems – Cardiovascular, Respiratory, Gastrointestinal, Genitourinary, Musculoskeletal, Central Nervous system. If your patient complaints of increased tooth sensitivity, check with them if they have changed their diet recently. If someone complaints of night grinding or jaw pain, check if they have had any significant change in their personal life in the past year (trouble at work, break-up). Usually, an external change can cause a significant internal disturbance.
Family history – if you suspect the patient may have a condition which could be of genetic origin (depending on signs and symptoms/ pain described), ask them if their parents or siblings have been diagnosed with the same condition. For example, diabetes, hypothyroidism, epilepsy, etc.
Social History – ask them if they smoke, how much they smoke, how often, if they drink, how much and how often. Also, check with the patients if there are any other drugs they consume on a regular basis. If the patient is not in a condition to care for themselves, find out if they have someone to take care of them and help them adhere to any post-operative instructions given after a procedure.
Summarize – Once you have gathered sufficient information, repeat the patient’s concerns to them in a simple language to confirm that you have understood them correctly. Give them plenty of opportunities to correct you or ask you questions.
All these points may seem crazy and daunting but you’re not trying to play 20 questions with the patient. You are trying to make an informed diagnosis and put in every bit of effort from your side, so it isn’t a hit and miss. People get irritated when they’re asked a million questions but sometimes, asking questions saves lives.
References –