EVALUATION OF THE DENTAL
PATIENT:DIAGNOSIS AND
MEDICAL RISK ASSESSMENT
Objectives for the health status of the US population for the early twenty-first century have already been published by the US Department of Health and Human Services.
Three sweeping goals have been introduced: (1) an increase in the span of healthy life; (2) the reduction of health disparities; and (3) universal access to preventive services. These are commendable goals that need to be achieved for a rapidly aging population that is suffering from an increased incidence of medical and physical disabilities requiring improved access to medical services.
The mean age for individuals in the United States in 1998 was 36.2 years, with 12.7% of the population over 65 years of age. However, by 2015, the number of Americans over the age of 65 years will have increased by almost 16%, compared to the number of such Americans in 1998.
PATIENT:DIAGNOSIS AND
MEDICAL RISK ASSESSMENT
Objectives for the health status of the US population for the early twenty-first century have already been published by the US Department of Health and Human Services.
Three sweeping goals have been introduced: (1) an increase in the span of healthy life; (2) the reduction of health disparities; and (3) universal access to preventive services. These are commendable goals that need to be achieved for a rapidly aging population that is suffering from an increased incidence of medical and physical disabilities requiring improved access to medical services.
The mean age for individuals in the United States in 1998 was 36.2 years, with 12.7% of the population over 65 years of age. However, by 2015, the number of Americans over the age of 65 years will have increased by almost 16%, compared to the number of such Americans in 1998.
The increase will be even more dramatic among African Americans, who will show an increase of 20%. Many different factors contribute to this extended survival trend, including better nutrition, healthier lifestyles, life modifications that directly reduce risks of developing specific diseases, and more advanced medical technologies and therapies (such as advanced imaging modalities, gene therapy, and organ transplantation that will enable survival for medically complex patients). This trend is also a reflection of longer survival among younger individuals with chronic debilitating conditions. The gathering of relevant patient-specific medical information for the purpose of the provision of oral health care needs to reflect continuous social changes as well as changes in medical management. Social changes (such aschanging sexual practices), access to dental and medical care, and the insurance industry affect every aspect of health care delivery. Dental therapy must be modified to accommodate these social changes to ensure that patients can receive affordable care that is specifically designed to their needs.
The oral health status of Americans is undergoing changes. Because more people are going to retain their dentition, the use of dental services will increase.
The need for preventive dental care is predicted to increase while the need for direct restorative intervention will decrease among the younger patient population. However, this will not be the case with the aging adult population. These patients will have a continuous need to improve masticatory function while still demanding superior esthetic results. Furthermore, recent information suggests that there is a more intimate relationship between oral and systemic health.
Thus, the challenge facing dentists in the twenty-first century is a rapidly growing population of patients who have chronic medical conditions, take multiple medications, yet still require routine, safe, and appropriate oral health care. This chapter addresses the rationale and method for gathering relevant medical and dental information (including the examination of the patient) and the use of this information for dental treatment. This process can be divided into the following four parts:
1. Taking and recording the medical history 2. Examining the patient and performing laboratory
studies 3. Establishing a diagnosis 4. Formulating a plan of action (including dental treat-
ment modifications and necessary medical referrals) It is of interest to note that by the end of the initial history and physical examination in medical practices, the diagnosis has been correctly established in almost 90% of cases.