Medical History

General Health

Current health

Single choice

Are you in a good health?
πŸ”˜ Yes
πŸ”˜ No
πŸ”˜ Don't know
note

This question implies the patient's subjective impression of his general health.

Health past year

Single choice

Has there been any change in your general health within the past year?
πŸ”˜ Yes
πŸ”˜ No
πŸ”˜ Don't know
note

Data on the patient's changed health status in the last year can be of great importance in making a dental diagnosis. Certain systemic diseases can be the cause of certain pathological changes in the oral mucosa and hard dental tissues. If yes, what condition was/is being treated?

Health past 5 years

Single choice

Have you had a serious illness, operation or been hospitalised in the past 5 years?
πŸ”˜ Yes > What was the illness or problem? (short text)
πŸ”˜ No
πŸ”˜ Don't know
note

Answer to this question provides a better insight into the patient’s health status in the past. Illnesses that require surgery or treatment in a hospital setting can seriously affect a patient's general health, including oral health. In most cases, serious chronic diseases include long-term use of various drugs and the use of treatments that can cause various side effects on oral tissues long after they are discontinued from regular use.

Allergies

Multiple choice > Short text

Are you allergic or have you had allergic reaction to any of following.
πŸ”˜ None
⬜️ Local anesthetics
⬜️ Aspirin
⬜️ Penicillin or other antibiotic
⬜️ Barbiturates, sedatives or sleeping pills
⬜️ Sulfa drugs
⬜️ Codeine or other narcotics
⬜️ Metals
⬜️ Latex (rubber)
⬜️ Iodine
⬜️ Hay fever/seasonal
⬜️ Animals
⬜️ Food
⬜️ Other > (Short text)
Please describe your reaction. (Short text)
note

Allergic reactions in the oral cavity can occur as a consequence of direct contact of the allergen with the oral mucosa or as an oral manifestation of systemic allergic reactions. oral manifestations of allergic reactions include the appearance of: redness, swelling of the lips and tongue , burning sensation, itching, blisters or ulceration. A local allergic reaction can be caused by a large number of factors such as: food, medications, dental materials, oral hygiene products, etc. Data on previously determined allergic reactions are diagnostically very important in dentistry.

Contact lenses

Single choice

Do you wear contact lenses?
πŸ”˜ Yes
πŸ”˜ No
note

Information on wearing contact lenses is important in the context of certain dental treatments, such as caries removal, root scaling and planning. During these treatments, an aerosol is released, which contains a large amount of bacteria and other microorganisms from the oral cavity. These microorganisms can very easily contaminate the surface of contact lenses and lead to eye infection. Eye dryness occurs in a large number of contact lens wearers. Considering that dry eye can also occur as part of certain syndromes that have an oral manifestation, this information is diagnostically important.

Systemic diseases

Multiple choice > Short text

Have you had any of the following diseases?
πŸ”˜ None
⬜️ Heart murmur
⬜️ Mitral valve prolapse
⬜️ Artificial heart valves
⬜️ Rheumatic fever
⬜️ Angina pectoris
⬜️ Arteriosclerosis
⬜️ Congestive heart failure
⬜️ Coronary artery disease
⬜️ Damaged heart valves
⬜️ Heart attack
⬜️ Low blood pressure
⬜️ High blood pressure
⬜️ Congenital heart defects
⬜️ Pacemaker
⬜️ Rheumatic heart disease
⬜️ Abnormal bleeding
⬜️ Anaemia
⬜️ Hemophilia
⬜️ Leukopenia
⬜️ Thrombocytopenia
⬜️ Thrombophilia
⬜️ AIDS or HIV infection
⬜️ Arthritis
⬜️ Rheumatoid arthritis
⬜️ Systemic lupus erythematosus
⬜️ Other autoimmune diseases > Please specify the type. (short text)
⬜️ Other autoimmune diseases
⬜️ Bronchitis
⬜️ Emphysema
⬜️ Sinusitis
⬜️ Tuberculosis
⬜️ Chest pain upon exertion
⬜️ Chronic pain
⬜️ Diabetes > Please specify the type. (short text)
⬜️ Eating disorder > Please specify the type. (short text)
⬜️ Malnutrition
⬜️ Gastrointestinal disease > Please specify. (short text)
⬜️ Gastroesophageal reflux disease/heartburn
⬜️ Thyroid problems > Please specify the type. (short text)
⬜️ Stroke
⬜️ Glaucoma
⬜️ Hepatitis, jaundice, or liver disease > Please specify the type. (short text)
⬜️ Epilepsy
⬜️ Fainting spells or seizures
⬜️ Neurological disorders
⬜️ Sleep disorders
⬜️ Mental health disorders > Please specify the type. (short text)
⬜️ Recurrent infections > Please specify the type. (short text)
⬜️ Kidney problems > Please specify the type. (short text)
⬜️ Night sweats
⬜️ Osteoporosis
⬜️ Persistent swollen glands in neck
⬜️ Severe headaches/migraines
⬜️ Severe or rapid weight loss
⬜️ Sexually transmitted disease > Please specify. (short text)
⬜️ Excessive urination
⬜️ Cancer > Please specify the type. (short text)
⬜️ Chemotherapy/radiation treatment
Please specify onset, duration, is disease still active... (long text)
note

