History taking.pptxHistory taking.pptxHistory taking.pptx

History taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptxHistory taking.pptx

1. History taking history taking principles medical and dental history

2. CASE HISTORY TAKING

3. A case history is defined as a planned professional conversation that enables the patient to communicate his/her symptoms, feelings and fears to the clinician so as to obtain an insight into the nature of patient’s illness & his/her attitude towards them. INTRODUCTION

4. Objectives:- To establish a positive professional relationship. To provide the clinician with information concerning the patient’s past dental, medical & personal history. To provide the clinician with the information that may be necessary for making a diagnosis. To provide information that aids the clinician in making decisions concerning the treatment of the patient.

5. Steps in case history taking Assemble all the available facts gathered from statistics, chief complaint, medical history, dental history and diagnostic tests. Analyze and interpret the assembled clues to reach the provisional diagnosis. Make a differential diagnosis of all possible complications. Select a closest possible choice- final diagnosis. Plan a effective treatment accordingly.

6. Methods of obtaining the patient history There are 3 methods :- Interview Health questionnaire Combination of these

7. 1) INTERVIEW :- In this the patient is asked about his or her health in an organized fashion . The patient is allowed to discussed any problem fully. The disadvantage include :- Method depends on the dentist skill as an interviewer. The interviewer may skip some important topics. The interviewer requires time to be done well.

8. 2) HEALTH QUESTIONNAIRE :- The health questionnaire is a printed list of heath related questions that the patient is requested to answer at the first appointment. Advantage :- it takes little of the dentist’s time it offers a standardized approach for each patient. Disadvantage :- Little time to build rapport with the patient The questions or their format may be interpreted inaccurately by some patient.

9. 3)Combination The combined method is considered by the authors to be the best appropriate technique for history taking in the routine practice of Dentistry. This approach uses the advantages of both techniques and reduces the disadvantages after reviewing a completed health questionnaires, the dentist discusses the response with the patient. 8

10. COMPONENTS- Statistics Chief complaint History of present illness Medical history Past dental history Personal history General examination Extraoral examination Intraoral examination Provisional diagnosis Investigations Final diagnosis Treatment plan

11. STATISTICS Patient registration number Date Name Age Sex Address Occupation Marital status

12. Patient registration number Useful for- 1. maintaining a record, billing purposes, medico legal aspects. Date Useful for- Time of admission reference during follow up visits Record maintenance.

13. NAME to communicate with the patient to establish a rapport with the patient Record maintenance Psychological benefits AGE For diagnosis Treatment planning Behavioral management techniques

14. DISEASE MORE COMMONLY PRESENT AT BIRTH Micrognathia Cleft lip & cleft plate Ankyloglossia Predecidous dentition Teratoma Hemophilia DISEASE PRESENT IN CHILDREN & YOUNG ADULTS Benign migratory glossitis Juvenile periodontitis Pemphigus Recurrent apthous stomatitis Dental caries Dentigerous cyst Diptheria Rickets Infectious mononucleosi s

15. DISEASE PRESENT IN ADULTS & OLDER PATIENTS Attrision Abrasion Gingival recession Periodontitis Lichen planus Ameloblastoma ( 30 – 50) Trigeminal neuralgia Fibroma Verrucous carcinoma Iron deficiency anemia Diabetes Hypertension Asthma

16. AGE used to calculate the dose of the drug. adult dose CHILD DOSE YOUNG RULE = child’s age age + 12 CLARK RULE adult dose child age at next birthday 24 adult dose 3) DILLING RULE = age 20

17. SEX SINGNIFICANCE- Certain diseases are gender specific: Diseases common in males: Attrition, leukolpakia, cancer like squamous cell carcinoma, melanoma, lymphoma etc Diseases common in females: Iron deficiency anemia, sjogren’s syndrome, osteoporosis, recurrent apthous ulcers etc Drug interaction :- in females, special consideration must be given to pregnancy & lactation.

