Assessing The Patient
Having ample knowledge of the patient's dental history is vital to the clinician-patient relationship. If the clinician is aware of the patient's previous dental experiences, he or she can plan a suitable course of treatment as well as utilize strategies to cultivate future compliance.
No practitioner can fully understand a patient's total health or provide appropriate care without a thorough medical history. Some systemic diseases may influence oral health and/or dental treatment to some degree, and, conversely, dental treatment may have an influence on some systemic conditions.1
Anxiety over dental treatment is not uncommon: over half of the American population suffers from "dental phobia or related anxieties."2 Some have a fear of dentists and what they might say or do, while others are terrified of dental procedures, some to the point that they do not want to think about or be aware of even minor interventions. Others have specific problems, such as a bad gag reflex, a fear of needles, or a prohibitive embarrassment about seeing a dentist.3
There are various methods of treatment, pharmacological or otherwise. Psychological methods, distraction, relaxation techniques, and hypnosis are among the most popular non-pharmacological methods used today. The pharmacological methods include various means of sedation (inhalation, oral, and intravenous) and general anesthesia.
Social history is a record of the social and familial circumstances of the patient.4
Patients who are addicted to drugs or undergoing treatment for drug addiction present a variety of management issues when it comes to dental care. The dental team should be aware of several factors related to treatment planning and clinical management in order to treat these patients sensitively and effectively. Important issues include behavioral disorders, pain management, cross-infection, medical problems associated with drug abuse, and the ways in which drug abuse and its subsequent treatment affect the dentition. The more that practitioners know about types and patterns of drug abuse and recovery programs, the more safely the special needs of these patients can be managed.5
The elderly are increasing in numbers and have a longer life expectancy in most parts of the world than in the past. Combined with the fact that older adults are now visiting their dentists with increasing frequency, this means that dentists will be treating more elderly patients in the future. It is important for dentists as well as hygienists to be aware of the common medical conditions of (and medications taken by) the elderly, including vision and hearing loss and other physical limitations.6
The other demographic of particular interest in this subject area are children. In a study by Yeung, Howell, and Fahey, the authors concluded that repetition and reinforcement components of dental heath education programs significantly improve the oral hygiene performance of adolescent subjects.7 Socioeconomic factors also greatly impact children's dental health, as discussed later in this article.
Tickle, Williams, Jenner, and Blinhorn studied the effects of socioeconomic status and dental attendance on dental caries experience and treatment patterns in five-year-old children. Their results confirm other findings in the literature that children from deprived backgrounds tend towards increased caries in the primary dentition and are more likely to be irregular dental attendees.
Culture, Western or otherwise, can have a significant impact upon professional practice and patient health behaviors, especially in multicultural societies.8 The dental professional should be aware of his or her patients' backgrounds.