Heart murmur

The presence of a heart murmur may be of significance in dental patients because it may be an indication of underlying heart disease.Depending on the underlying cause of the heart murmur an antibiotic prophylaxis might be advised prior to the dental treatment. There is no evidence of the oral manifestations of the heart murmur but some oral changes in patients with this condition can be observed due to medications used in treatment of the underlying disease.


Artificial heart valves

In patients with artifical valves an antibiotic prophylaxis might be advised prior to the dental treatment.There is no evidence of the oral manifestations caused by artificial valves. Nevertheless, oral changes might be observed due to medications used in treatment such as blood thinners which can cause abnormal bleeding or petechial bleeding spots on the oral mucosa.


Rheumatic fever

In patients with rheumatic fever an antibiotic prophylaxis might be advised prior to the dental treatment.


Angina pectoris

In patients with angina pactoris, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, etc.


Arteriosclerosis

Arterioslerosis can be associated with higher risk of periodontal disease. Also, oral changes might be observed due to medications used in treatment of the disease. Some of the oral changes include: dry mouth, taste sense alterations, blleding, lichenoid reactions, salivary gland swelling, etc.


Congestive heart failure

In people with congestive heart failure, a pink sputum can be observed if the primary disease is associated with acute pulmonary edema. Otherwise, there is no evidence of the other oral manifestations associated with congestive heart failure. Oral changes might be observed due to medications used in treatment of the disease. Some of the oral changes include:dry mouth,lip and face edema, metallic taste in the mouth, burning sensations in mouth, gingival enlargement, etc.


Coronary artery disease

In patients with coronary artery disease, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth etc.


Damaged heart valves

In some patients with damaged heart valves, an antibiotic prophylactic regimen might be considered prior high - risk dental treatments. In patients with this condition oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth etc.


Heart attack

In some patients with heart attack, an antibiotic prophylactic regimen might be considered prior high - risk dental treatments.

In patients with heart attack oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth etc. Some of these drugs may have potential interactions with vasoconstrictors in local anesthetic.


Low blood pressure

Informations about hypotension are important for dental treatment and diagnosis. Hypotensive patients are prone to sudden drops in blood pressure when getting up abruptly from a dental chair, which should be taken into consideration when it comes to dental treatment.

There is no evidence of the oral manifestations of the low blood pressure, but some oral changes in patients with this condition can be observed due to medications used in treatment of the underlying disease. Medications used to treat hypotension can cause oral side effects: redness of the oral mucosa, dry mouth, and oral candidiasis.


High blood pressure

The oral manifestations of high blood pressure include gingivitis, periodontitis, salivary gland swellingor pain and lichenoid reactions. Also, medication used in treatment of high blood pressure can cause oral side effects such as: redness and swelling of oral mucosa, burning sensations in mouth, metallic taste and other taste disturbances, dry mouth, etc.


Congenital heart defects

In some patients with non repaired congenital heart defects, an antibiotic prophylactic regimen might be considered prior high - risk dental treatments.

In patients with this condition, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth, etc.


Pacemaker

Informations about pacemaker placement are important for dental treatment and diagnosis. Pacemakers are electronic devices sensitive to strong electromagnetic signals. There are possible electromagnetic interferences to pacemakers, due to dental devices such as ultrasonic scalers, electrosurgical unit, ultrasonic bath cleaners, and battery driven light cure composite unit. Although pacemakers of new generation have more protective features than those of past, still precautionary measures should be taken prior to treatment.