18. ADDRESS For future correspondence Gives a view of socio-economic status -to know about the nourishment, hygiene & payment capacity of the patient Prevalence of diseases like fluorosis as a result of increase level of fluorides in water are spread differently in various parts of the country. .

19. OCCUPATION To asses the socioeconomic status. Predilection of diseases in different occupations for eg: hepatitis B is common in dentists & surgeons. MARITAL STATUS To see any history of consanguineous marriages. The high consanguinity rates, coupled by the large family size in some communities, could induce the expression of autosomal recessive diseases.

20. CHIEF COMPLAINT The chief complaint is usually the reason for the patient’s visit. It is stated in patient’s own words in chronological order of their appearance & their severity. The chief complaint aids in diagnosis & treatment therefore should be given utmost priority.

21. HISTORY OF PRESENT ILLNESS Elaborate on the chief complaint in detail Ask relevant associated symptoms The symptoms can be elaborated in terms of:- Mode & cause of onset Duration Location- localized ,diffuse ,referred, radiating. Progression- continous or intermittent. Aggravating & relieving factors Treatment taken

22. COMMON CHIEF COMPLAINTS Pain Swelling Ulcer

23. PAIN Original Site of pain Origin & mode of onset Severity Nature of pain Progression of pain Duration of pain Movement of pain Periodicity of pain Effect of functional activity Precipitating factors Relieving factors Associated symptoms Treatment taken

24. a) Anatomical location where the pain felt ? Origin & mode of onset :- activity which inducing the pain should be taken in consideration. Intensity of pain :- whether the pain is mild , moderate or severe. Nature of the pain :- it can be throbbing , shooting , stabbing, dull , aching, lancinating, boring, griping, sharp, gnawing, squeezing. Progression of pain:- The patient should be asked ‘how is it progressing? The pain may begin on a weak note & gradually reach a peak & then gradually declines. It may begin at its maximum intensity & remains at this level this disappears.

25. Duration of pain- Duration of pain means the period from the time of onset to the time of pain disappearance. Movement of the pain :- referred, radiating , shifting or migration of pain. Periodicity of pain- Sometimes an interval of days , weeks , months or even years may elapse between two painful attack. Effect on functional activity :- the effect of various activity such as brushing , shaving , washing the face, turning the head , lying down etc. should be noted. i) Aggrevating & relieving factor- whether it aggrevates or relieved with chewing or any other factors.

26. Associated symptoms- Severe pain may be associated with: Pallor Sweating Vomiting Treatment taken- Any medication taken by patient & its outcome.

27. SWELLING Duration :- for how many days swelling is present. Mode of onset :- mass that increase in size just before eating :- salivary gland retention phenomenon. slow growth :- chronic infection cyst, benign tumors rapid growing mass :- abscess, infected cyst, hematoma mass with accompanying fever :- infection & lymphoma Symptoms :- like pain, difficulty in respiration swallowing, disfiguring.

28. Progress of the swelling :- swelling can increase gradually in size or rapidly Associated symptoms :- fever presence of other swelling & loss of body weight Secondary changes :- like softening , ulceration, inflammatory changes Recurrence of swelling :- if swelling recurs after removal,it may indicate malignant changes

29. ULCER Mode of onset :- duration of ulcer should also be noted. Pain :- ulcer associated with inflammation are painful & ulcers associated with epithelial or basal cell carcinoma are painless. Discharge :- discharge from ulcer like serum, blood, pus should be noted down. Associated disease :- like tuberculosis , diabetes & syphilis

30. MEDICAL HISTORY The medical history includes the information about past & present illness. All diseases suffered by patient should be recorded in chronological order. Check list of medical history- by Scully and Cawson - A nemia - B leeding disorders - C ardio respiratory disorders - D rug treatment and allergies - E ndocrine disorders - F its and faints - G astrointestinal disorders - H ospital admissions and surgeries - I nfections - J aundice - K idney disease

31. Medical history usually organized into the following subdivisions : - Serious or significant illness :- In the dental context, ask about any history of heart, kidney, liver or lung disease. History of any infection disease, immunologic disorders radiation or cancer chemotherapy & psychiatric treatment. Hospitalization :- a record of hospital admission along with the history of any major surgery. Transfusion :- a history of blood transfusions, including the date of each transfusion & the number of transfused blood units. In some instances ,transfusion can be a source of a persistent transmissible disease.

