Why does my dentist ask so much about my health?

I consider myself very lucky to have attended one of the best educational institutions in the world, Columbia University in NYC. At Columbia we took the first 2 years of medical school side by side with the med students, aside from a handful of courses. This was on top of our preclinical dental curriculum! Those were two very hard, tiring years.

Knowing our patient’s medical history was therefore ingrained in us from day one; regardless of if it was radiology, a scaling and root planing, or a dental extraction, we had to know the conditions and medications, and their implications to care. There were no exceptions.

This is how I continue to practice.

The first conversation I have with a patient (after asking what brought them to the office) is to review their medical history and medications. Many of my patients wonder why I am paying so much attention to this if all they want is a dental cleaning.

There are the obvious reasons why dentists pay attention to your health:

-diabetes is associated with poor healing

-bone medications can result in jaw necrosis after dental surgery

-some heart conditions require antibiotic premedication

-we need to know if someone has allergies, or has had a heart attack or stroke.

I even ask about natural remedies and supplements because they can affect clotting or drug metabolism.

Having a thorough conversation with someone about their health also allows me to get a better understanding of what kind of rapport I can build with the patient, and permits me to see what kind of potential challenges lie ahead to having them make positive changes to their health patterns.

This conversation matters

If someone is not able to recall their health conditions, or medications, perhaps we need to take a more simplified approach to explain the dental findings, diagnoses and options. Someone who knows the mechanism of action and dosage of the drugs may want more of a detailed explanation. I feel like some of my patients leave here with a year's worth of dental lectures to outline a simple dental filling procedure.

We have plenty of patients who are on natural medications and look towards "non-western" therapies. Will we have trouble recommending fluoride, or x-rays? Are they going to seek alternative options to our recommendations? Essential oils are not going to treat severe periodontal disease, but we have had people refuse our recommendations and try to cure things themselves.

A big one for me is whether or not someone is taking ownership of their health. It is a big difference when someone says "My dentist drilled too far and killed the nerve", versus "I had significant tooth decay and my dentist recommended a root canal". It is much harder to help someone make changes in their life if they do not own their problems and their solutions.

So much of what we do as health care providers revolves around trying to encourage positive behaviour changes, and we know how hard it is to do. We see it with smoking, alcohol and obesity; these are all conditions that can be improved by lifestyle changes. In dentistry, even though we try and try to get people to brush and floss every day, it doesn't always happen. And sadly, some parents don’t give their kids fluoride and refuse to let us take x-rays to check for tooth decay. What we do in the office will not succeed if healthy patterns are not established for the other 363 days of the year.

You can see why it is important to have a good chat with someone to find out more about how they manage their general health. Engaging in a conversation about someone’s health is more than finding out their history; it is about finding out how we can help improve their lives moving forward.

Oral health is part of your general health, why wouldn’t we care, right?

Thanks for reading,

Dr. Dave