Also, in patients with this condition, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth, etc.


Rheumatic heart disease

In patients with rheumatic heart disease, an antibiotic prophylactic regimen should be administered prior high - risk dental treatments. In patients with this condition, oral changes might be observed due to medications used in treatment.

These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth, etc.


Anaemia

Oral manifestations of anaemia include pallor of the oral mucosa,burning sensation of tongue and or lips atrophy of the tongue papillae, angular cheillitis.

In patients with anaemia, oral changes such as tooth discoloration, might be observed due to medications used in treatment.


Abnormal bleeding

Informations about abnormal bleeding and blod clotting disorders are very important for dental treatment and diagnosis. Knowing that a patient has an abnormal bleeding disorder is very important before the dental treatment itself in order to avoid unwanted and prolonged bleeding, since many dental interventions involve bleeding.

Abnormal bleeding disorders also have an impact on oral tissues where petechial hemorrhages and hematomas can be seen, as well as spontaneous gingival hemorrhages. Therefore, this information is diagnostically very important.


Hemophilia

Oral manifestations of hemophilia include bleeding from multiple sites, frequently manifested in the mouth as gingival and post-extraction hemorrhages. Also, oral ulcerations and bleding spots involving lips and often. Informations about this disorder have a significant diagnostic value.


Leukopenia

Oral manifestations of leukopenia include recurrent aphthous stomatitis, recurrent gingivitis, and periodontitis.The periodontal manifestations range from marginal gingivitis to rapidly advancing periodontal bone loss caused by bacterial infection of the supporting dental structures.

In patients with this condition, oral changes might be observed due to medications used in treatment. These medications can cause redness of the oral mucosa and oral candidiasis.


Thrombocytopenia

Oral manifestations of thrombocytopenia include small, single or multiple petechial haemorrhages, ecchymosis and haemorrhagic blisters or spontaneous bleeding. The thrombocytopaenic lesions are usually located on the soft tissues most susceptible to trauma, such as the buccal mucosa, the junction between the hard and soft palate and on the gingiva.


Thrombophilia

In patients with thrombophilia, oral changes might be observed due to medications used in treatment. These medications can cause:gingival bleeding , petechie on the oral mucosa, post- extraction bleeding and often nose bleeds.


AIDS or HIV infection

Oral manifestations of AIDS or HIV inflection include include oral candidiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival redness, necrotizing ulcerative periodontitis, aphtae and ulcerations.


Arthritis

Oral manifestations of arthritis include painful opening and closing mouth, limited mouth opening and periodontal disease.

In patients with arhtritis, oral changes might be observed due to medications used in treatment: dry mouth, redness, swelling of lips and tongue, metallic taste in mouth, oral candidiasis.


Rheumatoid arthritis

Oral manifestations of rheumatoid arthritis include painful opening and closing mouth, limited mouth opening, xerostomia and aphtous ulcerations. In patients with rheumatoid arhtritis, oral changes might be observed due to medications used in treatment: oral ulcerations, gingival bleeding, redness and edema, dry mouth, taste disturbances and oral candidiasis.


Systemic lupus erythematosus

Oral manifestation of this condition include oral ulcerations, honeycomb plaque, raised keratotic plaque, nonspecific erythema, purpura, petechiae, cheilitis, hyposalivation, xerostomia, as well as higher risk of dental caries.

In patients with this condition , oral changes such as oral candidiasis might be observed due to medications used in treatment.


Other autoimmune diseases

A broad spectrum of oral manifestations of autoimmune diseases has been observed. These manifestations include: erythematous and edematous mucosal lesions,erosions, ulcerations, diffuse and severe stomatitis, vesicles, bullous lesions and blisters.

In patients with this autoimmune conditions , oral changes such as oral candidiasis might be observed due to medications used in treatment.


Asthma

Oral manifestations of asthma include dry mouth due to decreased salivary flow, excessive dental calculus, dental caries, periodontitis and geographic tongue. In patients with asthma, oral changes such as oral and pharyngeal candidiasis might be observed due to medications used in treatment.


Bronchitis

Oral manifestations of bronchitis include dry mouth dental calculus, dental caries, periodontal disease and gingival enlargement. In patients with bronchitis, oral changes might be observed due to medications used in treatment: dry mouth, taste disturbances, ulcerations, oral and pharyngeal candidiasis, perioral dermatitis and tongue hyperthrophy.


