Present Dental Illness

A history of the present illness should indicate the severity and the urgency of the problem. If the problem is long-standing, proceed with detailed questions about past episodes of pain or swelling and any previous treatment performed to remedy the condition.

Pain is frequently the main component of the patient’s complaint. A history of pain that persists without exacerbation may indicate a problem not of dental origin. If the chief complaint is “toothache” but the symptoms are too vague to establish a diagnosis, analgesics can be prescribed to help the patient tolerate the pain until the toothache localizes. If the patient arrives self-medicated with analgesics or sedatives, a diagnosis may be difficult to establish. The initial questions should help establish two basic components of pain: time (chronicity) and severity (or intensity). Start by asking such questions as “ How long have you had this problem?” “ How painful is it?” and “ How often does it hurt?” Continue the questioning with “ When does it hurt?” “ When does it go away?” “ What makes it hurt?” “ What makes it hurt worse?” and “ What makes it hurt less or go away?”

A history of painful responses to thermal changes suggests a problem of pulpal origin and will need to be followed up with clinical tests, using the thermal test that would most closely duplicate the patient’s complaint: use ice if the complaint is pain with cold, and se a hot stimulus if the complaint is pain with such things as hot drinks. It could also be important to learn that a tooth has been sensitive to thermal changes but no longer responds to such stimuli; this would indicate that the tooth may have a pulp that is now necrotic.

The question, “What kind of treatment have you had?” might elicit a history of pulp capping, deep fillings with sedative bases, or indirect pulp caps. These teeth, as well as those that have received impact trauma, may exhibit calcific metamorphosis or dystrophic calcifications and may be a difficult endodontic treatment problem.

A history of long-standing, severe pain should raise suspicion that the condition may be other than pulpal in origin. Additional examinations for myofascial or neurologic pain, as well as cardiac referred pain or possibly psychogenic pain, should be considered.

In reviewing the medical history, particular emphasis must be placed on illnesses, history of bleeding, and medications. Illness often means hospitalization to patients; consequently, they may not list weight changes, accidents, or problems related to stress and tension.

Дата добавления: 2015-10-16