32. Allergy :- the patient’s record should document any history of classic allergic reactions such as urticaria, hay fever, asthma as well as any other adverse drug reaction. Events reported by the patient as fainting, stomachache, weakness ,flushing ,rash etc should be noted. Medications :- an essential component of a medication history is a record of all the medication a patient is taking. Identification of medications helps in the recognition of drug induced disease and oral disorders associated with different medication. Pregnancy :- knowing whether or not a women of following age is pregnant is particularly important when deciding to administer or prescribe any medication & procedure involving exposure of the pregnant patient to ionization radiation.

33. In case of young patient:- BIRTH HISTORY :- Asked from the parents as if any problem were encountered at birth. Rh incompatibility :- may result in the condition termed as ‘erythroblastosis fetalis’. The effect may be seen in the dentition , with well described entities such as hump on the tooth and the characteristic blue – green discoloration. Neonatal jaundice :- - the immature RBC’s in an infant are rapidly destroyed in the spleen. This increased bilirubin cannot be sufficiently cleared by the liver leading to transient ‘ jaundice’ in the child. 3) Trauma due to forceps delivery

34. POSTNATAL HISTORY In post natal history , significant is attached to the amount of time the child was breast fed, bottle fed etc. Vaccination status needs to be assessed along with the present illness , if any Presence of any habit and its duration and frequency. Any previous experience with the dentist and what bearing it have on the present visit. Progress in the school, how he interact with the children will indicates the development of the child’s emotions.

35. PAST DENTAL HISTORY History of dental treatment undergone by the patient, along with patients experience before, during and after the dental treatment. History of complications experienced by the patient

36. FAMILY HISTORY Family members share their genes, as well as their environment, lifestyles and habits. Risks for diseases such as asthma, diabetes, cancer, and heart disease also run in families. There are also several inherited anomalies & abnormalities that can affect the oral cavity such as congenitally missing lateral incisors, amelogenesis imperfecta , ectodermal dysplasia & cleft lip & cleft palate.

37. PERSONAL HISTORY It includes:- Diet Apetite Bowel & micturation habit Sleep Oral hygiene measures Oral habits Adverse habits

38. DIET :- whether the diet is vegetarian , mixed or spicy food. soft diet :- adhere tenaciously to the teeth because of lack of rough edges leading to more dental caries. coarse diet :- cause more amount of attrition. carbohydrate & vitamin diet :- increase carbohydrate contents leads to increase risk for dental caries , while diet deficient in vitamin may cause enamel hypoplasia. Appetite :- whether the appetite is regular or irregular. Bowel & micturition habit :- whether it is regular or irregular. Sleep :- sleeping hours should be asked. Insomnia occurs in case of primary thyrotoxicosis.

39. Habits Oral hygiene method :- poor oral hygiene & improper brushing technique may leads to dental caries & periodontal disease. Horizontal brushing technique may leads to cervical abrasion. oral habits :- pressure habit like thumb sucking lip sucking leads to anterior proclination of maxillary incisors.Tongue thrusting habit leads to anterior n posterior open bite. Mouth breathing leads to anterior marginal gingivitis & dental caries. Deleterious habits :- tobacco, smoking & drinking habit should be asked as these patient having high risk for cancer development.

40. GENERAL EXAMINATION Analyze the patient entering the clinic for built, height ,gait, and posture. Check for any pallor, icterus, clubbing, cyanosis, lymphadenopathy & edema. Vital signs like pulse, blood pressure, temperature, respiratory rate should be noted.