Emphysema

Oral manifestations of emphysema include dry mouth excessive, dental calculus, dental caries,geographic tongue, periodontal disease and gingival enlargement. In patients with asthma, oral changes might be observed due to medications used in treatment: dry mouth, taste disturbances, ulcerations, oral and pharyngeal candidiasis, perioral dermatitis and tongue hyperthrophy.


Sinusitis

Due to the proximity of maxillary teeth to the maxillary antrum, pain in the maxillary sinus can mimic dental pain. Oral symptoms of sinusitis include sensitivity to percussion of a group of teeh without any obvious dental and periodontal pathology and pain in teeth while patient is descending stairs, jump or runs. In patients with sinusitis, oral changes such as oral and pharyngeal candidiasis might be observed due to medications used in treatment.


Tuberculosis

Oral manifestations of tuberculosis include ulcerations in the posterior part of oral cavity, granulomas , osteomyelitis of the jaws, salivary gland inflammation and enlarged cervical lymph nodes. In patients with tuberculosis, oral changes might be observed due to medications used in treatment:excessive salivation, metallic taste in the mouth, pink saliva, pllor of oral mucoasa and gingival bleeding.


Chest pain upon exertion

Information about chest pain upon exertion is important for dental treatment as well as diagnosis. Chest pain upon exertion is usually associated with cardiovascular and respiratory diseases, so duration of dental treatment as well as the position of the patient in dental chair should be adjusted. Oral lesions found in patients who experience pain upon exertion are usually associated with primary disease and with medications used in the treatment.


Chronic pain

Chronic pain is associated with large number of chronic diseases. There is no specific oral manifestations or chronic pain. Oral lesion found in patient with chronic pain conditions are usually associated with long term use of prescribed analgetics and off the counter painkillers: dry mouth, metallic taste in the mouth, redness or oral mucosa, oral ulcerations, lip and tongue swelling, etc.


Diabetes

Oral manifestations of diabetes include dry mouth, increased rate of dental caries, periodontal disease, especially parodontal and gingival abscesses, burning mouth sindrome, oral lichen, fissured tongue, salivary gland enlargement and delayed found healing.


Eating disorder

Oral manifestations of eating disorders include: dental erosions, increased rate of dental caries, gingivitis and periodontitis, angular cheilitis, inflammatory changes of oral mucosa, mucosal ulcerations and mechanical injuries, burning mouth syndrome and enlarged salivary glands.

Malnutrition

Oral manifestations of malnutrition includea large number of oral pathologies: delayed tooth eruption, structural changes of dental tissue, reduced size of the dental roots, abnormal alveolar bone patterns, gingivitis, angular cheilitis, crcked lips, bad breath, burning mouth syndrome, very rad and painful tongue, pallor of oral mucosa and salivary gland dysfunction.


Gastrointestinal disease

Oral manifestations of gastrointestinal diseases include reccurent aphthae, mucosal tags, labial and facial swelling, taste disturbanceas and multifocal mucosal thickening. In patients with gastrointestinal diseases, oral changes might be observed due to medications used in treatment: licheonid reactions of oral mucosa, dry mouth, loss of taste, erythema multiforme and oral candidiasis.


Gastroesophageal reflux disease/heartburn

Oral manifestations of gastroesophageal reflux disease include bad breath, burning sensations in the mouth, redness of soft palate and uvula, increased salivation, increased rate of dental caries, dental erosions, taste disturbances, and difficulty with swallowing.


Thyroid problems

Oral manifestations of thyroid problems include tooth eruption disturbances, increased rate of dental caries, periodontal disease, oral ulcerations, enlarged tongue, taste disturbances,enlargement of extraglandular thyroid tissue (mainly in the lateral posterior tongue), maxillary or mandibular osteoporosis and burning mouth syndrome.


Stroke

Oral manifestation of stroke include unilateral paralysis of the face, loss of sensation in the oral mucosa, flaccid tongue with multiple folds, difficulty with swallowing, neglect of oral care on the one side of the mouth, increased rate of dental careis and periodontal disease and bad breath. In patients with stroke, oral changes might be observed due to medications used in treatment:dry mouth, metallic taste in the mouth and gingival bleeding.


Glaucoma

There is no specific oral manifestations or glaucoma. Oral lesions found in patient with this condition are usually associated with medications used in treatment such as dry mouth.


