Adult Health History Part 1

Front 1

What is an important thing to remember to keep a patient as comfortable as possible?

Back 1

Make sure you are eye level with the patient

Front 2

What is question 1?

Back 2

Do you think that your teeth are affecting your health?

Front 3

Why is question 1 important?

Back 3

1. Establishes in pt’s mind that oral health is a part of general health.
2. Pt’s dental problems may be related to systemic complaints.
Ex: Diabetes, Periodontal Disease

Front 4

What is question 2?
Why is this important?

Back 4

- Are you dissatisfied with the appearance of your teeth?
- Determine if pt’s expectations are realistic!

Front 5

What is today’s population most concerned with?

Back 5

Esthetics of teeth.
Whiter, brighter teeth.

Front 6

What is question 3?

Back 6

Are you worried about receiving dental treatment?

Front 7

_____ of dental emergencies come from fear and anxiety

Back 7

75%

Front 8

If the patient marks yes on patient 3 what should you do with the patient?

Back 8

- Determine the reason for apprehension.
- Discuss fears with pt. Being a sympathetic listener may help alleviate fears

Front 9

_____ for the patient means listening to the patient express their concerns.

Back 9

Therapeutic ventilation time

Front 10

What is question 4?

Back 10

Have you ever experienced an unusual reaction to a dental anesthetic?

Front 11

What are some things that occur during an allergic reaction?

Back 11

Itching, hives, rash, swelling (edema), inability to breath.
Vomiting and fainting are not true allergic reactions.

Front 12

What should you do if a patients says yes to question #4?

Back 12

- Ask the patient what symptoms did they experience during previous dental treatment.

Front 13

What are most reactions due to?

Back 13

- Most unusual reactions are due to fear, anxiety, or syncope (fainting).

Front 14

What is question 5?

Back 14

Do you have any difficulty chewing your food or opening your mouth wide?

Front 15

What are the clues to a patients problem that can be raised from question 5?

Back 15

- Ill-fitting denture or partial dentures.
- TMJ problems
- Carious lesions
- Missing teeth
- Malocclusion

Front 16

What is question 6?

Back 16

Do you have sensitive teeth, bleeding gums, or sore gums?

Front 17

If the patient answers yes to question 6 what must you ask them regarding their complaint?

Back 17

Need to question the patient regarding the severity and duration of their complaint.

Front 18

What are the precipitating factors that are involved with sensitive teeth and gums?

Back 18

Pain
Hot sensitivity
Cold sensitivity
Percussion
Mobility

Front 19

Cold sensitivity suggests what?

Back 19

Hypermia of the pulp and a possible reversible situation

Front 20

Hot sensitivity suggests what?

Back 20

An irreversible process in the dental pulp

Front 21

Percussion (biting pressure) suggests what?

.

Back 21

Involvement of the PDL

Front 22

Mobility indicates what?

Back 22

Periodontal disease, bruxism (grinding teeth),periapical lesion, or trauma

Front 23

Bleeding gums indicates what?

Back 23

Perio disease, blood dyscrasias (Leukemia)

Front 24

Rebound tenderness suggests what?

Back 24

Fractured tooth

Front 25

What is a common cause of sensitive teeth?

Back 25

Gingival recession

Front 26

Where an infection is draining from out of the bone through the gingeva is what?

Back 26

Parulis

Front 27

Teeth can receive referred pain from where?

Back 27

Maxillary Sinus

Front 28

What is question 7?

Back 28

Do you ever have canker sores, cold sores, or a sore mouth?

Front 29

What is the etiology of a cold sore?

Back 29

May be caused by trauma, physical or emotional stress, nutritional deficiencies acidic foods (tomatoes, oranges), immunologic defect or unknown cause

Front 30

What is another name for cold sore?

Back 30

Also called Aphthous Stomatitis, or Canker sores.

Front 31

When is a cold sore considered a chronic problem?

Back 31

Frequent sores that occur more than 4 - 6 times per year.

Front 32

What are the clinical characteristics of Aphthous Ulcers?

