case history in dentistry

1. CASE HISTORY IN ENDODONTICS
Presented by:
Aiman zafar

2. CONTENTS
Introduction
What is case history
Purpose of case history
General information
medical history
extra oral examination
Intra oral examination
Diagnosis
conclusion

3. INTRODUCTION
WHAT IS CASE HISTORY?
Case history is define as the data concerning an
individual and his or her family and
environment ,including the individual medical
history that may be useful in analyzing and
diagnosing his or her case or for instructional
purpose.

4. PURPOSE OF THE CASE HISTORY
 History taking is a clinical procedure.
 Doctor should put the questions in a simple way
relieving the tension and anxiety of the patient
 Should asked duration,mode of the development
 Family history and medical history also asked to
the patient because many medical problems
associated with dental problems.
 Collect necessary informations that give the
CORRECT DIAGNOSIS

5. NAME
 While taking case history first question to be
asked is the name.
 To register in the hospital record to remember
and recall the patient
 If the patient is brought unconsciousness

6. AGE
Age is important in case history because certain
diseases accur in certain age groups.
Eg: eruption disorder
Pericorinitis
Viral infections
Sarcomas

7. SEX
 Sex is important because certain diseases of
mouth accur in a particular sex
 Pubertal gingivitis,pregnangingiviyis,menopausal
gingivitis will accur in females
 Stomatitis nicotina palatine accur in male
 Leukoplakia in smooking males

8. OCCUPATION
 Certain occupation produce charecteritics oral
lesion.
 Eg: 1 lead factory workers develop a blue line in
the gingivai i.e;Bartonion line
 2 match factory workers developed necrosis of
soft tissues.
 3 A notch will be seen in middle nentral incisor in
tailors
 4 bakery workers develop multiple carius lesion
as the carbohydrates fumes accumulates on the
surface of the teeth

9. ADDRESS
 Address is very important because we have to
recall the patient
 Some time address will give clue for certain
diseases
 Like flourosis

10. income
 Poor income people will develop nutritional
deficiency
 Poor oral hygiene

11. Chief complain
 It is usually documented in the patient’s words.
 The complain when started,where,exactly,how
started and the duaration.
 After obtaining the chief complain ,the
examination process continued by obtaining a
dental history of present illness and olso asked
medical history that will help in diagnosis and
treament plan.

12. History of Present illness
 A history of present illness should determine the
severity and urgency of the problem.
 It is procedure in which each complain should be
explained about the origin , progress and
complications
 If the patient complain of pain should asked
when it is started, how it started , type of pain
 Pain is aggrevated during eating and drinking

13. PAST MEDICAL HISTORY
 Medical history is important in planning the
treatment.
 The following questions should be asked from
the patient:
 Whether the patient has any previous systemic
disease
 Whether he/she has hypertention and diabetic
 Under any medication
 Whether he/she has hospitalised
 Any drug allergy

14. Amarican society of
anesthesiologist
classification
 ASA health classification system and suggested
treatment modification
 They described in six groups with treatment
modification

15. ASA PHYSICAL
CLASSIFICATIO
N
DESCRIPTION THERAPY MODIFICATION
ASA 1 A normal healthy patient none
ASA 2 Patient with mild systemic
disease
Possible stress reduction and
other modification as needed
ASA 3 Patient with severe systemic
disease that limit activity ,but is
not incapitating
Possible strict modification
stress reduction medical
consultation priorties
ASA 4 Patient with an incapitating
systemic disease that is constant
threat to life
Minimal emergency care in
office medical emergency
urged
ASA 5 A moribound patient who is not
expected to survive without the
opration
Treatment in the hospital is
limited to life support only for
example airway,hemorrhage
management
ASA 6 a declared brain dead patient
whose organs are being removed
for donor purpose
Not applecable

16. HYPERTENTION
 It is one of the most common medical condition
 Those receiving the mean systolic blood pressure
140mm hg and dystolic pressure 90mm hg they
have hypertention.
 Prior to any dental treatment to check the B.P at
every visit for an invasive dental dental procedure
planned.