Hepatitis, jaundice, or liver disease

Oral manifestations of hepatic diseases include mucosal membrane jaundice, bleeding disorders, petechiae, increased vulnerability to bruising, gingivitis, gingival bleeding bad breath, cheilitis, smooth tongue, dry mouth, crusted perioral rash and salivary gland enlargement. In patients with hepatic diseases, oral changes might be observed due to medications used in treatment:dry mouth, metallic taste in the mouth and oral candidiasis.


Epilepsy

Oral manifestations of epilepsy include mucosal injuries and ulcerations due to biting to the tongue and cheeks, increased rate of dental caries, fractured teeth and temporomandibular joint displacement. In patients with epilepsy, oral changes might be observed due to medications used in treatment of epilepsy such as dry mouth, taste disturbances, gingival enlargement and gingival bleeding.


Fainting spells or seizures

Information about fainting spells or seizures are important for dental treatment as well as diagnosis. Fainting spells or seizures are usually associated with variety of systemic diseases so duration of dental treatment as well as the position of the patient in dental chair should be adjusted. Oral manifestations of these conditions include mucosal injuries and ulcerations due to biting to the tongue of cheeks and dental traumatic injuries.


Neurological disorders

Oral manifestations of neurological disorders include weaknes of facial and masticatory musles, difficulty with swallowing and chewing food, pain in jaws and temporomandibular joint, increased rate of dental caries and periodontal disease. In patients with neurological disorders, oral changes might be observed due to medications used in treatment : dry mouth, taste disturbances, oral candidiasis.


Sleep disorders

Sleep disturbances can be caused by several systemic diseases such as cardiovascular diseases, obesity , neurological and mental health disorders. There is a few oral manifestations of the sleep disorders such as gingivtis and gingival enlargement. Most oral findings are caused by the primary disease. In patients with sleep disorders, oral changes might be observed due to medications used in treatment :dry mouth, taste disturbances, burning mouth syndrome.


Mental health disorders

Oral manifestations of mental health disorders include increased rate of dental caries, poor oral hygiene, dental erosions, ginigvitis, periodontal disease, bruxsism, temporomandibular joint disorders, mechanical injuries of oral mucosa, salivary gland enlargement. In patients with mental health disorders, oral changes might be observed due to medications used in treatment: dry mouth, metallic taste in the mouth, burning mouth syndrome, gingival enlargement and gingival bleeding.


Recurrent infections

Recurrent infection in oral mouth can be bacterial, viral or fungal origin.These infections are often sign of weakened immune system or underlying systemic disease. Oral manifestations of recurrent infections include multiple vesicles on lips and oral mucosa, mucosal erosion and ulcerations, white pathches on mucosa, gingivitis and abscesses.


Kidney problems

Oral manifestations of kidney diseases include pallor of the oral mucosa, petechiae and hemorrhages in the oral cavity, inflammatory changes of the oral mucosa, altered taste sensations, dry mouth, bad breath, gingivitis and white pathches on the oral mucosa. In patients with kidney problems, oral changes might be observed due to medications used in treatment: dry mouth due to decreased salivary flow, gingival enlargement and oral candidiasis.


Night sweats

Night sweats are associated vith a number of systemic diseases: cardiovascular diseases, tuberculosis, diabetes, thyroid diesases etc.

Information about night sweats in combination with oral lesions may indicate the existence of a systemic disease.


Osteoporosis

Oral manifestations of osteoporosis include periodontal disease, alveolar bone loss, tooth mobility and fractures of the jaws. In patients with osteoporosis, oral changes might be observed due to medications used in treatment: metallis taste in mouth, swelling of tongue and lips, dry mouth, medication induced osteonecrosis of the jaws, etc.


Persistent swollen glands in neck

Persistent swollen glands in neck can be caused by various diseases associated with oral tissues as well as systemic diseases. Swelling of the lymph nodes in neck can be caused by dental conditions such as dental abscess, bacterial and viral infections of the oral cavity and throat. Also, swelling of the neck lymph nodes can be sign of very serious condition so, so knowing about this condition is of great importance for the diagnosis.


Severe headaches/migraines

Severe headaches can be caused by conditions associated with oral cavity such as dental conditions and temporomandibular joint disorders. In patients with severe headaches/ migraines, oral changes might be observed due to medications used in treatment: dry mouth, and taste disturbances.