Back 32

Round or oval concave lesions with white, yellowish- gray centers and a red (erythematous) border.
Mutliple ulcerations are common.

Front 33

Where do Aphthous Ulcers typically occur?

Back 33

Typically occur on nonkeratinized mucosa: labial and buccal mucosa, ventral surface of tongue, soft palate, tonsillar fauces, floor of mouth.

Front 34

What defines a Minor Aphthous Ulcer?
A Major one?

Back 34

Minor Ulcers: less than 0.5 cm in diameter
Major Ulcers: larger than 0.5 cm in diameter

Front 35

What is the healing and treatment for Aphthous Ulcers?

Back 35

-Heals in 7-10 days without scarring for minor ulcers
- Major ulcers can heal with scar formation
- Treat with topical steroids such as Kenalog in Orabase, Lidex.

Front 36

What are recurrent herpes lessions (cold sores) caused by?

Back 36

Herpes Simplex Virus Type 1

Front 37

What are the intraoral and extraoral locations of cold sores?

Back 37

Extra-oral location may be on the lip or nose.
Intra-oral location is usually on attached gingival tissue over bone

Front 38

What is Primary Herpes known as?

Back 38

Primary Herpetic Gingivostomatitis

Front 39

What is the etiology of primary herpes?

Back 39

Acute infection with herpes simplex type 1 virus in a person with no previous exposure to the virus.

Front 40

What age groups can contact Primary Herpes?

Back 40

Can occur in infant, child, or young adult

Front 41

What are the symptoms of Primary Herpes?

Back 41

Fever, malaise
Dehydration
Difficulty eating
Irritability
Painful cervical lymphadenopathy
Pharyngitis

Front 42

What are the clinical characteristics of Primary Herpes?

Back 42

- Multiple vesicles that rupture, coalesce (form clusters),with ulcers on the lip, buccal and labial mucosa, gingiva, palate and tongue.
- Ulcers are painful, small, yellow with red inflammatory borders

Front 43

What is the onset of Primary Herpes and how long can they last?

Back 43

Onset is within several days of contact (3-10 day incubation period) with person infected with the virus. Lesions last for 12-20 days

Front 44

What is the treatment for primary herpes?

Back 44

- Acyclovir
- Antipyretic agents -Tylenol, do not give aspirin or NSAIDs
- Oral anesthetic rinses
- Plenty of fluids

Front 45

What is the etiology of recurrent herpes?

Back 45

- Reactivation of Herpes Simplex virus Type 1
- Virus leaves the trigeminal ganglion and travels down the nerve to produce lesions on the perioral skin or oral mucosa.

Front 46

What can cause reactivation of recurrent herpes?

Back 46

Reactivation of the virus can be triggered by aging, sunlight, local trauma, physical or emotional stress, and immuno-suppression

Front 47

What is the clinical characteristics of Recurrent Herpes?

Back 47

Clusters of small vesicles which rupture to form small ulcers that can merge to form larger ulcers.

Front 48

Where is Recurrent Herpes most commonly found?

Back 48

Lower lip (Recurrent herpes labialis). Ulcers will form a crust on the perioral skin.

Front 49

What are the clinical characteristics of Intraoral Recurrent Herpes?
Where do they occur and do the reoccur?

Back 49

- Intraoral lesions (Recurrent intraoral herpes), are less common than Herpes labialis.
- Occurs on kertainized mucosa such as the hard palate and attached gingiva.
- Lesions recur at the same site.

Front 50

What is the onset of Recurrent Herpes and how long do they last?

Back 50

- Onset is rapid and is preceded by a prodromal stage with burning and tingling of the site.
- Lesions last 7-14 days and heal spontaneously.

Front 51

What is the treatment for Recurrent Herpes?

Back 51

Acyclovir -oral or ointment
Valtrex (valacyclovir)
Denavir (penciclovir)

Front 52

What is Herpetic Whitlow caused by?

Back 52

Caused by auto-inoculation from a herpes lesion, from lip or genital area. Can be HSV Type 1 or Type 2

Front 53

What is the incubation period for Herpetic Whitlow and what characterizes it?

