<img > </img> THE UNIVERSITY OF **WESTERN** **AUSTRALIA** DENT 3005:Introduction to Pharmacology **Medical and medication** **history** Dr Thuy Linh Truong thuy.truong@uwa.edu.au # **THE UNIVERSITY OF WESTERN AUSTRALIA** ## **DENT 3005: Introduction to Pharmacology** ### **Medical and medication history** Dr Thuy Linh Truong thuy.truong@uwa.edu.au **Acknowledgement** of country The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge. <img src="https://i.imgur.com/7I0pYpJ.png" alt="A black and white abstract artwork resembling indigenous Australian art, a logo for The University of Western Australia in the top right corner."> Artist: Dr Richard Barry Walley OAM # **Acknowledgement of country** The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge. Artist: Dr Richard Barry Walley OAM **Learning Outcomes** **Learning objectives** 1. Explain the rationale for each medical history question 2. Identify how systemic diseases and medications impact dental treatment 3. Practice applying this knowledge in clinical setting A female physician holding a clipboard next to a large medical record with checkboxes # **Learning Outcomes** ## **Learning objectives** 1. Explain the rationale for each medical history question 2. Identify how systemic diseases and medications impact dental treatment 3. Practice applying this knowledge in clinical setting # **Medical History** * **Professional duty** * Required by Code of Conduct * Foundation for safe, ethical care * **Accurate records** * Factual, up-to-date, legible * No biased or judgmental language * Include history, diagnosis, treatment, and consent * **Continuity of care** * Clear for other providers * Include social, cultural, and psychological factors * **Confidentiality** * Secure storage and access * Follow privacy laws * **Patient rights**: patients can access and request their records <img src="A logo for Ahpra & National Boards, with a stylized fan design in blue and teal."> # **Medical History** - **Professional duty** - Required by Code of Conduct - Foundation for safe, ethical care - **Accurate records** - Factual, up-to-date, legible - No biased or judgmental language - Include history, diagnosis, treatment, and consent - **Continuity of care** - Clear for other providers - Include social, cultural, and psychological factors - **Confidentiality** - Secure storage and access - Follow privacy laws - **Patient rights**: patients can access and request their records Impressions 🙂 - **First impressions matter** - Build trust from the start - Negative impressions can last - **Patient anxiety is common** - Be calm, friendly, and reassuring - **Team roles** - Dentist: hold the ultimate responsibility - Receptionist, dental assistance: aid in building rapport - **Next steps** - What info is needed? - How to collect it well? # **Impressions 🙂** - **First impressions matter** - Build trust from the start - Negative impressions can last - **Patient anxiety is common** - Be calm, friendly, and reassuring - **Team roles** - Dentist: hold the ultimate responsibility - Receptionist, dental assistance: aid in building rapport - **Next steps** - What info is needed? - How to collect it well? **Open Vs Closed** * **Closed questions** * Require brief, definite answers (Yes/No) * Useful for medical history * E.g., *Do you take medication?* * **Open questions** * Begin with *What, When, Who, Where, Which, or How* * Encourage detailed responses and feelings * E.g., *What are your main dental concerns?* * **Use both types** * Helps gather complete and relevant info * Sets the tone for a positive patient relationship # **Open Vs Closed Questions** - **Closed questions** - Require brief, definite answers (Yes/No) - Useful for medical history - E.g., *Do you take medication?* - **Open questions** - Begin with *What, When, Who, Where, Which, or How* - Encourage detailed responses and feelings - E.g., *What are your main dental concerns?* - **Use both types** - Helps gather complete and relevant info - Sets the tone for a positive patient relationship **Personal history – why it matters** * Confirm name, DOB, address, and contact details * Job roles may affect oral health * *Eg. Pastry chef, sommelier...* * Stressful jobs $\rightarrow$ clenching, bruxism * Occupation may influence treatment planning * *Eg. Singers or wind musicians* * Personal history provides context for tailored care # **Personal history – why it matters** - Confirm name, DOB, address, and contact details - Job roles may affect oral health - *Eg. Pastry chef, sommelier...* - Stressful jobs → clenching, bruxism - Occupation may influence treatment planning - *Eg. Singers or wind musicians* - Personal history provides context for tailored care **Medical history – a clinical essential** * Critical for safe and effective treatment * Prevents avoidable medical complications * Use clear formats: verbal, written, or electronic * Ensure patient understands the questions * Signature $\neq$ comprehension * Verify unclear answers * Update regularly – health changes over time # **Medical history – a clinical essential** - Critical for safe and effective treatment - Prevents avoidable medical complications - Use clear formats: verbal, written, or electronic - Ensure patient understands the questions - Signature ≠ comprehension - Verify unclear answers - Update regularly – health changes over time **Dental history – more than what you see** * Ask about past and recent dental experiences * Regular attendance? * Recent treatments? * Current pain or sensitivity? * Bleeding gums? * Dental anxieties? * Patients often recall useful details not visible on exam * Supports better diagnosis and treatment planning * Helps build rapport and address patient concerns # **Dental history – more than what you see** - Ask about past and recent dental experiences - Regular attendance? - Recent treatments? - Current pain or sensitivity? - Bleeding gums? - Dental anxieties? - Patients often recall useful details not visible on exam - Supports better diagnosis and treatment planning - Helps build rapport and address patient concerns | System/Category | Medical History Questions | | :--- | :--- | | **Cardiovascular** | Do you have any cardiovascular disease? (e.g. hypertension, heart disease) | | **Bleeding/Clotting disorders** | Do you have a bleeding or clotting disorder? | | | Have you ever had excessive bleeding? | | | Do you have any blood disorders (e.g. anaemia)? | | **Respiratory** | Do you have a respiratory disease? (e.g. asthma, emphysema) | | **Neurological** | Do you have a neurological disorder? (e.g. epilepsy) | | **Gastrointestinal** | Do you have a gastrointestinal disease? (e.g. coeliac disease, inflammatory bowel disease, gastritis) | | **Endocrine** | Do you have an endocrine