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Dr.Sundos abu-zaid

Dr.Aceil AlKhatib

23 / 9 / 2013

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Lecture title : INTRODUCTION

* In this course we will learn: -how to obtain and import the chief complaint of the patient -how to obtain medical and dental history -how to ask questions -how to interview a patient -how to use the vital signs including (pulse rate and respiratory rate and blood pressure) -how to do extra and intra oral examination -how to perform cranial nerves -how to examines these nerves because its a very important major in FDF examinations -how to perform routine diagnostic tests -how to chart teeth and how to report findings -how to plan the treatment into phases especially in multi caries teeth

Learning Objectives
Conduct a patient interview, and obtain medical, dental, and psychosocial histories( in some cases the psychosocial history is the most important however in certain cases its the medical history is , and we will learnt how to differentiate between the importance in each case.

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 Understand the significance of certain medical histories including medications use Perform a routine extra oral examination, including cranial nerves and TMJ Perform routine diagnostic tests

Assessment
First Semester (40 marks): Midterm online exam: Theory: 20 MCQs. Clinical: 20 MCQs. Remember (memorization is important) Second Semester (60 marks): Clinical assessment: 20 marks + Final online MCQ exam: Theory: 20 MCQs. Clinical: 20 MCQs **In the first semester you are going to work in each other in the practical course and in the second semester you are going to work with real patients.** - The doctor interviewed the syllabus for us , hopefully you find it later on elearning.

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Now the lecture begins : You know that your first mission to do in you clinic is interveiwning the (The introductory phase/First phase ) By : Greet the patient by name and take an initial briefing Introduce yourself and establish a rapport with the patient, be sure to inspire confidence in the patient by appearing self confident and making eye contact, (shaking hands with the patient is optional in this society especially between Males & Females, as well as a source of cross-contamination- so Handshakes is not a requirement). You can use introductory comments (small talk) such as the traffic, weather, recent events etc. Avoid using dental terminology when discussing things with the patient, use common easily understandable language. Record the patients first statement as it may be related to the chief complaint which very important . Record or check biographical data (gender.address.occupation) Listening to the patients account/ Second phase : ask the patient a useful question as : how can I help you and do not interrupt the patient . Record the chief complaint in the patients own words , use the same exact words of the patient but in English Record the symptoms in order of severity (symptom taking is guided by asking the patient questions).

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 Relate the chief complaint with the patients initial statement . Structured questioning/ Third phase : History of chief complaint Medical history Previous dental history Family history Social history, and you have to record what you are going to do in the two following weeks . ** During the initial meeting and information gathering from the patient gloves should NOT be worn; but as soon as you begin to examine the patient (with your hands) you must start to take the infection control measures. Use universal precaution measures for all bodily fluids (saliva, nasal droplets, and blood) and assume that all patients are Hepatitis and HIV positive. ** Cross Contamination has a specific pathway which may involve shaking hands with an infected patient writing on the file with contaminated hands file contamination, and may end up at your home. " Therefore you should always follow the infection control guidelines, and keep in mind that washing hands is THE most important factor in illuminating cross infection and disease transmission. "

- They first discovered the importance of hand washing in

Britain in 80's when the first medical schools were opened; they noticed that women who gave birth under Medical students had a much higher risk of dying than Women who gave birth under a Mid Wife, the reason being that mid wives always consistently washed their hands.
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-When should you wash your hands: Hands must be cleaned before and after treating each patient After handling contaminated items, after blowing your nose or Using the toilet, and before eating or handling food and any time your hands are visibly contaminated. **Any incident that occurs that leads you to suspect contamination of your hands requires that you wash your hands. **If you have lesions on your hand (oozing or non-oozing- ex: herpetic whitlow) any contact with patients should be avoided until the lesions have healed.

Fingernails
Fingernails should be kept short and trimmed Long natural or artificial nails should be avoided Freshly applied nail polish on short nails is acceptable Chipped nail polish should be avoided

** Always remember that you should : Use gloves, masks, protective eyewear or face shields and protective clothing, however Protective eyewear is not required in the Oral Diagnosis clinic since we dont use any vibrating/ultra-sonic devices . The mask should be changed whenever it becomes contaminated , wet or touched with hands Using extreme caution when passing sharps during fourhanded dentistry.
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- In the Oral Diagnosis clinic the only sharp instruments you will use are the probe and occasionally a syringe for aspiration, but you must take safety measure while dealing with these and be careful not to cut yourself, your assistant or the patient. Any Needle stick injury should follow the guidelines available in the clinic; you must document the incident and record the hepatitis & HIV status of both the patient and the dentist .

Gloving
Wearing gloves reduces contamination of the hands by flora that can be transmitted from one patient to another, dentists only started wearing gloves in the early 90s. The same pair of gloves should not be worn for the care of more than one patient. Gloves should not be washed or reused. Gloves should be removed after caring for a patient.

Dental Record
The dental record is the file that records everything that is related to the patient, including any communication, compliance, advice, radiographs, lab exams, drug prescriptions s and the detailed document of the history of the illness, physical examination, diagnosis, treatment, and management of a patient and all patient-related communications . Now most clinics are starting to use electronic dental records for easier access and faster retrieval, but the clinic in Irbid still uses paper records. These records should be in a place easily accessible by the dental staff; but not accessible by anyone else in order to protect the confidentiality of the patients.

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Dental records are very important for several reasons: Evidence (corpse identification), Legal Implications for insurance and mal-practice suits(double checking if the procedure you carried out is the same that the patient wanted). The dental record contains the patients information, medical history, medication, clinical examination, teeth charting, new diagnosis, treatment plan and documentation of informed consent (informed consent involves informing the patient of all complications and possible results of an operation that you will perform).

THE END

Note : due to the very bad record of this lecture , I referred back to 2009's script and the slides , dont worry both lectures are almost the same , Sorry for any mistakes found .

Sundos Abu-Zaid

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