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any patients, and some members ongoing records (particularly of the patient history)
of the dental team, may regard where it states:
treatment as ‘doing’ rather than
discussing. However, some of the ‘You must make and keep complete and accurate
most important aspects of dental care relate to patient records, including an up-to-date medical
talking and listening to patients, as well as working history, each time that you treat patients.’
in their mouths. Communicating effectively
together, particularly at the first contact or visit, Any information obtained must also be kept
provides vital information needed for safe and confidential as confidentiality is an absolute
effective treatment. While the treating clinician still relationship of trust between patients and the dental
has the ultimate responsibility for all of the patient’s team. If a patient thinks that their information will
dental treatment, this contact is a role that can be not be kept confidential then they will be reluctant
delegated to the dental nurse. to ever give true facts about themselves and their
But why is this information so important? oral health. GDC (2013) guidance is again clear,
saying:
Confidentiality and records
Good information, and good records, are essential ‘Confidentiality is central to the relationship and
for clinical and ethical risk management. Keeping trust between you and your patients. You must keep
out of trouble is all about providing good treatment patient information confidential.
for patients but also about communicating well and
This applies to all the information about patients
finally recording what was said and done.
that you have learnt in your professional role
Moreover, General Dental Council (GDC, 2013)
including personal details, medical history,
guidance is clear on the need for good initial and what treatment they are having and how much
it costs.’
National Examining Board for Dental Nurses have a positive view of all members of the dental
and is now an emeritus dental nurse examiner. team. Quite often patients, particularly if it is
their first visit, will be nervous about the prospect
Email: andrew.collier@mps.org.uk of treatment so friendly reassurance, while still
obtaining the information needed, can be an ideal
start in their relationship with the practice or clinic. can cause pain in itself or affect the outlook of any
Unfortunately, a bad first impression can also stay restorative treatment.
with them just as effectively as a good one. Some jobs may also affect both our and the patient’s
As already mentioned, although the ultimate views on future treatment. For example, the career of
responsibility for all of the patient’s clinical treatment, a singer or wind instrument musician would be much
as well as the information obtained, lies with the more disadvantaged by any nerve injury following a
treating clinician who is usually the dentist, dental difficult or surgical extraction.
nurses can have a pivotal role in gaining patient
confidence and obtaining that information. Medical history
So what information is needed and how is it best A thorough medical history is essential. If problems
obtained? occur that could have been prevented had the
necessary information been obtained, then it
‘Open’ and ‘closed’ questions is a serious omission as well as being clinically
Good communication is essential for successful dangerous. Formats vary; some clinicians go through
dentistry. Patients must feel at ease and if they do, the questions on each and every occasion. Others
then obtaining an accurate history is so much easier. use a standard form that the patient fills in. The
latter is efficient but it should never be forgotten that
How are the best results obtained? the patient must understand the questions and be
Questions can be ‘closed’ or ‘open’. ‘Closed’ questions happy with their reply. A patient signature of a form
are used when a clear and definite answer is needed. An is no protection if he or she did not understand the
initial, or updated, medical history is a good example. questions. If there is any doubt, the understanding
Do you take medication? Do you have any heart or must be verified. Medical histories must also be
chest problems? The (initial) answer is yes or no. regularly updated.
‘Open’ questions usually begin with one of the
5 ‘Ws’ or the ‘H’; Who? What? When? Which? Where? Dental history
and How? ‘Open’ questions are used when we want It is often tempting to think that all of a patient’s
greater detail or to understand how a patient feels. For dental history will be revealed by examining the teeth
example, ‘what are your main dental concerns?’ and soft tissues. However, a lot of information can be
The right questions, using the right manner, will obtained from a history of previous dental treatment.
get the relationship with the patient off to the best Even though the patient is a lay-person they will
start and the appropriate information will be obtained usually have much to tell; for example:
before commencing the clinical examination. n Are you a regular attender?
n What treatment have you received in the last
Personal history 5 years?
Checking the patient’s name, date of birth and address/ n Are any teeth painful/sensitive?
contact details is very much a ‘baseline’ requirement. n Do your gums ever bleed on brushing or
However, other information is often very important. spontaneously?
For example, although details of the patient’s job may n Are you worried about any area of dental treatment?
not seem relevant, they frequently are. The pastry chef n Have you had any particular problems with dental
breathing in sugar dust all day may develop caries treatment previously?
much quicker than average. Other factors such as a The following case study shows the importance of
stressful job may lead to bruxism or clenching, which good history taking and the dental nurse’s role.
facial muscles. A full medical and dental history crowns and that there were no other factors.
was taken by the dental nurse on the dentist’s behalf, Unfortunately, despite careful occlusal adjustment the
which revealed nothing abnormal. On examination patient returned complaining of continued muscular
the dentist was of the opinion that the problem discomfort for which no apparent cause could be
found. However, when the dentist briefly left the The dentist was duly informed and a soft splint was
room the patient told the dental nurse that she had constructed, which the patient wore while driving and
just started a new job. The job was not only stressful at nights. The symptoms resolved as the cause of the
in itself but also included a lot of driving, which she pain, clenching due to stress, was now known.
found difficult, and that she felt she was clenching Following this incident, it was agreed that a
her teeth. The patient further stated that she had not thorough personal history would also be taken with
felt this was relevant to her dental treatment and had the medical and dental histories for new patients,
therefore not mentioned it when she first saw the as well as a personal history update for existing
nurse nor when she subsequently saw the dentist. practice patients.