41. Pulse Normal pulse rate is 60- 80 beeats/min Average pulse is 72 beats/min Physiologic increase in infants, after exertion. Pathologic increase in fever, cardiopulmonary diseases. Temperature normal temp is 98.6 degree F or 37 degree celsius. Measured by thermometer. Respiratory rate Adult rate–16- 24 breaths per minute Observe Feel for chest movement Auscultate

42. Blood pressure Systolic- 110- 140 mm Hg Diastolic- 60- 90 mm of Hg Measured by Sphygmomanometer.

43. HARD TISSUE

44. TEETH PRESENT Size Color structural changes of teeth Eruption status of teeth Retained deciduous teeth Any trauma to tooth

45. TEETH MISSING Reason for missing teeth/tooth History of removal Co- relation of the missing teeth as an oral manifestation of a systemic disease or genetic abnormality. The sequel of missing teeth may include supra eruption,tilting,drifting or rotation, all of which may have an impact on treatment plan.

46. CARIOUS TEETH The primary examination technique for evaluating the teeth include: Visual inspection, Probing Percussion Transillumination Basic tools required are: A good light source, A mirror, A sharp explorer and An air syringe are the most basic tools required.

47. RADIOGRAPHIC METHODS BITE WING RADIOGRAPHY : To diagnose proximal decay. INTRA- ORAL PERI APICAL RADIOGRAPH : To detect the extent of occlusal caries. To assess the periapical area. DISADVANTAGES: A . To be radiographically visible, mineral loss should be more than 20- 30%

48. OTHER METHODS: Fibro Optic Transilluminator. Digital Fibro Optic Transilluminator. Fluorescence (acid dissolution of structure). Use of caries detector dye e.g. silver nitrate, methyl red and alizarin stain to detect caries by color change).

49. WASTING DISEASES OF TEETH: ATTRITION: physiologic wearing away of a tooth as a result of tooth to tooth contact, as in mastication. SITE: occurs on occlusal,incisal and proximal surfaces of teeth. ETIOLOGY: seen in bruxisum, traumatic occlusion, and also associated with aging process. It is an abnormal process.

50. ABRASION Friction between tooth & an exogeneous agent ETIOLOGY: use of abrasive dentifrice, tooth floss, tooth picks etc. EROSION: defined as irreversible loss of dental hard tissue by a chemical process that does not involve bacteria. SITE: cervical areas of teeth. ETIOLOGY: INTRINSIC : due to gastro esophageal reflux and vomiting EXTRINSIC: acidic beverages, citrus fruits.

51. ABFRACTION The pathological loss of enamel and dentine due to occlusal stresses. Occlusal forces which cause the tooth to flex, cause small enamel flecks to break off, inducing the abrasive lesions These lesions are often diagnosed as toothbrush abrasion, but they differ as their angles are sharper Common in patients with poor tooth alignment

52. MOBILITY OF TEETH: 53 To evaluate the integrity of the attachment apparatus surrounding the teeth. Test is carried out by moving the tooth laterally in the socket or preferably in the handles between two instruments. TYPES: PATHOLOGIC MOVEMENT : it results from inflammatory process, para functional habits. ADAPTIVE MOBILITY: occurs due to anatomic factors such as short roots or poor crown to root ratio.

53. GRADES OF MOBILITY: (GLICKMAN’S CLASSIFICATION) N o detectable movement when force is applied other than what is considered normal (physiologic) motion. GRADE- I : movement of tooth about 1 mm in bucco- lingual direction GRADE- II: movement of tooth more than 1 mm in bucco- lingual direction and labio palatal direction. GRADE- III: depression of tooth in the socket . 54

54. OCCLUSION: MALOCCLUSION CLASS-I MOLAR RELATION: mesio buccal cusp of the maxillary Ist molar occludes in the buccal groove of mandibular Ist permanent molar. CLASS- II: Distobuccal cusp of upper first molar occludes in the buccal groove of lower first permanent molar. CLASS- III: mesiobuccal cusp of maxillary first permanent molar occludes in interdental space between mandibular first & second molar.