condition? (e.g. diabetes, thyroid disorder, dyslipidaemia) | | **Renal/Hepatic** | Do you have kidney or liver disease? (e.g. hepatitis) | | **Bone-modifying agents** | Have you ever taken medications such as bisphosphonates or denosumab? | | **Skin conditions** | Do you have any skin diseases? | | **Psychological health** | Do you have any psychological conditions? (e.g. anxiety, depression, dental phobia) | | **Cancer/Radiation** | Do you have a history of cancer? | | | Have you received radiation therapy to the head or neck? | | **Infectious disease** | Have you ever had an infectious disease? (e.g. tuberculosis, hepatitis, HIV) | | **Hospitalisations** | Have you had any past operations or hospitalisations? | | | Were there any complications? | | **Pregnancy** | Are you currently pregnant? If yes, what is your due date? | | **Allergies** | Do you have any allergies to medications, food, or chemicals? | | **Medications** | Are you currently taking any medications, including supplements? | | **Recreational drug use** | Have you ever used recreational drugs? | | **Smoking/Vaping** | Do you currently or previously smoke or vape? | | | Please specify product, quantity (per day/week), and duration | | **Alcohol use** | Do you consume alcohol? | | | Please specify type of drink, amount (per day/week/month/year), and duration | # **Medical History Questions by System/Category** | System/Category | Medical History Questions | | :--- | :--- | | **Cardiovascular** | Do you have any cardiovascular disease? (e.g. hypertension, heart disease) | | **Bleeding/Clotting disorders** | Do you have a bleeding or clotting disorder? | | | Have you ever had excessive bleeding? | | | Do you have any blood disorders (e.g. anaemia)? | | **Respiratory** | Do you have a respiratory disease? (e.g. asthma, emphysema) | | **Neurological** | Do you have a neurological disorder? (e.g. epilepsy) | | **Gastrointestinal** | Do you have a gastrointestinal disease? (e.g. coeliac disease, inflammatory bowel disease, gastritis) | | **Endocrine** | Do you have an endocrine condition? (e.g. diabetes, thyroid disorder, dyslipidaemia) | | **Renal/Hepatic** | Do you have kidney or liver disease? (e.g. hepatitis) | | **Bone-modifying agents** | Have you ever taken medications such as bisphosphonates or denosumab? | | **Skin conditions** | Do you have any skin diseases? | | **Psychological health** | Do you have any psychological conditions? (e.g. anxiety, depression, dental phobia) | | **Cancer/Radiation** | Do you have a history of cancer? | | | Have you received radiation therapy to the head or neck? | | **Infectious disease** | Have you ever had an infectious disease? (e.g. tuberculosis, hepatitis, HIV) | | **Hospitalisations** | Have you had any past operations or hospitalisations? | | | Were there any complications? | | **Pregnancy** | Are you currently pregnant? If yes, what is your due date? | | **Allergies** | Do you have any allergies to medications, food, or chemicals? | | **Medications** | Are you currently taking any medications, including supplements? | | **Recreational drug use** | Have you ever used recreational drugs? | | **Smoking/Vaping** | Do you currently or previously smoke or vape? | | | Please specify product, quantity (per day/week), and duration | | **Alcohol use** | Do you consume alcohol? | | | Please specify type of drink, amount (per day/week/month/year), and duration | **PATIENT PERSONAL & MEDICAL QUESTIONNAIRE** **PRIVATE & CONFIDENTIAL** Welcome to our Practice Please answer these questions as completely as possible. It will greatly assist us to provide the best dental treatment for you. (Family Name) Name(Mr/Mrs/Miss/Ms/Dr/Other) .......................................................................... (First Names) .......................................................................................... Address ..................................................................................................................................................................................................................................................................................................................... Postcode ............................................................................. Date of Birth ......................................................................................... Phone (Home) ......................................................................................... Phone (Work) ............................................................................................ Phone (Mobile) .......................................................................................... Preferred Daytime Contact: Home / Work / Mobile (**Please Circle**) ................................................................................................. E-mail ........................................................................................................................................................................................................................................................................................................................................................................... Occupation ..................................................................................................... Employer ........................................................................................................................................................................................................................... Emergency Contact ........................................................................................ Relationship .............................................................................................. Phone .............................................................................................. Person responsible for payment of accounts ......................................................................................................................................................................................................................................................................... Private Health Fund (if applicable) ..................................................................................................................................................................................................................................................................................... Whom may we thank for recommending you to our practice? ................................................................................................................................................................................................................................................ **The state of your health may have a very significant effect on your dental care.