Despite the fact that dentists are primarily concerned with the areas around, and in the mouth, the mouth is a part of the body. The medication that a patient has and any other health problems can, and usually are interrelated to the dentistry care that they may be provided. Cosmetic dentistry serves little functional value to the patient, which is why it must only be carried through if it does not cause, or exacerbate the patient’s health problems (U.S. Department of Health and Human Services, 2004). Accurate recording and evaluation of the patient’s medical history is important in determining not only the suitability of the patient’s suitability for the varied procedures, but also in determining the care that would be subsequently offered.
The important medical history information, usually included in the Medical History Form include whether the patients are under physician care, have ever had major operations or been hospitalized, had serious neck or head injuries or are under any drugs, pills and medications. Further, it is important to determine if the patient has ever taken Redux, Phen-Fen, special diets, tobacco or any other controlled substances. The patient’s indications towards certain pain medications and other drugs that are used in the procedure and management of the patient is also crucial (Newton Cosmetic Dentistry, 2011). Effectively, the doctor must determine if the patient is allergic to aspirin, acrylic, penicillin, latex, metal, local anaesthetics and codeine. All the patient history responses must be accompanied by a fairly detailed explanation of the nature of the conditions, in order to facilitate accurate decision-making on whether the procedure should be performed at all, and how it should be managed.
In addition, certain medical conditions and diseases involve the administration of drugs that have contraindications against the pain medications etc, which may be used during the procedure and further management of the cosmetic dentistry patient. Other diseases and/or their treatments have physiological effects etc that may results in the impairment of organ and bodily functions as well as the immune system, which in turn affect the nature of the drugs may be used if at all (Newton Cosmetic Dentistry, 2011). These diseases include HIV/AIDS, anaphylaxis, Alzheimer’s disease, arthritis, angina, anaemia, artificial heart valve, asthma, breathing problems and glaucoma. In addition, patients with blood diseases; received blood; bruise easily; have cancer or are undergoing cancer treatments should clearly indicate in the patient history form, along with any other information that may help the dentist make an accurate decision. Other diseases include congenital heart disorder, fever blisters, chest pains, convulsions, diabetes, cortisone medicine, diabetes, epilepsy, genital herpes, cardiac complications, haemophilia, Hepatitis A, B and or C, lung diseases, hypoglycaemia, tuberculosis, sickle cell anaemia and kidney problems. The patient should also provide information about lifestyle and behavioural factors that may affect the nature of the medication as well as the effectiveness of varied treatments. These factors include drug use, sedentary lifestyles, the nutritional content of foods commonly eaten, the nature of the patient’s occupation, sleeping times and duration, community and family among others.
The patient history is critical to the dentist’s decision-making especially in regard to the contraindications to the placement of dental implants and other cosmetic dentistry conditions. Contraindications include heart problems that affect valves, recent infarcts and serious cardiac insufficiency or Cardiomyopathy (The European Society of Cardiology, 2008). Other factors that would completely preclude cosmetic dentistry procedures include active cancer, chemotherapy, bone diseases and a variety of immunological diseases including HIV/AIDS as well as the use of immunosuppressant medications especially associated organ transplantations. Some mental illnesses, strong radiation of jawbones, bisphosphonate treatments for osteoporosis and other complications arising from buccal surgery may also preclude a patient from cosmetic surgery. In addition, age is an important consideration, with children whose jawbones are still growing (below the age of 19) being precluded in common with elderly patients whose health condition is shaky.
Relative contraindications, which may also preclude the patient from cosmetic surgery include insulin-dependent diabetes, angina pectoris/angina, seropositivity, significant tobacco use, a range of mental diseases, serious clenching or teeth grinding, alcohol and drug dependency, pregnancy. Others include autoimmune diseases, neighbouring teeth infections and radiotherapy around the face and neck. There are equally serious localized contraindications, which must be taken into consideration. These include insufficient bone quantity, mucous membranes infection, periodontal diseases that cause loosening of teeth and poor oral hygiene.
The severity of the diseases and other medical conditions differs from one patient to another, and it is important that as much attention is paid to the specific patient’s medical history. Patients’ with absolute contraindications must be excluded from cosmetic dentistry. Relative contraindications are perhaps the most difficult to manage, not least because the patients may qualify for cosmetic dentistry, but present the highest probability of complications. Complications may include severe pain, failed procedures, reduce effectiveness of drugs and even development of further health complications. Effectively, it is important that contraindicative patients are adequately advised on the risks of cosmetic dentistry procedures and management. Equally importantly, patients who are allergic to important pain relief medications may equally be excluded because of the excruciating pain involved with major procedures. Effectively, whether or not patients would qualify for the procedure depends on the availability of effective pain and other treatments to which the patient is not allergic.
Healthy patients i.e. those with the least health problems or risky lifestyles are the best candidates for cosmetic dentistry. Perhaps the biggest problem lies in the need to ensure that any drugs used during the procedure and subsequent management is ensuring that the drugs used are not contraindicative with any other medications that the patient may be already under, or may need in the near future (The European Society of Cardiology, 2008). This involves the examinations of all the medications that the patient is under for contraindications etc, and if there are significant problems with the drugs that may be used in the management of the patient, then the patient should also be advised accordingly, and precluded. This similarly applies to patients who are at risk of suffering diseases or other medical conditions that are contraindicative to cosmetic surgery or to the drugs that may be used to manage them. These include risk factors to heart diseases and diabetes etc. The most important factor is to ensure all necessary patient history is covered, properly evaluated facilitate accurate decision-making and advise to the patient.
Newton Cosmetic Dentistry. (2011). Patient History. New York: Newton Cosmetic Dentistry.
The European Society of Cardiology. (2008). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. European Heart Journal 29 , 2909–2945.
U.S. Department of Health and Human Services. (2004). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.