medical and dental history of case history

1. CASE HISTORY
MEDICAL AND DENTAL HISTORY
SHRUTI ANANYA
1879077

2. MEDICAL HISTORY
• first step in determining the etiology of the person’s illness- may be related to
the diagnosis
• WRITTEN IN CHRONOLOGICAL ORDER
• precautionary measures are indicated
• pre-medication or controlling before dental treatment
• dental treatment might affect the person’s health
• IF NO RELEVANT HISTORY IS FOUND THEN “NRH” IS WRITTEN WHICH
MEANS “NO RELEVANT HISTORY”

3. DISEASES UNDER MEDICAL HISTORY
• diabetis mellitus
• hypertension/hypotension {target organ damage}
• cardiovascular diseases - rheumatic fever
• GI Disorders- peptic ulcer
• endocrine disorders- thyrotoxicosis
• respiratory diseases-asthma
• blood disorders- anemia, haemophila
• veneral- syphilis
• transmissible diseases- hiv aids, hepatitis, corona

4. MEDICAL HISTORY INCLUDES:
• Current illness
• surgical procedures undergone
• post operative complications
• current medication and drugs he’s on
• diseases that require special treatment/pre medication- MI, Haemophilia,
Radiation therapy
• diseases under treatment-> contraindicate the usage of additional
medicine- anticoagulants, steroids, sedatives
• diabetes mellitus-> delayed wound healing due to narrowing of blood
vessels {less oxygen perfusion}
• allergies- penicillin {patch test}, local anesthesia {necrosis and type IV
hypersensitivity reaction-anaphylactic shock}

5. • immunization-vaccines
• diseases that may endanger the dental surgeon- HIV, Tuberculosis,
Hepatits
• physiological state- pregnancy,aging
• infections
• ADRs
• pregnancy- danger of teratogenicity->generally during the first trimester-
exposure to drugs, radiations, infections

6. QUESTIONAIRE
• are you suffering/ have you suffered from any major systemic disease?
• what was the duration of the disease?
• what was the treatment you have undergone?
• are you currently on any medication?
• what was the history of hospitalization?

7. DISEASES AFFECTING TREATMENT
• patient on anticoagulant therapy/ with bleeding disorder- major surgeries are
not performed {Aspirin should be withdrawn 1 week prior to elective surgery
because of the risk of bleeding.}-->coagulants required or else the person
bleeds to death
• also bleeding--->myocardial infarction
• asthma- NSAIDS are contraindicated
• juvenile diabetes mellitus
• cardiac defect- needs to get physician’s report

8. BRONCHIAL ASTHMA
• caused by release of histamine, PGs, LTs and other inflammatory mediators that
constrict the bronchial smooth muscles and lead to increased mucosal secretion.
• MANAGEMENT-->
1. identify the precipitating factors, severity and duration of the attacks and the time of
the day when the attacks are frequent
2. PATIENTS WITH NIGHT ASTHMATIC ATTACKS MUST BE GIVEN LATE MORNING
APPOINTMENTS
3. beta blockers, anticholinesterases, barbiturates and narcotics are contraindicated in
asthma. Morphine (pain killer) may start histamine release which aggravates asthma.
• NSAIDS {ASPIRIN} precipitate bronchospasm- asthma --> aspirin induced asthma
• PARACETAMOL- PREFERRED ANALGESIC AND ANTI PYRETIC AGENT IN
ASTHMATICS
• ADRENALINE- DOC- 0.2ML-0.5ML of 1:1000 solution subcutaneously

9. 4. ask the patient to bring their medication/ inhaler with them
5. prophylactic inhalation is recommended
6. stress during appointment is reduced to avoid an attack
NITROUS OXIDE IS THE SEDATIVE USED IN STRESSED ASTHMATIC PATIENT AS IT
HAS NO RESPIRATORY DEPRESSING PROPERTIES
7. LA containing ephedrine has some sulfite content- precipitate asthma. Therefore
plain LA is advised for moderate to severe asthmatic patients.
ORAL MANIFESTATIONS
• mouth breathing and allergic rhinitis--> allergy induced asthma
• mouth breathing= greater palatal height and greater overjet
• GERD is common which may cause teeth erosion
• asthmatic medication= low salivary flow, increased caries and gingivitis
• oral candidiasis due to steroid therapy- inhaler with spacer

