Is There Ever a Time You Can Skip the Health History?

Tiffanie White, MEd, BS, a clinical assistant professor in the Dental Hygiene Program at the University of North Carolina (UNC) at Chapel Hill Adams School of Dentistry, shares why it’s important to take your time reviewing a patient’s health history.  

A medical history only takes a few minutes, and those few minutes could save a life. As a dental hygiene student, you are learning about the most frequently encountered medical emergencies, and how taking a medical history can prevent such emergencies in the office and outside of it after the appointment is finished.

TOP EMERGENCIES

The top five medical emergencies in the dental office are syncope, asthma, allergic reaction, heart attack, and stroke. All of these emergencies can be prevented by taking a thorough health history.

At the beginning of my career, I remember being so focused on staying on time that I overlooked key aspects of a patient’s health history. My oversight caused me to become embarrassed and extremely concerned when I missed a patient’s latex allergy. The dental team had to give the patient Benadryl to prevent a potential reaction. The anxiety of possibly harming the patient and my embarrassment taught me a valuable lesson: conducting and closely reviewing patients’ medical histories are paramount to safe patient care. 

The most dramatic experience I’ve encountered in the dental office regarding medical histories is the time a patient fainted and emergency medical technicians (EMT) were called. The patient presented for an extraction. Local anesthesia was administered and then the patient fainted while in the semi-supine position. Once the EMTs arrived, the first question asked was “What was the patient’s blood pressure?” My face grew hot with embarrassment as I realized I had not taken the patient’s blood pressure prior to administering local anesthesia due to time constraints. I skipped a very important step that could have prevented this emergency situation. 

Reviewing and updating a patient’s health history not only prevents medical emergencies but also may save a life as it helps dental hygienists detect diseases based on the patient’s previous or present symptoms and/or medication use. For example, consider a patient with a history of benign lesions in the head and neck area who reported a lesion 10 years ago on his or her health history. As a new dental hygienist, if you skip reviewing this patient’s health history and only rely on his response to the question “Are there any health updates?” you will not know about the patient’s history of benign lesions. Without this knowledge, you will go on to treat the patient, and because he has excellent oral health, radiographs may not be taken for up to three years. It will only be during that visit when a 5 x 4 radiolucent lesion is seen in the alveolar region around tooth number 31. This is when you realize that the patient has a history of benign lesions,  a condition documented in his or her health history. Radiographs should have been taken more often, and you should have suggested the patient see a specialist several months ago. The lesson: do not skip the health history. 

ALL IT TAKES IS 5 MINUTES

How can you quickly perform a health history update? The first step is to review histories before patients are sitting in your chair. This will allow you more time to review and save time while the patient is getting ready for the appointment. Next, ask the patient if he or she has allergies, confirm medications, and ask if there have been any changes in their health history since the last visit. Conclude by taking blood pressure and pulse. Using this technique will allow you to ask some open-ended questions and complete the update in less than 5 minutes.