Severe or rapid weight loss

Information about severe or rapid weight loss is of great importance in diagnosis. Severe weight loss in combination with oral findings and information about night sweats and swollen lymph glands can be a sign of serious illness.


Sexually transmitted disease

Oral manifestations of sexually ransmitted disease include erosions and ulcerations of the oral mucosa,tongue and throat, vesicles on lips and oral mucosa, papillomas or warts.

In patients with sexually transimtted disease,, oral changes might be observed due to medications used in treatment: dry mouth, taste disturbances and fungal infection.


Excessive urination

There is no specific oral manifestation of excessive urination except dry mouth. Excessive urination can be a symptom of underlying systemic disease , so this finding is very important in diagnosis, especially in case of some specific findings in the oral cavity.

Excessive urination can be a symptom of a known systemic disease such as kidney disease or endocrine disorder, or can be a side effect of some medications, for example diuretics.


Cancer

Oral manifestation of cancer include variety of symptoms , depending of the type of the cancer: pallor of the oral mucosa, gingival bleeding, petechiae and hemorrhages in the oral cavity, dry mouth, ulcerations of the oral mucosa, bacterial , viral and fungal infections,increased rate of dental caries and periodontal disease.

In patients with cancer, oral changes might be observed due to medications used in treatment.


Chemotherapy/radiation treatment

Oral manifestations of chemotherapy and radiation treatment include variety of oral lesions: sever inflamation of oral mucosa, redness of the oral mucosa and thorat, dry mouth, metallic taste in the mouth, taste disturbances, mucosal ulcerations, severe dental caries, gingivitis, gingival bleeding, periodontal disease,lichenoid reacions and. osteoradionecrosis.

Other conditions

Single choice > short text

Do you have any disease, condition, or problem, not listed above?
πŸ”˜ Yes > Please specify. (short text)
πŸ”˜ No
πŸ”˜ Don't know
note

The questionnaire contains a list of the most common diseases. If you have a disease that is not listed in the questionnaire, write the name of the disease, the onset of the disease, duration, and whether the disease is still active.

Medical Care

Physician care

Single choice

Are you under care of a physician?
πŸ”˜ Yes
πŸ”˜ No
πŸ”˜ Don't know
note

We ask this question because we want to know are you being treated by a primary care or family doctor for some kind chronic illness or for regular check-ups

Last physical exam

Date πŸ“† (MM.YYYY)

Date of last physical exam.
note

This question involves entering the date of the last medical examination by the family physician or specialist. If the patient does not remember the exact date, he can enter the approximate date of the examination.

Prescription medicine

Single choice > Short text

Are you taking or have you recently taken any prescription or over the counter medicine?
πŸ”˜ Yes > Please list all. Iincluding vitamins, natural or herbal preparations and/or diet supplements. (short text)
πŸ”˜ No
πŸ”˜ Don't know
note

A wide range of prescription and over the counter drugs can cause various oral side effects (e.g. dry mouth, redness of the mucosa, altered taste, swelling of the lips or tongue, etc.). This information can be of great importance in diagnosing various dental conditions.

Diet drugs

Multiple choice

Are you taking, or have you taken, any of these diet drugs?
⬜️ Pondimine (phenylfuramine)
⬜️ Redux (dexfenfluramine)
⬜️ Phen-fen (fenfluramine-phentermine combination)
πŸ”˜ No
πŸ”˜ I don't know
note

These diet medications are used as appetite suppressants. Cardiotoxicity has been demonstrated for these drugs, which has led to permanent damage to the heart valves in a significant number of patients. For this reason, prior to the dental treatment of these patients, antibiotic prophylaxis is required. These medications have oral side effects such as dysgeusia or metallic taste in the mouth, dry mouth, and prolonged paraesthesia, which may be important for the diagnosis of oral diseases.

Bisphosphonates

Multiple choice

Are you taking or scheduled to begin any of these medications?
⬜️ Alendronate (Fosamax)
⬜️ Risedronate (Actonel) for Osteoporosis or Pagets disease
πŸ”˜ No
πŸ”˜ I don't know
note

Alendronate (Fosamax) are Risedronate (Actonel) are bisphosphonates, drugs used in treatment of osteoporosis, Paget's disease and in treatment and prevention of bone metastases of various malignant tumors.
These drugs have a serious side effect: osteoinecrosis of the jaw, which is manifested by exposed bone in the oral cavity, inflammation and pain. Osteonecrosis most often occurs after tooth extraction, but it can also occur spontaneously.
Information on the use of these drugs is very important in distinguishing this disease from other diseases with similar symptoms but a completely different cause: osteoradionecrosis and osteomyelitis.