** **Please answer these questions fully or discuss them with your dentist:** * I have private and confidential medical matters which I wish to discuss with the dentist * Are you receiving any medical treatment at present? * Name of your medical practitioner/specialist * Have you ever been in hospital? If yes, nature of hospitalisation and dates * Some medicines may interfere with your dental treatment or react with medicaments used by your dentist. It is important that your dentist knows precisely what medications (if any) that you are taking. **Please list any medications you are currently taking, or have been taking recently including** injections, herbal remedies, vitamins, supplements, cold/flu treatments, sleeping pills, pain relievers, implants, so we can take appropriate precautions and avoid drug interactions. | Drug Name | Dosage | Duration of Treatment | Purpose/Condition | | :--- | :--- | :--- | :--- | **Please list any known ALLERGIES or ADVERSE REACTIONS to drugs (especially antibiotics eg. penicillin),** medicines, antiseptics, local anaesthetics, latex, preservatives that we should know about. | Drug Name | Nature of Reaction | How Long Ago | | :--- | :--- | :--- | If you are in any doubt about your medication, please bring a Pharmacy Medication Summary or the bottle or packet(s) to the practice to show the dentist. **Please indicate YES or NO if you have ever had any of the following:** | Condition | Y | N | Condition | Y | N | | :--- | :--- | :--- | :--- | :--- | :--- | | Rheumatic fever | ☐ | ☐ | Jaw, neck or shoulder injury or pain | ☐ | ☐ | | Heart condition/cardiac surgery/pacemaker | ☐ | ☐ | Epilepsy/Seizures | ☐ | ☐ | | Heart valve replacement | ☐ | ☐ | Thyroid disease (including goitre) | ☐ | ☐ | | High or low blood pressure | ☐ | ☐ | Tuberculosis (TB) | ☐ | ☐ | | Blood disorders | ☐ | ☐ | Asthma/Bronchitis/lung conditions | ☐ | ☐ | | Excessive bruising or bleeding | ☐ | ☐ | Nervous system disorder | ☐ | ☐ | | Hepatitis, jaundice or liver disease | ☐ | ☐ | Anxiety/Depression | ☐ | ☐ | | Kidney/renal disease | ☐ | ☐ | Gastroesophageal reflux disease (GORD) | ☐ | ☐ | | Diabetes | ☐ | ☐ | Cancer or malignancy of any kind | ☐ | ☐ | | Osteoporosis or low bone density | ☐ | ☐ | Chemotherapy/Radiation therapy | ☐ | ☐ | | Rheumatoid arthritis/Lupus (SLE)/Polymyalgia | ☐ | ☐ | Transplanted organ/bone marrow/stem cells | ☐ | ☐ | | Joint replacement surgery | ☐ | ☐ | Snoring/Sleep Apnoea | ☐ | ☐ | Have you ever smoked? Y ☐ N ☐ Approx date if quit ..................................... Do you currently smoke or vape? Y ☐ N ☐ If yes, for how long? .......................................................................................... How much do you smoke ........................................................................ per day Have you ever used illicit substances and/or recreational drugs? Y ☐ N ☐ If yes, when? Recent ☐ More than 1 yr ago ☐ Do you consume alcohol? Y ☐ N ☐ Do you suffer from any illness not listed above or carry any infectious disease? Y ☐ N ☐ If yes, please provide details ......................................................................................................................................................................................................................................................................................... Females: Are you pregnant or is there a chance you could be pregnant? Y ☐ N ☐ If yes, date due ...................................................................... Are you currently breastfeeding? Y ☐ N ☐ **DECLARATION:** In signing this form I acknowledge that this represents an accurate medical history. I will advise my dentist of any changes to my medical history in the future. I understand that all medical details will be treated with complete professional confidentiality. I have read the privacy document provided by this practice. Patient Signature: .................................................................................................... Date .................................//....................................                                                                                     (Parent or guardian under 18 years) Dentist Signature: ................................................................................................. Date .................................//.................................... **Practice Use Only: Review of Information** Patient Signature: ................................................................................................................................................................................ Date .................................//.................................... Dentist Comment: ....................................................................................................................... Signature ................................................................................ Date .................................//.................................... Patient Signature: ................................................................................................................................................................................ Date .................................//.................................... Dentist Comment: ....................................................................................................................... Signature ................................................................................ Date .................................//.................................... Patient Signature: ................................................................................................................................................................................ Date .................................//.................................... Dentist Comment: ....................................................................................................................... Signature ................................................................................ Date .................................