General Dentistry

Health History at the Dentist – 4 Things Patients Should Know

image of health history form

I just want my teeth checked, do I really have to fill out this entire form?

Why does your dentist make it his/her business to know what diseases you have and what medications you take?  How much does your dentist really need to know just to take care of your teeth?  Many patients are surprised by the answers.  Here are 4 reasons why it’s important to fully disclose your health history at the dentist.

 

1. Diseases Change the Natural Defenses of the Mouth

First, let’s establish one important fact: the mouth is connected to the rest of the body.  As obvious as this statement may sound, it’s often the most overlooked concept.

The diseases you have can change the natural defenses of the mouth.  Your saliva has all sorts of proteins and antibodies that help protect your teeth from harmful bacteria.  Many diseases will reduce salivary flow or change the composition of your saliva. This alters the ability of your saliva to protect your teeth.  Let’s look at some examples.

 

Diabetes

For example, patients with type II diabetes are at greatly increased risk for tooth decay.  In poorly managed diabetes, this risk increases. Diabetes causes changes all throughout the body, and saliva is also highly affected.

Many people are familiar with poor wound healing associated with diabetes.  Due to this, patients with poorly managed diabetes tend to be poor candidates for dental implants.  If a diabetic patient needs to have teeth replaced, the status of their disease management will affect their treatment options.

 

Autoimmune Diseases

Sjogren’s Syndrome (SHO-grens) is an autoimmune disorder that greatly reduced the secretions of the body.  This includes saliva for the mouth, tears in the eyes, sweat, etc. For patients with Sjogren’s, meticulous oral hygiene is extremely important.  In addition, we can prescribe some medications to help stimulate salivary flow, or recommend a saliva substitute such as Biotene. Take home topical fluoride trays are another way to help keep the teeth mineralized.

If your dentist knows your medical conditions, they can help determine how to tailor your preventive care to reduce your risk of cavities, gum disease, and soft tissue problems.

 

2. Treatment and Medication Side Effects

You’ve seen the TV commercials for various drugs where they go through the long list of side effects?  Jeff Foxworthy has joked about how the side effects of medications are worse than the conditions they treat.  Medication side effects can also impact the mouth.

 

Polypharmacy

One of the most common side effects of taking many drugs is dry mouth.  Remember that your saliva provides defense for your teeth. Your teeth and gums have much less protection against harmful bacteria when your salivary flow is reduced.

image of prescription medicine bottles

We have a number of patients who have been with our practice for decades.  One particular patient had all 32 teeth in near-perfect health for his entire life.  Three years ago he had a stroke, had an extended hospital stay, and was placed on 8-10 new medications.  It had been only 18 months since the last dental visit. Upon return, the patient had a cavity on nearly every tooth.  Some of these teeth were decayed to the extent we could not save them.

If you have recently been placed on any new medications, consult your dentist.  He/She can advise you on any changes to your hygiene routine that can keep your mouth healthy.

 

Radiation Treatment

Radiation treatment is another factor that can cause major changes of the mouth’s defenses.  Particularly, patients who have had radiation treatment to the head and neck will experience changes to the salivary glands.  These patients will be prone to dry mouth for the rest of their lives.

During active treatment, head and neck radiation can also cause inflammation of the soft tissue in the mouth. We call this condition “oral mucositis”.  This can cause a burning feeling in the mouth that can be very uncomfortable. Your dentist can recommend mouth rinses or gels that can help with the symptoms.

We coordinate with doctors at M.D. Anderson for many of our patients in cancer treatment. This allows us to help maintain their oral health during treatment.

 

3. Adverse Treatment Outcomes

Sometimes, your health conditions and medications you take can cause adverse reactions with dental treatment.

One common example would be patients who take blood thinners such as warfarin.  If the patient requires any kind of oral surgery, I certainly want to know if they’re taking blood thinners!  We can plan to use additional techniques to help the patient’s blood clot following a tooth extraction. The last thing we want is for the patient to have trouble getting the bleeding to stop.

 

MIONJ

A condition called “medication-induced osteonecrosis of the jaws” or MIONJ is a particularly notorious example.

In MIONJ, certain medications can elevate the risk of the jaw bone dying in areas around recent oral surgery procedures.  It has been heavily researched over the past decade, and its definitions and risk factors are still being defined. Dental extractions have been commonly noted to stimulate MIONJ in patients taking certain drugs.

image of lesion from MIONJ
Exposed, dying bone on the lower jaw due to MIONJ

Most notably, patients taking bisphosphonate drugs are at risk. Administration of bisphosphonates via IV increases this risk. Bisphosphonates are designed to preserve bone density, and are commonly taken by patients with osteoporosis.  Sometimes patients being treated for metastatic cancers take prescription bisphosphonates in an attempt to keep their bones sturdy.

The most intimidating thing about MIONJ is we are still trying to figure out how to treat it.  In some cases, it is self limiting. But in many cases, conservative therapies are unable to stop the disease process.  Some patients need to have more invasive surgery to remove the dying parts of the jaw bone.

Sometimes, patients only disclose the medications they take daily at home and forget to include those administered at their doctor’s office.  It is imperative that patients disclose all medications to the dentist in order to avoid complications with your treatment!

 

4. Adverse Reactions to Dental Anesthetic

Dental anesthetics have a history of being extremely safe.  Allergies to drugs like lidocaine are exceedingly rare. These drugs are also designed to work only at the site of injection. However a minimal amount of the drug will enter the blood stream.

This trace amount of anesthetic is normally negligible and causes no side effects.  However, some patients may uncommonly feel their heartbeat slightly accelerate. This is most likely due to the small amount of epinephrine contained in the solution.

Side effects from local anesthetics are extremely rare, and the ones that do occur are very mild.

A notable exception to this is for patients who have recently used recreational drugs.  The stimulants, or the “uppers”, most notably cocaine, can potentially cause a lethal reaction.  A normal dose of dental anesthetic can potentially kill a patient who recently used cocaine.

If a patient withholds information regarding recent use of cocaine, the result can truly be catastrophic.

We need to know your drug history because we want to be able to properly and safely take care of you.

 

Final Remarks

It’s worth noting before I learned anything about fixing teeth in dental school, we learned the importance of the health history and review of systems.  In fact, all throughout dental school we had several courses that constantly worked to prime us on reading and interpreting the health history in order to properly deliver dental treatment.

When filling out your health history, don’t just put what you think the dentist should know.  There may be something in your health history that could greatly affect your treatment! In some cases, our full knowledge of your health history can help prevent serious complications.  To maximize your treatment outcomes, be sure to fully disclose your health history at the dentist!

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