17. CLASSIFICATION SYSTOLIC
BLOOD PRESSURE
in mmhg
DIASTOLIC
BLOOD
PRESSURE IN
mmhg
NORMAL < 120 < 80
PREHYPERTENTION 120 - 139 80- 89
STAGE 1
HYPERTENTION
140 - 159 90 - 99
STAGE 2
HYPERTENTION
> 160 <100

18.  NORMAL SBP<120mm hg
DBP<80mm hg
 All dental procedure can do
 prehypertention SBP 120-139mm hg
 Consult the physician routine dental
procedure recommended
 STAGE 1 – HYPERTENTION SBP 140-159
mm hg DSB 90-99 mm hg
 STAGE 2- HYPERTENTION SBP>160mm hg
DSB<100mm hg

19. ISCHEMIC HEART DISEASE
 An impediment to the flow of blood, as in the
case of an artery that has become constricted,
will decrease the perfusion of oxygenated blood
to tissue or organs.When the reduction of
perfusion to the myocardium of the heart is
sufficient enough that the myocardial cells
weaken but do not die, a condition known as
angina.

20. ANGINA
 Treatment for angina pectoris begins with a
thorough review of the medical history.
 Patients who have been diagnosed with stable
angina pectoris usually are aware of the events
that will precipitate an angina attack.The stress
and anxiety that some patients experience during
dental treatment can be one such factor.
.

21. These patients usually have a prescription for
nitroglycerin, either as a sublingual metered
0.4 mg spray or a 0.3 mg sublingual tablet
that dissolves quickly.Therefore, patients
with a known history of angina pectoris
should be asked to bring their own
nitroglycerin tablets to the dental office.
Dentists should have nitroglycerin included in
their emergency kits .

22. ISCHEMIC HEART DISEASE
 When coronary athersclerotic heart disease
become advanced to produced symptoms it is
referred to as ischemic heart disease
 Treatment modification for patient morning
appointment,short appointment,profond LA ,oral
medication with an anxiolytic drug and adequate
pain management.

23. INFECTIVE ENDOCARDITIS
 Dental management requires evalution of the
type of heart condition and risk of bacaterimia
from planned dental procedure.
 Antibiotic prophylaxis should recommended for
patient with valvular heart diseases with highest
risk of patient

24. ANTIBIOTIC PROPHYLAXIS RECOMMENDED
High risk of adverse effects from infective endocarditis
All dental procedure that involve manipulation of gingival tissue
or periapical region of teeth of oral mucosa
Does not include routine LA through non infections through non
infected tissue

25. Standard oral
regimen
Adult 2 g
Children 5o mg
Alternative oral
regimen for patient with
allergic to pencillin
ADULT
2 g clindamycin 1st and 2nd generation
Or 600 mg clindamycin
Or 500mg azithromycin
CHILDREN
50mg/kgcephalexin
20mg clindamycin or 15mg azithromycin
Patilent unable to take oral Adult-2g IV ampicillin
1g IM cefazolin
Children
50mg IM/IV ampicillin
50 mg IM/IV cefazolin
Alternative IM/IV regimen
for patient allergic to
pencilin and unable to take
oral medication
Adult-1g IM cefazolin or 600mg IM/IV clindamycin
Children 500mg/kg IM/IV clindamycin
20mg/kg IM/IV clindamycin 30 minutes before procedure

26. BLEEDING DISORDER
 Prevent the formation of the prothrombin and clot
 Limited oral surgery can perfomed
 Consult physician
 investigate the bleeding time
 Clooting time
 Limited surgical procedure can performed
 Avoidance of periapical surgery because clear field
require for any surgery
 If the patient under anticoagulant discontinuation of
warfarian 2days prior to surgery

27. CARDIAC PACEMAKER
 Disturbance in the normal rate of rhythm of the
heartbeat.

28. CCF
 Inability of heart to pump blood that can involve
one or both ventricles.
 Always consult physician
 do the possible treatment
 Vosoconstrictor should be ovoided
 Chair position should be upright