Back 53

- 2-20 days incubation
- Pain, erythema, vessicles, crusting, desquamation

Front 54

How long does it take for Herpetic Whitlow to clear up an what is the treatment?

Back 54

Heals in 2-3 weeks Treatment: Acyclovir

Front 55

What is Herpes Simplex Blepharitis?

Back 55

- Herpes Simplex virus (HSV) infection involving the eyelid

Front 56

What is the classic appearance of Herpes Simplex Blepharitis?

Back 56

- Accumulation of small vesicles or pustules along the lid margin and/or periocular skin.
- Vesicles ulcerate and harden into crusts

Front 57

What are the trigger factors for Herpes Simplex Blepharitis?

Back 57

Fever, trauma, emotional stress, menstruation, exogneous immunosuppressive agents,overexposure to UV radiation

Front 58

What is the treatment of Herpes Simplex Blepharitis?

Back 58

- Use of warm saline compresses with a topical drying agent (70% alcohol).
- Topical antibiotic ointment to prevent secondary opportunistic bacterial infection.
- Topical or oral antiviral agents

Front 59

What is question 8?

Back 59

Have you ever had a toothache?

Front 60

What are the follow up questions that you are to ask a patient that says yes to question 8?

Back 60

What is the nature of the toothache?
Was it treated or not?
What type of treatment?
What is the present status of the tooth?

Front 61

What is question 9?

Back 61

Have you ever had an injury to your face or jaws?

Front 62

What are some possible findings when a patient answers yes to question 9 and you inquire further?

Back 62

Devitalization of teeth
Malocclusion
TMJ pain
Facial deformity
Retained foreign object

Front 63

What is question 10?

Back 63

Do you ever have sinus trouble?

Front 64

What is the possible reason a patient would answer yes to question 10?

Back 64

Possibility of a maxillary molar toothache when no disease is present in the tooth.
Look on radiograph to see if roots are adjacent to infected sinus.
Necessary to consider a sinus infection in a differential diagnosis when the patient presents with a maxillary toothache.

Front 65

What is question 11?

Back 65

Are you being treated by a physician at the present time?

Front 66

What must you determine if a patient answers yes to question 11?

Back 66

Must determine the nature of the condition and type of treatment that the pt. is receiving

Front 67

What are some things you need to keep in mind if a patient answers yes to question 11?

Back 67

- Establishes any chronic or acute disease states.
-->Nitroglycerin (Angina pectoris)
-->Insulin (Type 1 diabetes or Type 2 insulin dependent diabetic)
- May need a consultation with the pt.’s physician before dental treatment begins.
- Patient’s state of health will influence dental diagnosis, therapy, and prescribed drugs.

Front 68

What is question12?

Back 68

Are you taking any prescription or nonprescription medications (pills, tablets, syrups) now or within the past six weeks?

Front 69

How do you handle the information given by a patient who answers yes to question 12?
How will this affect the patient?

Back 69

- Drugs should be listed along with purpose of the medication.
- Medications may indicate a specific disease and severity.

Front 70

What are some possible side affects to medications that are currently out there?

Back 70

Xerostomia - antianxiety,antihypertensive
Increased bleeding - blood thinners (Coumadin), Aspirin, NSAIDs, herbal OTC (Gingko)
Susceptibility to infection- corticosteroids
Intolerance to stress - corticosteroids

Front 71

What is question 13?

Back 71

Are you currently taking any Bisphosphonate drugs (Actonel, Fosamax, Boniva, etc)?

Front 72

What are bisphosphonates?

Back 72

- Synthetic analogues of inorganic pyro-phosphate that has a high affinity for calcium.
- Potent inhibitors of osteoclastic activity. During bone remodeling, drug is taken up by osteoclasts & inhibits osteoclast function and causes cell death.

Front 73

What potential damage can bisphosphonates do to the oral cavity?

Back 73

- Lleads to brittle bone and inability for bone to repair microfractures in skeleton from daily activity
- Theory - If not repaired, may set the stage for osteonecrosis.