55. PROVISIONAL DIAGNOSIS It is also called tentative diagnosis or working diagnosis. It is formed after evaluating the case history & performing the physical examination. DIFFERENTIAL DIAGNOSIS The process of listing out of 2 or more diseases having similar signs and symptoms of which only one could be attributed to the patient’s suffering A final diagnosis is only possible after carrying out further investigations.

56. INVESTIGATIONS: 57 CHAIR SIDE INVESTIGATIONS: PULP VITALITY TESTS PERCUSSION TESTS CYTOLOGY ASPIRATION ROUTINE COMPLETE HEMOGRAM - HEMOGLOBIN, RED CELL COUNT, WBC, PLATELET COUNT ESR, TOTAL LEUKOCYTE COUNT, TOTAL DIFFERENTIAL COUNT, BLEEDING TIME, CLOTTING TIME, PLATELET COUNT, SERUM IRON, CALCIUM, PHOSPHORUS AND ALKALINE PHOSPHATASE LEVEL.

57. PERCUSSION TEST: to evaluate the status of the periodontium surrounding a tooth TYPES: VERTICAL PERCUSSION TEST – positive indicates periapical pathology HORIZONTAL PERCUSSION TEST – positive indicates periodontium associated problems. 58

58. RADIOLOGICAL INVESTIGATIONS 59 INTRAORAL PROJECTIONS ; - Intra- Oral Periapical, Occlusal, Bitewing views. EXTRAORAL PROJECTIONS;- OPG, PA view of skull and jaws, AP view PNS view, SUBMENTOVERTEX view, TMJ views.

59. OTHER INVESTIGATIONS:- URINE EXAMINATION Special investigations like:- Sialography MRI CT Scan

60. FINAL DIAGNOSIS: The final diagnosis can usually be reached following chronologic organization and critical evaluation of the information obtained from the, patient history, physical examination and the result of radiological and laboratory examination. The diagnosis usually identifies the diagnosis for the patient primary complaint first, with subsidiary diagnosis of concurrent problems. 173

61. TREATMENT PLAN The formulation of treatment plan will depend on both knowledge & experience of a competent clinician and nature and extent of treatment facilities available. Evaluation of any special risks posed by the compromised medical status in the circumstance of the planned anesthetic diagnostic or surgical procedure. Medical assessment is also needed to identify the need of medical consultation and to recognize significant deviation from normal health status that may affect dental management.

62. Treatment phases 63 Preliminary phase Nonsurgical phase Surgical phase Restorative phase Maintainance phase

63. 1.Preliminary phase 64 Treatment of emergencies: Dental or periapical Periodontal Other Extraction of hopeless teeth and provisional replacement if needed(may be postponed to a more convenient time)

64. 2.Nonsurgical phase 65 Plaque control and patient education: diet control (in patients with rampant caries) Removal of calculas and root planing Correction of restorative and prosthetic irritational factors. Excavation of caries and restoration (temporary or final,depending whether a definitive prognosis for the tooth has been determind and on the location of caries)

65. 3.Surgical phase 66 Periodontal therapy including placement of implants Endodontic therapy Restorative phase Final restorations Fixed and removable prothodontic appliances Evaluation of response to restorative procedures Periodontal examination

66. 5.Maintenance phase 67 periodic rechecking: Plaque and calculas Gingival condition(pockets ,inflammation) Occlusion, Tooth mobility Other pathologic changes.

67. PRESCRIPTION WRITING SUPERSCRIPTION : general background information regarding the dentist and the patient and the date of prescription is written. INSCRIPTION: specific information regarding the drug and the dosage. SUBSCRIPTION : direction to the pharmacist for filling the inscription. TRANSCRIPTION: instruction to the patient to be listed on the container label. SIGNATURE AND EDUCATIONAL DEGREE OF PRESCRIBING DOCTOR: a signature is required by law only for certain controlled substance. 68

68. PROGNOSIS It is defined as act of foretelling the course of disease that is the prospect of survival & recovery from a disease as anticipated from the usual course of that disease or indicated by special features of the case.

69. THANK YOU