//.................................... # **PATIENT PERSONAL & MEDICAL QUESTIONNAIRE** **PRIVATE & CONFIDENTIAL** Welcome to our Practice Please answer these questions as completely as possible. It will greatly assist us to provide the best dental treatment for you. --- ## **Personal Information** Name(Mr/Mrs/Miss/Ms/Dr/Other) .......................................................................... (First Names) .......................................................................................... (Family Name) .......................................................................... Address ..................................................................................................................................................................................................................................................................................................................... Postcode ............................................................................. Date of Birth ......................................................................................... Phone (Home) ......................................................................................... Phone (Work) ............................................................................................ Phone (Mobile) .......................................................................................... Preferred Daytime Contact: Home / Work / Mobile (**Please Circle**) ................................................................................................. E-mail ........................................................................................................................................................................................................................................................................................................................................................................... Occupation ..................................................................................................... Employer ........................................................................................................................................................................................................................... Emergency Contact ........................................................................................ Relationship .............................................................................................. Phone .............................................................................................. Person responsible for payment of accounts ......................................................................................................................................................................................................................................................................... Private Health Fund (if applicable) ..................................................................................................................................................................................................................................................................................... Whom may we thank for recommending you to our practice? ................................................................................................................................................................................................................................................ **PATIENT PERSONAL & MEDICAL QUESTIONNAIRE** **PRIVATE & CONFIDENTIAL** Welcome to our Practice Please answer these questions as completely as possible. It will greatly assist us to provide the best dental treatment for you. Name (Mr/Mrs/Miss/Ms/Dr/Other) ........................................ (First Names) ..................................... (Family Name) ........................................ Address ................................................................................................................................................. Postcode ............................................ Date of Birth ....................................... Phone (Home) ....................................... Phone (Work) ........................................ Phone (Mobile) ...................................... Preferred Daytime Contact: Home / Work / Mobile (Please Circle) E-mail .................................................................................................................................................................................................................... Occupation ............................................. Employer ........................................................................................................................................... Emergency Contact ................................. Relationship .................................... Phone ..................................................................................... Person responsible for payment of accounts ..................................................................................................................................................... Private Health Fund (if applicable) ..................................................................................................................................................................... Whom may we thank for recommending you to our practice? ......................................................................................................................... **PRIVACY STATEMENT:** We value your privacy. All of the information which you provide to us will be held and used by us in accordance with our Privacy Policy. A copy of our Privacy Policy is attached to this Questionnaire. Please take the time to read through our Privacy Policy before answering the Questionnaire and speak to one of our staff members if you have any concerns about how we will use your personal information. A logo for the Australian Dental Association Western Australia (ADA WA) ## **Privacy Statement** We value your privacy. All of the information which you provide to us will be held and used by us in accordance with our Privacy Policy. A copy of our Privacy Policy is attached to this Questionnaire. Please take the time to read through our Privacy Policy before answering the Questionnaire and speak to one of our staff members if you have any concerns about how we will use your personal information. --- **The state of your health may have a very significant effect on your dental care.