2.1: Significance of medical history

General health and oral health

Dental treatment should be tailored to each patient’s specific circumstances to ensure the best possible outcome as part of person-centred care. Dental practitioners must not only consider the patient’s dental and oral health, but also their general health and any chronic conditions they may have.

A thorough medical history is essential to identify any risk factors for dental disease, investigate the patient’s ability to undergo treatment, and anticipate any possible complications.

A patient’s systemic conditions should be detailed in a thorough medical history in order to:

1. Identify risk factors for dental disease
2. Investigate the patient’s ability to undergo dental treatment
3. Anticipate possible treatment complications and predict the influences of systemic conditions on the treatment outcomes.

Identify and manage risk factors for dental diseases

The patient’s systemic diseases give insight into their risk factors for disease and may contribute to the causes and progression of conditions that dental practitioners address.

Removing causative factors to reduce the risk of disease initiation and progression is potentially more important than actively treating the disease presentation in the oral environment.

For example, acidic attacks on dental structures in anorexia cause erosive lesions which dental treatment can best complement with psychological assessment and management of the underlying anorexia cause.

A thorough medical history is important to identify these risk factors and address them during treatment to also prevent disease progression.

Investigate the patient’s ability to undergo dental treatment

Chronic conditions and multiple medications are common in the elderly population, who are also more likely to have poor oral health.

This means that dental clinicians will see an increasing number of patients with chronic conditions who require dental treatment. It is crucial to recognize the implications that these conditions have on dental management to provide optimal treatment outcomes.

Systemic conditions can impact a patient’s ability to receive treatment and may also lead to complications during treatment. Therefore, it is essential to anticipate potential medical emergencies and consider the impacts of these conditions on treatment outcomes to formulate the most favorable treatment plan.

Australian context

According to the Australian Bureau of Statistics, in 2018 at least 47% of Australians had one chronic condition and at least 20% had two chronic conditions.

Around 80% of people aged 60 or above have at least one chronic condition (Australian Bureau of Statistics [ABS], 2018), and this age group is expected to make up 20% of the world’s population by 2050 (Dagli & Sharma, 2014). Poor oral health is also more common among the elderly, with higher rates of periodontal disease, tooth loss, and decay (Razak et al., 2014). As a result, dental practitioners will inevitably encounter more patients with chronic conditions and multiple medications requiring dental treatment.

Therefore, it is crucial for dental practitioners to understand how these factors can affect dental management and strive for optimal treatment outcomes.

Watch the Interview with Rob McCray for Medical History (YouTube, 1m39s):explaining the role of a good medical history in day to day dental practice.

Watch the Interview with Dr Jessica Zachar for Medical History (3m5s) explaining how medical history plays a part in more invasive procedures such as an extraction.

Watch the Interview with Special Needs Dentistry Team @ UQ (13m35s) explaining in detail how medical history is important when planning care plans for medically compromised patients, but also in managing chair side emergencies and handovers.

Acknowledgements: Thank you to UQ staff for participating in the creation of these videos: Drs. Robert McCray, David Fu, Lydia See, Claudia Lopez Silva and Jessica Zachar.