10. BLEEDING DISORDERS
• haemophilia- continuous bleeding due to the deficiency of clotting factor VIII and IX
• ADRENALINE = LOCAL HAEMOSTATIC TO CONTROL BLEEDING AND EPISTAXIS
following tooth extraction and surgery-> vasoconstrictor effect
• people on aspirin- advised to withdraw its use- 1 WEEK PRIOR TO SURGERY {as
aspirin is an anticoagulant}
• haemostatic agents= astringents, adrenaline, thrombin, gelatin, sodium alginate etc
DISTURBANCES IN THE HAEMATOPEOTIC SYSTEM:
1. patient experiences prolonged bleeding that cannot be controlled by routine
disturbances
2. may cause internal bleeding due to blunt injury--> if unnoticed may cause life
threatening complication
3. leukemic and thalassemic patients- repeated blood tranfusions--> have liver disorders
due to excessive deposition of hemosiderin
4. in agranulocytosis, anemia, leukemia- post operative infection and delayed wound
healing rate is high

11. PREOPERATIVE INVESTIGATIONS
• bleeding time and clotting time
• prothrombin time
• platelet count
• hemoglobin levels
• liver function test
• complete blood count
For a hemophiliac, factor VIII should be raised for more than 50-70% prior to the
procedure. Adequate blood must be cross matched and kept ready, in case, if needed.
For leukemics, broad spectrum antibiotics- before and after the operation.
INTRA AND POST OPERATIVE MANAGEMENT
• avoid entering deep tissues blindly to avoid internal injury
• complete hemostasis must be achieved before wound closure
• monitor the vital parameters closesly
• post the operation patients should be on vitamin K for 3-5 days

12. MANAGEMENT OF HAEMOPHILIAC
• build up factor viii to 50-70%
• avoid injecting into deep tissues- avoid block techniques and use infiltration
technique
• atraumatic extraction
• avoid suturing, if not required
• Bleeding after Tooth Extraction
Topical haemocoagulase solution—applied with a cotton swab
Or
A cotton swab soaked in adrenaline (1:10,000 solution) applied with pressure over the
bleeding area
Or
Adrenochrome monosemicarbazone, 1–5 mg oral or i.m.

13. IMPORTANCE OF MEDICAL HISTORY
• identification of diseases that may affect the treatment, the patient’s
health and the dental surgeon
• protection of dentists- transmissible diseases- hepatitis, HIV, syphilis
• medico-legal identification
• general health=role in determining the status of dental tissues

14. DRUGS AFFECTING TREATMENT
1. steroids- diminish the signs and symptoms of infection- makes the
diagnosis difficult
2. anticoagulants- development of bleeding from minor injuries
3. antidepressants

15. SURGICAL HISTORY
• general anesthesia complications, if any
• allergies or complications with LA
• prolonged bleeding after sugery
1. wound infection- treated with antibiotics
2. deep vein thrombosis- causes pulmonary embolism, shock--> when clot
breaks and travels to the lungs and brain--> medical emergency--> death
3. urinary retention

16. DENTAL HISTORY
• if undergone past dental treatment- shows his attitude towards dental
treatment
• reason for the loss of teeth or missing teeth -trauma, extraction, caries,
periodontal diseases
• past treatment?
• post treatment complications?
• radiation to head and neck?
• any denture given - condition of the present treatment and reason for
replacement of old denture
• history of gagging
• pre-extraction record

17. • frequency of dental visit=person’s interest in dental health
• history of dental sensitivity, pain, infection, soft tissue lesions, bleeding,
swelling, and oral periodontal surgery
• if history of previous bad behaviour is present- behaviour moulding is done by
behaviour management technique
• dental history= basis for caries rate determination+rate of plaque and calculus
formation+susceptibility of periodontal diseases