History Taking

History taking involves obtaining information about the accident in chronologic order to determine what effect it has had on the patient. It is important to know if there has been any treatment before this examination. The patient needs to be questioned about previous injuries involving the same area.

The following questions need to be asked:

1) History: While taking history you must take care of the following points:

a) When did the accident happen? — Record the time and date as closely as the patient can recall. The time elapsed since injury can seriously affect the prognosis as in case of avulsion.

b) How did it happen? — This question provides information on the nature of injury for e.g, blunt or sharp object, direct or indirect blow, all of which will have a bearing on the injury. They also help predict if there could be any concomitant injuries.

c) Where did it happen? — Note the location, for example, car accident, cricket pitch, basketball court etc.

d) Previous injury or treatment. — Prior treatment affects both the treatment plan and the prognosis. If the tooth was avulsed, was it replanted immediately or how soon after the accident? These questions

can provide clues about the standard and quality of emergency care.

e) Have you had similar injuries before? — Repeated injuries to teeth affect the pulps and their ability to recover from trauma, which could alter the treatment plan.

2) General Conditions

Medical history should be enquired about. This is required to detect medical conditions as well as medications given to the patient. It may also be required to provide prophylactic antibiotic therapy for patients at risk. Was the patient conscious? Is there a history of amnesia? - Signs and symptoms to watch for are dizziness; vomiting; severe headaches; seizures or convulsions; blurred vision; unconsciousness; loss of smell, taste, hearing, sight or balance; or bleeding from the nose or ears. Affirmative response to any of the above indicates the need for emergency medical evaluation.

3) Chief Complaint

When diagnosing the origins of pain, most of the diagnosis should be done by what we hear and not what we see. In fact, visual clues might throw us off track resulting in incorrect diagnosis. Once a comprehensive history has been taken the practitioner should in most cases know the diagnosis of the problem.

The clinical examination and diagnostic tests should then be done to ascertain which tooth fits this diagnostic category. The primary goal of the diagnostic procedure is to evaluate whether the disease process is reversible or irreversible, which in turn has a bearing on treatment planning.

Listening carefully to the patient’s description of his/her symptoms can provide invaluable information. It is quicker and more efficient to ask patients specific, but not leading, questions about their pain.

The following questions are absolutely critical

1) How long have you had the pain?

2) Do you know which tooth it is?

3) Does anything initiate the pain or is it spontaneous?

4) How would you describe the pain?

• Sharp or dull
• Throbbing
• Mild or severe
• Localised or radiating

5) How long does the pain last?

6) Does it hurt most during the day or night?

7) Does anything relieve the pain?

8) Does a change in posture modify the intensity of the pain?

9) Does the pain respond to pain medication?

It is usually possible to decide, as a result of questioning the patient, whether the pain is of pulpal, periapical or periodontal origin, or if it is non-dental in origin.

In early pulpitis the patient often cannot localise the pain to a particular tooth or jaw because the pulp does not contain any proprioceptive nerve endings. As the disease advances and the periapical region becomes involved, the tooth will become tender and the proprioceptive nerve endings in the periodontal ligament are stimulated. In cases of pulpitis, the decision the operator must make is whether the pulpal inflammation is reversible, in which case it may be treated conservatively, or irreversible, in which case either the pulp or the tooth must be removed, depending upon the patient’s wishes.

If symptoms arise spontaneously, without stimulus, or continue for more than a few seconds after a stimulus is withdrawn, the pulp may be deemed to be irreversibly damaged. Applications of sedative dressings may relieve the pain, but the pulp will continue to degenerate until root canal treatment becomes necessary. This may then prove more difficult over time, if either the root canals have become infected or if sclerosis of the root canal system has occurred. The correct diagnosis, once made, must be adhered to with the appropriate treatment.