Intravenous bisphosphonates

Single choice > Date πŸ“† (MM.YYYY)

Since 2001, were you treated or are you scheduled to begin treatment with intravenous bisphosphonates (Aredia or Zometa)?
πŸ”˜ Yes > When did you begin the treatment? (date)
πŸ”˜ No
πŸ”˜ Don't know
note

The start of bisphosphonate treatment and the duration of treatment are very important, as it has been proven that these drugs remain in the bones for at least 12 years, which means that they can cause side effects on the jaws long after stopping their use. The intravenous bisphosphonates (Aredia or Zometa) for bone pain, hypercalcemia, or skeletal complications resulting from Paget’s disease, multiple myeloma, osteoporosis or metastatic cancer?

Joint replacement

Single choice > Date > Short text

Have you had an orthopedic total joint (hip, knee, elbow, finger) replacement?
πŸ”˜ Yes > When was that? (Date)
> Have you had any complications?
πŸ”˜ Yes > Please describe complications. (Short text)
πŸ”˜ No
πŸ”˜ No
note

Patients with history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manifulation or local incision, prophylactic antibiotic regimen should be considered in consultation with orthopeadic surgeon. During bloody dental interventions, the patient is at risk for bacteria in the mouth entering the bloodstream which can infect artificial joints. After joint replacement patients very often use various medications, for extended period of time such as strong prescribed analgetics or over the counter painkillers. Prolonged usege of these medications can cause oral side effects such as: dry mouth, redness or taste disturbances, which is diagnostically important. If yes, when was that? Have you had any complications? Please describe complications.

Habits

Drugs use

Single choice > Short text

Do you use controlled substances (drugs)?
πŸ”˜ Yes > Please specify the substances. (short text)
πŸ”˜ No
note

Oral health problems are among the most prevalent health problems associated with drug consumption. .These problems may result from direct exposure of oral tissues to drugs during smoking or ingestion, biologic interaction of drugs with normal physiology of oral cavity, and effects of drugs on brain function which result in a spectrum of addictive behaviors such as risk-taking behavior, poor hygiene, aggression, and carelessness. A broad spectrum of oral disaseses are associated with druge use : generalised tooth decay, dry mouth, mucosal infections, severe periodontal disease, candidiasis excessive tooth wear, bruxsism, palate perforation,tooth loss and oral cancer, so data on controlled substances usage is very important in diagnosis.

Tobacco use

Single choice

Do you use tobacco (smoking, snuff, chew, bidis)?
πŸ”˜ Yes
πŸ”˜ No
note

Tobacco has chemical and termal effects on oral tissues. The use of tobacco products has been associated with various lesions in oral cavity: teeth staining, dental abrasions, smoker’s melanosis, acute necrotizing ulcerative gingivitis and other periodontal conditions, burns and keratotic patches, black hairy tongue, nicotinic stomatitis, palatal erosions, leukoplakia, epithelial dysplasia and squamous-cell carcinoma.

Alcohol use

Single choice > Short text

Do you drink alcoholic beverages?
πŸ”˜ Yes > How much do you typically drink in a week? (short text)
πŸ”˜ No
note

The consumption of the alchoholic beverages has been associatedvith different lesions in teh oral cavity such as dry mouth, dental caries, periodontitis, erosive tooth wear, candidiasis, mucosal lesions and oral cancer. If yes, how much do you typically drink in a week?

Sugary drinks

Single choice

Do you drink fizzy drinks or sweetened beverages?
πŸ”˜ No
πŸ”˜ Rarely
πŸ”˜ 1-2 times a week
πŸ”˜ 3-4 times a week
πŸ”˜ Daily
note

The consumption of the fizzy drinks or sweetened beverages has been asociated with severe dental caries and erosive tooth wear.

Sugary foods

Single choice

Do you eat sweets or sugary foods?
πŸ”˜ No
πŸ”˜ Rarely
πŸ”˜ 1-2 times a week
πŸ”˜ 3-4 times a week
πŸ”˜ Daily
note

Frequent consumption of sweets and sugary foods has been associated with lerger number of decayed teeth. Information on sweets and sugary food intake is very important in caries risk assesment.