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Up to 40 percent of patients lie to their doctors about their health habits.1 Is a little “something-something” left unsaid? In medical school one doctor said he was taught to double the amount of alcohol patients claimed to consume.2 Some patients are late to their appointments or worry they are keeping the dentist waiting while filling out health history form, so they rush. On generic forms clipped to a board, nothing is easier to do than run a pen down the “no” column. A vague concern ensues when the patient’s breath smells of cigarettes — yet they clearly checked “no” when the form asked about smoking.
Below are a few examples of how verbal questions about a patient’s health may prompt interesting and more accurate answers.
Increasingly, the staff at a dental office may hand the patient an electronic tablet to complete and update their health status using a disinfectible stylus; the act of watching a patient answer health history questions while staff records their response is more uncommon than ever. When ample time to do so is available, try it. Dental team members engaging the patient in conversation allows them to get to know each other. Patients open up. A few things can be deduced in sleuthing while obtaining an oral health history.
Bleeding gums aberration. The patient has tender bleeding gums at first suspected as periodontal disease. The patient is a new mother nursing her baby. This is a patient so comfortable with the dental staff, she always discusses key points of her health. When she is asked if the bleeding status of her gums is typical or perhaps only this week due to a menstrual cycle. “Bingo!” she says, relieved to have found the answer.
‘My teeth hurt.’ Patients may complain of biting or generalized dental pain so severe they start on anti-inflammatories or pain medication. The dentist probes without specific reaction, and obtains radiographs and learns nothing. Doing “best guess” root canals is not an option. Only after discussing health habits, including sleeping patterns, it is learned the patient wears a mail-ordered boil-and-bite anti-snoring appliance. The dentist learns that after a recently placed large onlay, the patient continued wearing the old appliance. It no longer fit, and increasingly aggravated the bite. Upon the dentist’s suggestion to cease wearing the appliance, the pain disappeared.
Asking about sleeping patterns helped another patient with generalized tooth pain whose radiographs and oral examination were negative for pathology. The dentist, in talking about sleep position and comfort, learned the patient had two extra large foam pillows. After suggesting the patient try flattened pillows or try sleeping with just one, the patient’s pain resolved. Her teeth were fine.
‘Oh, my blood pressure pills must not be working.’ Sue Biegel, a supervising dentist in the dental hygiene program at Prairie State College in Chicago Heights, remembers a patient who finally admitted the truth: he was not taking his prescription blood pressure medicine. “He said it has side effects of affecting his male performance… Priorities!” Dr. Biegel said. On a serious note, she said she gave him a medical referral to his MD for his blood pressure: “Uncontrolled BP can be dangerous in the dental setting, and local anesthetics can elevate BP.”
Communicating verbally with patients about their health helps to ensure you’ve got the whole story. Prompting the patient to tell you about their full health history, even when the patient doesn’t think there’s any reason to talk about what ails them outside of their mouth, is in their best interest. And yours.
A tradition of working for the dental profession. The Chicago Dental Society was organized in 1864 and incorporated in 1878. The objective of the Chicago Dental Society is to encourage the improvement of the health of the public, to promote the art and science of dentistry and to represent the intrest of the members of the profession and the public that it serves.
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