29. NEWYORK
HEART
ASSOCIATION
CSF
CLASSIFICATION
SIGN AND SYMPTON DENTAL MANAGEMENT
CONSIDERATION
CLASS I No limitation on physical activity Should able to tolerate
routine treatment,stress
reduction protocol as
needed
CLASSII Slight limitation on physical
activity, comfartable, at rest but
may experience fatigue palpation
and dyspanea with ordinary
physical activity
routine dental treament
,stress reduction ,medical
consult
CLASSIII significant limitation of activity Medical consult consider
treatment in hospital
dental clinic
CLASSIV Sympton present at rest Medical consultation
;conservative treatment
nedeed, avoid
vasoconstrictor

30. DIABETES
 It is metabolic disorder,abnormality to
metabolise carbohydrates,protien,or due to
deficiency of insulin.

31.  Dentists should discuss the type of diabetes,
compliance with prescribed medications and dietary
recommendations
 problems with glycemic control, and acute and
chronic complications of the disease with all diabetic
patients before dental treatment begins.
 Consulting a patient's physician before initiation of
dental treatment can dcrease the chance of a
diabetic emergency.
 Diabetes-related emergencies in the dental setting
usually involve hypoglycemia (low blood glucose) or,
less frequently, hyperglycemia (elevated blood
glucose).

32. HYPOGLYCEMIA
 Hypoglycemia occurs most frequently in type 1
diabetics but can also occur in type 2 diabetics.
 When a normal dose of insulin or oral
hypoglycemic agent is taken prior to dental
treatment and the patient eats minimally or not
at all, blood glucose levels can plunge rapidly.
 Symptoms of hypoglycemia can develop rapidly
and include anxiety, skin that is cool and moist,
sweating, confusion.

33.  A glucometer provided by the patient or the
dental staff may be used to measure blood
glucose.
 A conscious hypoglycemic patient may take fruit
juice, regular soda, or a glucose gel that can be
absorbed through the oral mucosa in order to
stabilize the blood glucose level.
 After 15 minutes, the blood glucose should be
rechecked. If it has not returned to an acceptable
level (a concentration higher than 60 mg/dL),
another dose of glucose should be taken and the
levels rechecked in 15 minutes.

34.  . After the level has reached at least 60 mg/dL, a
mixed snack can be provided .
 Any remaining dental treatment should be
rescheduled, and the patient should be referred
to their physician for further evaluation

35. HYPERGLYCEMIA
 hyperglycemia is a less frequent emergency issue
among diabetics
 elevation in blood glucose among diabetics can lead
to an altered mental status, the odor of acetone on
the breath, blurred vision, excessive thirst and hunger,
rapid and deep breathing, cardiac arrhythmias, and in
severe cases, coma.
administration and dosage of insulin that is unique to
the patient's glycemic control goal,
 physician should be contacted and EMS summoned
for appropriate treatment. Monitoring the airway,
breathing, and circulation along with providing
supplemental oxygen as needed may be necessary
until EMS arrives.

36. ASTHMA
 It is chronic inflimatory respiratory disease
 instructed the patient to bring
inhaler(bronchodilator) to each oppointment
 reduced the anxiety and strees of the patient
 Used plain LA
 patient should be in semesupine position
 Avoidance of rubber dam
 Should not prescribed NSAID ‘S

37. RENAL DISEASE
 it is irreversible reduction in the glomerular filteration
rate.
 Dental treatment should performed on nondialysis
days,typically the day after dialysis
 To investigate BT,CT,PCT
 In dialysis patient increased tendency of bleeding
because of heparin due to abnormal function of
platelet
 Antibiotic prophylaxis recommended for all patients
 NSAID’S should be ovoided

38.  If patient under steroids therapy
 Under medication more than 2 weeks
 Double the dosage on the day of treatment
 To prevent adrenal crisis

39. SEIZURES
 Seizures are a rare occurrence in the dental
setting but can occur, and the characteristic
convulsive movements of the limbs may
endanger the patient.
 Epilepsy is a neurologic disease associated with
recurrent, spontaneous seizure activity.
 seizures can occur in patients without a history
of epilepsy for a variety of reasons, including
brain tumors and withdrawal from alcohol,
narcotics, or benzodiazepines.

