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Over the past few months my classmates and I have been slowly honing our skills at admitting patients into the dental school and treating emergency patients.  This requires a medical and dental history to be filled out and then reviewed by us to help us know what the patient wants, needs and what thier limitations are.  There are not many medical issues that prevent us from providing dental treatment, but there are many conditions that require medications to control so that proper treatment can be performed.  Note that what we are taught in dental school is always different than what you do in private practice, so if there are any dentists who would like to chime in about the ‘real world’ here, make a comment below.  An example is in our emergency clinic.  Some patients present with a severe toothache but their blood pressure is so high (highest I have seen was a classmate of mine with a patient who had a BP of 210/120!)  Patients like this are referred either to the ER immediately or to their physician so it can be evaluated and treated properly with the correct medication.  Why?  High blood pressure can lead to complications during dental surgery.  To name the extreme issues, we are concerned most about a stroke or a heart attack.  No one wants a stroke while getting a tooth extracted.  Here is an interaction I had recently with an emergency patient:

ME: “So have you ever been hospitalized?”

Patient: “No, never.” (At this point some people move to the next question)

It is important to prod and pry a little. ME: “Do you have any kids?”

Patient: “Yes…”

ME: “Were you in the hospital for that?”

Patient: “[LOL] Yeah, I guess I was.”

ME: “Okay, have you ever been hospitalized for anything else?”

Patient: “Haha, yeah, I had breast reduction surgery.”

ME: “Hmmm, okay, were there any complications”

Patient: “No.”

What dentists typically look for are certain conditions like excessive bleeding or other conditions that would warrant a prophylactic antibiotic before any dental treatment is performed, such as a recent myocardial infarction, etc.  AHA guidelines for dental treatment.

I have searched for some other references on the web about proper medical health history taking and it’s importance:

• AGD article on why dentists prescribe medication (dumbed down a little so maybe you could use this to give to your patient)
• A concise guide on taking a medical history (just include a recent dental history as well)

I really couldn’t find much more. Which probably proves that it is more of an art form learned along the way rather than something you learn from the internet - like dentistry! Remember that taking a good medical history can catch many diseases and conditions that could halp the patients lifestyle and even save thier life.  The dental school sends many patients to see thier physician for something they didn’t know they had so it can be evaluated and treated.