A patient’s medical history is a legal document, and it is essential to be thorough when obtaining information that could affect a patient’s dental outcome. With limited time in a dental hygiene appointment, it can be difficult to get the information needed to best treat patients. However, it is your ethical duty as a licensed professional to properly evaluate and document all information, even if you do not believe it is relevant at the time. For optimal patient care and best outcome, the clinician and patient must become partners in the assessment process.
Reviewing the patient’s medical history at every appointment is not the only assessment we should be tackling. I know that when you land your first clinical position as a dental hygienist, some things may slip your mind because all you can think about is staying on time. However, it is essential not to focus solely on meeting deadlines. Patients come to you, a healthcare professional, and it is best to do your due diligence and obtain all necessary information that could affect your patient’s oral and systemic health and your license.
Here are some assessment categories to include in your arsenal.
Related reading
Review of medical history
Medical history: the responsibility of a practice
Mild cognitive impairment
Do you assess mild cognitive impairment? MCI is the stage between the cognitive decline expected with aging and the more severe decline of dementia. There is no specific test to confirm a diagnosis of MCI except by asking people about their memory decline over time, their overall daily function, and whether they can follow instructions. Imagine an elderly patient entering perfectly into phase with his environment during an appointment. On their next visit, they may see another provider who thinks their confused behavior is normal. It would be because you didn’t take a comprehensive approach and noted in their chart that they were okay.
Diabetes
Another essential assessment is to make sure the diabetes is under control. Diabetics should be scheduled in the morning because their endogenous cortisol levels are usually higher at that time. In addition, cortisol raises blood sugar levels. If the patient is unable to show up first thing in the morning, schedule them after eating and remind them to eat before their visit. Also, it’s important that you document their A1C levels, the medications they take, why they take those medications, and when they last took them. It is in the patient’s best interest and in your best interest to avoid a medical emergency such as hypoglycemia.
Airway
When a parent brings their child for a dental appointment, checking for signs of airway problems offers both parent and child a better quality of life. For example, a mother who came for her routine visit brought her newborn daughter and was worried that she was choking on milk. After getting permission to assess the baby, I quickly realized that her tonsils were so enlarged that they were blocking her airway. I recommended that she consult her doctor or her ENT to be evaluated, and I took note of the follow-up. I recommend learning to use the Mallampati or Brodsky scale. Understanding how to use them will not only benefit you as a clinician, but also your patients.
Studies have shown that if airway problems are not treated early, it can have a significant impact on a person’s quality of life and IQ, especially in men. If a patient is unable to breathe properly through their nose, it can affect their arch development, lead to fatigue, and cause sleep disorders such as sleep apnea. Nasal breathing prevents allergens from entering the lungs and helps reduce fatigue and stress by delivering more oxygen to cells.
Tongue posture can also affect airway and arch development. In addition to oral cancer, one assessment I perform regarding a patient’s tongue is to have them swallow while I hold their lips to see if it is a tongue propeller. Tongue thrusting can lead to an abnormal orthodontic condition called an open bite.
Nutrition
As oral health specialists, it is within our scope of practice to discuss nutrition with patients as certain foods can affect oral health. In search of an ideal meal plan, many people emphasize one food group in particular: carbohydrates. Carbohydrates provide energy to cells, but certain types of carbohydrates have been linked to chronic inflammation such as gingivitis and periodontal disease.
However, not all carbs are harmful or contribute to inflammation to the same degree because they are not all digested at the same rate. These foods are measured on the glycemic index scale. Foods with a high glycemic index such as bread, pasta, and baked goods are digested quickly, which in turn leads to a spike in glucose and causes an insulin surge. According to nutritional studies, the consumption of complex carbohydrates such as fruits and vegetables has been shown to decrease inflammation.
Nutritional deficiencies may be linked to oral manifestations, and patients with eating disorders are at increased risk for poor oral and systemic health. Patients with eating disorders tend to have particular intraoral features, such as xerostomia, caries, erosion, hypersensitivity, and mucosal changes, to name a few. The implementation of screening tools and an interprofessional approach is essential to fight against this disorder.
In conclusion, we are a community of healthcare professionals dedicated to the prevention and relief of disease and the promotion of optimal oral and systemic health. The services we provide contribute to the health and well-being of our patients, and it is important to be comprehensive with them. It is our responsibility to document effectively to ensure that we are meeting our ethical duty to uphold our core values and our obligation to the healthcare profession.
Be thorough with every appointment with every patient and every document, but also remember that patients cannot disclose everything. Your work is important because you can help save lives and have the power to contribute to the success of patients’ overall health and quality of life. Remember to listen, empathize, and reassure patients, as they may give you clues about other health issues. Lately, breathe, and know that you have this!