Front 74

What are some uses of Bisphosphonate drugs?

Back 74

Osteoporosis
Paget’s disease of the bone
Hypercalcemia of malignancy

Front 75

Babies born to mothers with HIV:
positive or neg ELISA?
positive or neg Western?

Back 75

positive:
anti-gp120 crosses placenta

Front 76

How do you determine the type of Bisphosphonate used in treatment?

Back 76

Type of bisphosphonate medication used in treatment is determined by condition and potency of drug required

Front 77

Where do Bisphosphonates accumulate?

Back 77

All bisphosphonates accumulate in the bone matrix. Drug can remain in the body for years.

Front 78

What is an oral complication of cancer treatment?

Back 78

Bisphosphonate-associated osteonecrosis (BONJ)

Front 79

What does BONJ result from?

Back 79

- Results from complex interaction of bone metabolism, local trauma, increased demand for bone repair, infection, and hypovascularity.
- Exact mechanism that causes BONJ is unknown

Front 80

Is BONJ rare or common?

Back 80

rare with oral bisphosphonate drugs.
common with IV bisphosphonate drugs

Front 81

What are some risk factors of Bisphosphonates?

Back 81

- Use of IV bisphosphonates - Aredia (pamidronate), Zometa ( zolendronic acid), Bonefos.
- Diabetes mellitus
- Overall cancer stage and tumor burden
- Overall systemic and immune health
- Immunosuppressive drug use
- Any periodontal or other oral infection
- History of radiation to the jaws

Front 82

What are some treatment therapies for BONJ?

Back 82

Local debridement
Bone curretage
Local irrigation with antibiotics
Hyperbaric oxygen therapy
BONJ is difficult to treat and treatment is not always successful.
No definitive treatment for BONJ is available at this time.

Front 83

What is the protocol for prevention of complications from cancer chemotherapy or radiation therapy?

Back 83

- Comprehensive examination
- Excellent periodontal health
- Immediate extraction of all non-restorable or questionable teeth
- Elimination of dental caries
- Excellent oral hygiene and oral health maintenance

Front 84

What is the Dental Management of BONJ?

Back 84

- Use of routine local anesthetics to provide dental care.
- All procedures should be performed as atraumatically as possible with little tissue trauma, bleeding, and risk for post-operative infection.
- If BONJ occurs, only sharp edges of exposed bone should be removed with minimal surgery.
- If infection occurs, aggressive use of systemic antibiotics is indicated

Front 85

What is question 14?

Back 85

Have you been examined by a physician within the last five years?

Front 86

What should you ask if a patient says yes to question 14?

Back 86

- Dates of exam.
- Reasons for exam.
- Conditions discovered and treatment.
- Multiple physicians or specialists ?

Front 87

What is question 15?

Back 87

Have you ever been seriously ill, hospitalized or had surgery?

Front 88

Seriously ill indicates _____.

Back 88

Impairment of health

Front 89

What are some examples of details of hospital experiences that you should ask a patient when they answer yes to question 15?

Back 89

Excessive hemorrhage
Wound infection
Delayed healing
Drug allergies
Difficult convalescence

Front 90

Prions

Back 90

infectious proteins
spongiform encephalopathy
normal prions have alpha helix confirmation, these are beta pleated sheet that cant be digested

Front 91

What must you be aware of from any patient that has had a blood transfusion or general anesthetic?

Back 91

Be alert to the possibility of the patient being a Hepatitis B carrier from multiple transfusions.
-->Hepatitis C
-->HIV

Front 92

What must you record on the Health History about any anesthesia that the patient has received?

Back 92

Details and complications

Front 93

What is donated blood screened for?

Back 93

- Blood typing, Rh factor, blood grouping
- Hepatitis B surface antigen- detects present infection or carrier state.
- Hepatitis B core - detects past or present infection.
- Hepatitis C antibodies

Front 94

Carrier State

Back 94

Characterized by persistent low levels of the virus in the liver and serum and has viral antigens for six months without liver disease

Front 95

(True / False) People in the carrier state are potentially able to transfer to healthy people.

Back 95

True