** Please answer these questions fully or discuss them with your dentist: | | Y | N | | :---: | :---: | :---: | | I have private and confidential medical matters which I wish to discuss with the dentist | ☐ | ☐ | | Are you receiving any medical treatment at present? | ☐ | ☐ | | Name of your medical practitioner/specialist | | | | Have you ever been in hospital? If yes, nature of hospitalisation and dates: | ☐ | ☐ | * Some medicines may interfere with your dental treatment or react with medicaments used by your dentist. It is important that your dentist knows precisely what medications (if any) that you are taking. **Please list any medications you are currently taking, or have been taking recently including** injections, herbal remedies, vitamins, supplements, cold/flu treatments, sleeping pills, pain relievers, implants, so we can take appropriate precautions and avoid drug interactions. | Drug Name | Dosage | Duration of Treatment | Purpose/Condition | | :---: | :---: | :---: | :---: | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | **Please list any known ALLERGIES or ADVERSE REACTIONS to drugs (especially antibiotics eg. penicillin),** | Drug Name | Nature of Reaction | How Long Ago | | :---: | :---: | :---: | | | | | | | | | | | | | If you are in any doubt about your medication, please bring a Pharmacy Medication Summary or the bottle or packet(s) to the practice to show the dentist. ## **Medical History** **The state of your health may have a very significant effect on your dental care.** Please answer these questions fully or discuss them with your dentist: | | Y | N | | :--- | :---: | :---: | | I have private and confidential medical matters which I wish to discuss with the dentist | ☐ | ☐ | | Are you receiving any medical treatment at present? | ☐ | ☐ | | Have you ever been in hospital? | ☐ | ☐ | Name of your medical practitioner/specialist ......................................................................................................................................................................................................................................................................................... If yes to hospitalisation, nature of hospitalisation and dates: ......................................................................................................................................................................................................................................................................................... ### **Medications** Some medicines may interfere with your dental treatment or react with medicaments used by your dentist. It is important that your dentist knows precisely what medications (if any) that you are taking. **Please list any medications you are currently taking, or have been taking recently including** injections, herbal remedies, vitamins, supplements, cold/flu treatments, sleeping pills, pain relievers, implants, so we can take appropriate precautions and avoid drug interactions. | Drug Name | Dosage | Duration of Treatment | Purpose/Condition | | :--- | :--- | :--- | :--- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | ### **Allergies** **Please list any known ALLERGIES or ADVERSE REACTIONS to drugs (especially antibiotics eg. penicillin),** medicines, antiseptics, local anaesthetics, latex, preservatives that we should know about. | Drug Name | Nature of Reaction | How Long Ago | | :--- | :--- | :--- | | | | | | | | | | | | | | | | If you are in any doubt about your medication, please bring a Pharmacy Medication Summary or the bottle or packet(s) to the practice to show the dentist. **Please indicate YES or NO if you have ever had any of the following:** Y N | Condition | Y | N | Condition | Y | N | |---|---|---|---|---|---| | Rheumatic fever | □ | □ | Jaw, neck or shoulder injury or pain | □ | □ | | Heart condition/cardiac surgery/pacemaker | □ | □ | Epilepsy/Seizures | □ | □ | | Heart valve replacement | □ | □ | Thyroid disease (including goitre) | □ | □ | | High or low blood pressure | □ | □ | Tuberculosis (TB) | □ | □ | | Blood disorders | □ | □ | Asthma/Bronchitis/lung conditions | □ | □ | | Excessive bruising or bleeding | □ | □ | Nervous system disorder | □ | □ | | Hepatitis, jaundice or liver disease | □ | □ | Anxiety/Depression | □ | □ | | Kidney/renal disease | □ | □ | Gastroesophageal reflux disease (GORD) | □ | □ | | Diabetes | □ | □ | Cancer or malignancy of any kind | □ | □ | | Osteoporosis or low bone density | □ | □ | Chemotherapy/Radiation therapy | □ | □ | | Rheumatoid arthritis/Lupus (SLE)/Polymyalgia | □ | □ | Transplanted organ/bone marrow/stem cells | □ | □ | | Joint replacement surgery | □ | □ | Snoring/Sleep Apnoea | □ | □ | Have you ever smoked? Y □ N □ Approx date if quit /.../..... Do you currently smoke or vape? Y □ N □ If yes, for how long? ........................................... How much do you smoke ........................... per day Have you ever used illicit substances and/or recreational drugs? Y □ N □ If yes, when? Recent □ More than 1 yr ago □ Do you consume alcohol? Y □ N □ Do you suffer from any illness not listed above or carry any infectious disease? Y □ N □ If yes, please provide details .......................................................................................................................................................................................... ### **Medical Conditions** **Please indicate YES or NO if you have ever had any of the following:** | Condition | Y | N | Condition | Y | N | | :--- | :---: | :---: | :--- | :---: | :---: | | Rheumatic fever | ☐ | ☐ | Jaw, neck or shoulder injury or pain | ☐ | ☐ | | Heart condition/cardiac surgery/pacemaker | ☐ | ☐ | Epilepsy/Seizures | ☐ | ☐ | | Heart valve replacement | ☐ | ☐ | Thyroid disease (including goitre) | ☐ | ☐ | | High or low blood pressure | ☐ | ☐ | Tuberculosis (TB) | ☐ | ☐ | | Blood disorders | ☐ | ☐ | Asthma/Bronchitis/lung conditions | ☐ | ☐ | | Excessive bruising or bleeding | ☐ | ☐ | Nervous system disorder | ☐ | ☐ | | Hepatitis, jaundice or liver disease | ☐ | ☐ | Anxiety/Depression | ☐ | ☐ | | Kidney/renal disease | ☐ | ☐ | Gastroesophageal reflux disease (GORD) | ☐ | ☐ | | Diabetes | ☐ | ☐ | Cancer or malignancy of any kind | ☐ | ☐ | | Osteoporosis or low bone density | ☐ | ☐ | Chemotherapy/Radiation therapy | ☐ | ☐ | | Rheumatoid arthritis/Lupus (SLE)/Polymyalgia | ☐ | ☐ | Transplanted organ/bone marrow/stem cells | ☐ | ☐ | | Joint replacement surgery | ☐ | ☐ | Snoring/Sleep Apnoea | ☐ | ☐ | ### **Lifestyle** - Have you ever smoked? Y ☐ N ☐ Approx date if quit ..................................... - Do you currently smoke or vape? Y ☐ N ☐ - If yes, for how long? .......................................................................................... How much do you smoke ........................................................................ per day - Have you ever used illicit substances and/or recreational drugs? Y ☐ N ☐ - If yes, when? Recent ☐ More than 1 yr ago ☐ - Do you consume alcohol? Y ☐ N ☐ - Do you suffer from any illness not listed above or carry any infectious disease? Y ☐ N ☐ - If yes, please provide details ......................................................................................................................................................................................................................................................................................... Females: Are you pregnant or is there a chance you could be pregnant? Y ☐ N ☐ If yes, date due .......................... Are you currently breastfeeding? Y ☐ N ☐ **DECLARATION:** In signing this form I acknowledge that this represents an accurate medical history. I will advise my dentist of any changes to my medical history in the future. I understand that all medical details will be treated with complete professional confidentiality. I have read the privacy document provided by this practice. Patient Signature ......................................................................................................................... Date ................................... (Parent or guardian if under 18 years) Dentist Signature ......................................................................................................................... Date ................................... <div style="background-color: #e9e9e9; padding: 15px; border-radius: 5px;"> <span style="font-weight: bold;">Practice Use Only: Review of Information</span> Patient Signature: ........................................................................................... Date: ....../....../...... Dentist Comment: ................................................................................................................................................................... ................................................................................................................................................................... ....................................................................................................... Signature ........................................ Date: ....../....../...... Dentist Comment: ................................................................................................................................................................... Patient Signature: ........................................................................................... Date: ....../....../...... Dentist Comment: ................................................................................................................................................................... ....................................................................................................... Signature ........................................ Date: ....../....../...... Patient Signature: ........................................................................................... Date: ....../....../...... Dentist Comment: ................................................................................................................................................................... </div> ### **For Female Patients** - Are you pregnant or is there a chance you could be pregnant? Y ☐ N ☐ - If yes, date due ...................................................................... - Are you currently breastfeeding? Y ☐ N ☐ --- ## **Declaration** In signing this form I acknowledge that this represents an accurate medical history. I will advise my dentist of any changes to my medical history in the future. I understand that all medical details will be treated with complete professional confidentiality. I have read the privacy document provided by this practice. Patient Signature: .................................................................................................... Date .................................//....................................                                           &s;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      &- (Parent or guardian under 18 years) Dentist Signature: ................................................................................................. Date .................................//.................................... --- ### **Practice Use Only: Review of Information** Patient Signature: ................................................................................................................................................................................ Date .................................//.................................... Dentist Comment: ....................................................................................................................... Signature ................................................................................ Date .................................//.................................... Patient Signature: ................................................................................................................................................................................ Date .................................//.................................... Dentist Comment: ....................................................................................................................... Signature ................................................................................ Date .................................//.................................... Patient Signature: ................................................................................................................................................................................ Date .................................//.................................... Dentist Comment: ....................................................................................................................... Signature ................................................................................ Date .................................//.................................... # Cardiovascular conditions | Cardiovascular | Do you have any cardiovascular disease? (e.g. hypertension, heart disease) | |---|---| **Case:** a patient with hypertension on aspirin and a history of atrial fibrillation **Discussion points** * Why do we need to know about cardiovascular disease? * How might aspirin affect dental treatment? * What precautions are necessary before scaling or extractions? # **Cardiovascular conditions** ### **Case** A patient with hypertension on aspirin and a history of atrial fibrillation ### **Discussion points** - Why do we need to know about cardiovascular disease? - How might aspirin affect dental treatment? - What precautions are necessary before scaling or extractions? **Bleeding disorders** | Bleeding/Clotting Disorders | Do you have a bleeding or clotting disorder? | |---|---| | | Have you ever had excessive bleeding? | | | Do you have any blood disorders (e.g. anaemia)? | **Case:** a 45-year-old female with von Willebrand disease scheduled for dental scaling **Discussion points** * How does a bleeding disorder affect dental treatment? * What considerations are necessary? * What considerations if patient