40. • Dental appointments should only proceed if a
patient has been compliant with prescribed
medication
• .This provides an opportunity to remove any
objects from the mouth that were placed for
dental treatment to prevent aspiration or injury.
• This phase can also provide time to administer
anticonvulsant medications, such as 0.5 to 2 mg
lorazepam sublingually
• Attempting intramuscular injections or the
placement of an intravenous line to administer
anticonvulsant medications can be difficult and
dangerous while the patient is seizing

41. • Nothing, including a bite block or cotton rolls,
should be placed in the mouth once the seizing
activity has begun.
• The patient should remain in a supine position in
the dental chair, and any dental instruments in
the field of operation should be moved away to
protect the patient from injury.
• Breathing is usually unaffected by seizure
activity, but recording vital signs may not be
possible. However, upon conclusion of the
seizures, some patients will be unconscious and
must have an evaluation of their airway,
breathing, and circulation.

42. PREGNANCY
 Only few procedure contraindicated in pregnancy
 safety precaution should be followed
 Appropriate radiograph
 second trimester preferred
 Left lateral position recommended

43. ALLERGY WITH LA
 Allergic reactions can occur upon the
administration of local anesthetics.
 Some patients have allergies to the anesthetic
itself, but some patients will be allergic to sulfite
compounds
 Antioxidants such as sodium metabisulfite or
potassium metabisulfite are used as stabilizers in
local anesthetic solutions that contain
vasoconstrictor.

44. The presence of a documented sulfite allergy or a
history of an allergic-type asthma attack should
prompt the clinician to utilize a local anesthetic
without a vasoconstrictor

45. SYNCOPE
 Vasovagal syncope (or cardioneurogenic
syncope) occurs when an acute decrease in blood
pressure reduces the blood flow and subsequent
oxygen perfusion to the brain.

46. During the treatment patient fainted maintained
respiration and cardiac output and that
cardiopulmonary resuscitation
the use of aromatic ammonia to facilitate return to
consciousness can be used. After regaining
consciousness,
the patient may be too distraught to drive, and
arrangements should be made for
transportation, preferably to a physician's office.

47. EXTRA ORAL EXAMINATION
 The patient must be examined for
asymetric,localised swelling ,changes in colour
 Face
 Jaws
 Lip
 Salivary gland
 Lymph node

48. INTRA ORAL EXAMINATION
 Tongue
 Buccal mucosa
 Palate
 Gingiva
 Floor of the mouth

49.  No. of teeth present
 Carious teeth
 Filling
 Missing
 Occlusion
 Attrition
 Abrasion

50. PULPAL DIAGNOSIS
 INGLE introduced the term pulpalgia ie.pulpal
pain.
 Today this term not been in used,its degree of
severity,pathilogical process it known as
reversible pulpitis and irreversible pulpitis.

51. NORMAL PULP
Pulp is symptom free and normally responsive to
vitality testing

52. Reversible pulpitis
 Based on the subjective and objective findings.
 Increased response to cold,lingering pain
 Causes: incipient caries
root scaling
traumatic brushing

53. IRREVERSIBLE PULPITIS
Pulp no longer capable return to normal
Lingering pain
Causes: dental caries
CHRONIC HYPERPLASTIC PULPITIS
Also known as pulp polyp
Growth of pulp tissue
Seen younger patients

54. PULP NECROSIS
 Complete death dental pulp
 Due to persistance inflammation of pulp
 Very painful
 Causes: infected pulp
trauma
chemical irritation

55. APICAL DIAGNOSIS
 NORMAL PERIAPICALTISSUES
 Teeth with normal periapical tissue
 APICAL PERIODONTITIS
 inflammation in apical periodontium
 Pain on percussion
 On radiograph reveals radiolucency

56. APICAL ABSCESS
 inflammatory reaction to pulpal infection
 Discharge
 Pain
 Seen in radiograph

57. CELLULITIS
 Anather form of abscees
 Invasive microrganism spread diffusely through
connective tissue and facial planes
 Swelling
 Pain

58. s

59. CONCLUSION
 Dental treatment is usually not associated with
the development of acute medical emergencies.
 exacerbations of medical conditions or the
emergence of previously asymptomatic medical
problems can occur at any time during a dental
appointment.
 The stress and anxiety that some patients
associate with dental treatment, especially when
pain control is inadequate, has been a
precipitating factor in many of these cases .

60. Listen to your patient…
the patient will give you
diagnosis
Thanking
you………….