has anaemia or unexplained bleeding? # **Bleeding disorders** ### **Case** A 45-year-old female with von Willebrand disease scheduled for dental scaling ### **Discussion points** - How does a bleeding disorder affect dental treatment? - What considerations are necessary? - What considerations if patient has anaemia or unexplained bleeding? # Respiratory conditions | Respiratory | Do you have a respiratory disease? (e.g. asthma, emphysema) | |---|---| **Case: a 30-year-old asthmatic uses salbutamol regularly** **and has mild wheezing today** **Discussion points** * How should treatment be modified? * What emergency preparedness is required? * How should asthma be managed in the dental setting? * Are there any materials or procedures to avoid? # **Respiratory conditions** ### **Case** A 30-year-old asthmatic uses salbutamol regularly and has mild wheezing today ### **Discussion points** - How should treatment be modified? - What emergency preparedness is required? - How should asthma be managed in the dental setting? - Are there any materials or procedures to avoid? **Neurological conditions** | Neurological | Do you have a neurological disorder? (e.g. epilepsy) | |---|---| **Case:** a 28-year-old with well-controlled epilepsy had a seizure 6 months ago **Discussion points** * What are the risks during dental care? * How can seizures be prevented or managed? # **Neurological conditions** ### **Case** A 28-year-old with well-controlled epilepsy had a seizure 6 months ago ### **Discussion points** - What are the risks during dental care? - How can seizures be prevented or managed? # **Gastrointestinal conditions** | Gastrointestinal | Do you have a gastrointestinal disease? (e.g. coeliac disease, inflammatory bowel disease, gastritis) | |---|---| **Case:** a patient with Crohn's disease presents with recurrent ulcers and clinically signs of enamel wear on upper palatal **Discussion points** * What oral signs are associated with Crohn's? * Any product sensitivities? * Oral manifestations of some GI conditions # **Gastrointestinal conditions** ### **Case** A patient with Crohn's disease presents with recurrent ulcers and clinically signs of enamel wear on upper palatal ### **Discussion points** - What oral signs are associated with Crohn's? - Any product sensitivities? - Oral manifestations of some GI conditions # **Endocrine conditions** | Endocrine | Do you have an endocrine condition? (e.g. diabetes, thyroid disorder, dyslipidaemia) | | :--- | :--- | **Case: a 55-year-old with type 2 diabetes on metformin and insulin** **Discussion points** * How does diabetes affect periodontal health and healing? * What are hypoglycaemia risks? * What are the dental implications of diabetes? * What timing is best for appointments? # **Endocrine conditions** ### **Case** A 55-year-old with type 2 diabetes on metformin and insulin ### **Discussion points** - How does diabetes affect periodontal health and healing? - What are hypoglycaemia risks? - What are the dental implications of diabetes? - What timing is best for appointments? **Renal/Hepatic conditions** | Renal/Hepatic | Do you have kidney or liver disease? (e.g. hepatitis) | |---|---| | **Case:** a patient with stage 3 chronic kidney disease **Discussion points** * What implications for drug prescribing? * Dental implications for his medical conditions? # **Renal/Hepatic conditions** ### **Case** A patient with stage 3 chronic kidney disease ### **Discussion points** - What implications for drug prescribing? - Dental implications for his medical conditions? ## Bone modifying agents | Bone-modifying agents | Have you ever taken medications such as bisphosphonates or denosumab? | |---|---| **Case:** a patient on denosumab for osteoporosis presents for an extraction **Discussion points** * What is MRONJ and how can it be prevented? * Should extractions be delayed or avoided? ## **Bone modifying agents** ### **Case** A patient on denosumab for osteoporosis presents for an extraction ### **Discussion points** - What is MRONJ and how can it be prevented? - Should extractions be delayed or avoided? **Skin conditions** | Skin conditions | Do you have any skin diseases? | |---|---| | | | **Case**: a patient with severe eczema and known contact dermatitis **Discussion points** * What dental materials may trigger reactions? # **Skin conditions** ### **Case** A patient with severe eczema and known contact dermatitis ### **Discussion points** - What dental materials may trigger reactions? **Psychological health** <br> | Psychological health | Do you have any psychological conditions? (e.g. anxiety, depression, dental phobia) | |---|---| | | | <br> **Case: a 25-year-old with severe dental anxiety and** **panic attacks** <br> **Discussion points** * How do mental health conditions affect dental care? * How can we improve patient comfort? <br> # **Psychological health** ### **Case** A 25-year-old with severe dental anxiety and panic attacks ### **Discussion points** - How do mental health conditions affect dental care? - How can we improve patient comfort? # Cancer/Radiation Therapy <table> <tr> <td>Cancer/Radiation</td> <td>Do you have a history of cancer?</td> </tr> <tr> <td></td> <td>Have you received radiation therapy to the head or neck?</td> </tr> </table> **Case:** a patient with a history of head and neck cancer and jaw radiotherapy **Discussion points:** * What risks persist long after radiation? * What is osteoradionecrosis? * Considerations when treating this patient? Cancer/Radiation Do you have a history of cancer? Have you received radiation therapy to the head or neck? # **Cancer/Radiation Therapy** ### **Case** A patient with a history of head and neck cancer and jaw radiotherapy ### **Discussion points** - What risks persist long after radiation? - What is osteoradionecrosis? - Considerations when treating this patient? **Infectious disease** | Infectious disease | Have you ever had an infectious disease? (e.g. tuberculosis, hepatitis, HIV) | |---|---| **Case:** a patient discloses HIV-positive status with an undetectable viral load **Discussion points** * Are there additional infection control measures? * Is dental treatment safe? * Oral manifestations? # **Infectious disease** ### **Case** A patient discloses HIV-positive status with an undetectable viral load ### **Discussion points** - Are there additional infection control measures? - Is dental treatment safe? - Oral manifestations? **Past operations/Hospitalization/Complications** | Hospitalisations | Have you had any past operations or hospitalisations? Were there any complications? | | :--- | :--- | **Case**: patient reports allergic reaction after general anaesthesia during childhood surgery **Discussion points** * How should you investigate this history? * Does this affect dental care? # **Past operations/Hospitalization/Complications** ### **Case** Patient reports allergic reaction after general anaesthesia during childhood surgery ### **Discussion points** - How should you investigate this history? - Does this affect dental care? ## **Pregnancy** | Pregnancy | Are you currently pregnant? If yes, what is your due date? | | :--- | :--- | **Case**: a 32-year-old woman in her second trimester needing scaling and a filling **Discussion points** * Is it safe to treat during pregnancy? * What precautions should be taken? ## **Pregnancy** ### **Case** A 32-year-old woman in her second trimester needing scaling and a filling ### **Discussion points** - Is it safe to treat during pregnancy? - What precautions should be taken? # **Allergies** | Allergies | Do you have any allergies to medications, food, or chemicals? | |---|---| | | | **Case: patient reports penicillin allergy as a child** **Discussion points** * How should allergy be confirmed? * What are safer alternatives? # **Allergies** | Allergies | Do you have any allergies to medications, food, or chemicals? | | :--- | :--- | | | | **Case: patient reports penicillin allergy as a child** **Discussion points** - How should allergy be confirmed? - What are safer alternatives? **Medication history (including complementary)** | Medications | Are you currently taking any medications, including supplements? | |---|---| | | | **Case: patient is on SSRIs, fish oil, and St John's Wort** **Discussion points** * Why ask about supplements? * Any drug interactions? # **Medication history (including complementary)** | Medications | Are you currently taking any medications, including supplements? | | :--- | :--- | | | | **Case: patient is on SSRIs, fish oil, and St John's Wort** **Discussion points** - Why ask about supplements? - Any drug interactions? # Recreational drug use | Recreational drug use | Have you ever used recreational drugs? | | :--- | :--- | **Case**: patient occasionally uses cocaine and MDMA on weekends **Discussion points** * What are risks during dental procedures? * How does drug use affect oral health? # **Recreational drug use** | Recreational drug use | Have you ever used recreational drugs? | | :--- | :--- | | | | **Case**: patient occasionally uses cocaine and MDMA on weekends **Discussion points** - What are risks during dental procedures? - How does drug use affect oral health? **Smoking/vaping** | Smoking/Vaping | Do you currently or previously smoke or vape? Please specify product, quantity (per day/week), and duration | | :--- | :--- | **Case:** long-term smoker, switched to vaping 6 months ago **Discussion points** * What's the dental impact of smoking and vaping? * Should cessation be discussed? # **Smoking/vaping** | Smoking/Vaping | Do you currently or previously smoke or vape? Please specify product, quantity (per day/week), and duration | | :--- | :--- | | | | **Case:** long-term smoker, switched to vaping 6 months ago **Discussion points** - What's the dental impact of smoking and vaping? - Should cessation be discussed? ## **Alcohol use** | Alcohol use | Do you consume alcohol? Please specify type of drink, amount (per day/week/month/year), and duration | |---|---| **Case:** drinks 4 beers per night; recent liver test abnormalities **Discussion points** * What are oral and systemic impacts of alcohol? * How does it affect treatment? # **Alcohol use** | Alcohol use | Do you consume alcohol? Please specify type of drink, amount (per day/week/month/year), and duration | | :--- | :--- | | | | **Case:** drinks 4 beers per night; recent liver test abnormalities **Discussion points** - What are oral and systemic impacts of alcohol? - How does it affect treatment? [[L10 Medical and Drug History 2025.pdf#page=1|L10 Medical and Drug History 2025, p.1]] [[L10 Medical and Drug History 2025.pdf#page=2|L10 Medical and Drug History 2025, p.2]] [[L10 Medical and Drug History 2025.pdf#page=3|L10 Medical and Drug History 2025, p.3]] [[L10 Medical and Drug History 2025.pdf#page=4|L10 Medical and Drug History 2025, p.4]] [[L10 Medical and Drug History 2025.pdf#page=5|L10 Medical and Drug History 2025, p.5]] [[L10 Medical and Drug History 2025.pdf#page=6|L10 Medical and Drug History 2025, p.6]] [[L10 Medical and Drug History 2025.pdf#page=7|L10 Medical and Drug History 2025, p.7]] [[L10 Medical and Drug History 2025.pdf#page=8|L10 Medical and Drug History 2025, p.8]] [[L10 Medical and Drug History 2025.pdf#page=9|L10 Medical and Drug History 2025, p.9]] [[L10 Medical and Drug History 2025.pdf#page=10|L10 Medical and Drug History 2025, p.10]] [[L10 Medical and Drug History 2025.pdf#page=11|L10 Medical and Drug History 2025, p.11]] [[L10 Medical and Drug History 2025.pdf#page=12|L10 Medical and Drug History 2025, p.12]] [[L10 Medical and Drug History 2025.pdf#page=13|L10 Medical and Drug History 2025, p.13]] [[L10 Medical and Drug History 2025.pdf#page=14|L10 Medical and Drug History 2025, p.14]] [[L10 Medical and Drug History 2025.pdf#page=15|L10 Medical and Drug History 2025, p.15]] [[L10 Medical and Drug History 2025.pdf#page=16|L10 Medical and Drug History 2025, p.16]] [[L10 Medical and Drug History 2025.pdf#page=17|L10 Medical and Drug History 2025, p.17]] [[L10 Medical and Drug History 2025.pdf#page=18|L10 Medical and Drug History 2025, p.18]] [[L10 Medical and Drug History 2025.pdf#page=19|L10 Medical and Drug History 2025, p.19]] [[L10 Medical and Drug History 2025.pdf#page=20|L10 Medical and Drug History 2025, p.20]] [[L10 Medical and Drug History 2025.pdf#page=21|L10 Medical and Drug History 2025, p.21]] [[L10 Medical and Drug History 2025.pdf#page=22|L10 Medical and Drug History 2025, p.22]] [[L10 Medical and Drug History 2025.pdf#page=23|L10 Medical and Drug History 2025, p.23]] [[L10 Medical and Drug History 2025.pdf#page=24|L10 Medical and Drug History 2025, p.24]] [[L10 Medical and Drug History 2025.pdf#page=25|L10 Medical and Drug History 2025, p.25]] [[L10 Medical and Drug History 2025.pdf#page=26|L10 Medical and Drug History 2025, p.26]] [[L10 Medical and Drug History 2025.pdf#page=27|L10 Medical and Drug History 2025, p.27]] [[L10 Medical and Drug History 2025.pdf#page=28|L10 Medical and Drug History 2025, p.28]] [[L10 Medical and Drug History 2025.pdf#page=29|L10 Medical and Drug History 2025, p.29]] [[L10 Medical and Drug History 2025.pdf#page=30|L10 Medical and Drug History 2025, p.30]] [[L10 Medical and Drug History 2025.pdf#page=31|L10 Medical and Drug History 2025, p.31]] [[L10 Medical and Drug History 2025.pdf#page=32|L10 Medical and Drug History 2025, p.32]] [[L10 Medical and Drug History 2025.pdf#page=33|L10 Medical and Drug History 2025, p.33]] [[L10 Medical and Drug History 2025.pdf#page=34|L10 Medical and Drug History 2025, p.34]]