1st diagnosis lec _ introduction

7/27/2019 1st diagnosis Lec _ Introduction

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Dr.Sundos abu-zaid

Dr.Aceil AlKhatib

23 / 9 / 2013

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Lecture title : INTRODUCTION

* In this course we will learn:

-how to obtain and import the chief complaint of the patient

-how to obtain medical and dental history

-how to ask questions

-how to interview a patient

-how to use the vital signs including (pulse rate and respiratory

rate and blood pressure)

-how to do extra and intra oral examination

-how to perform cranial nerves

-how to examines these nerves because its a very important

major in FDF examinations

-how to perform routine diagnostic tests

-how to chart teeth and how to report findings

-how to plan the treatment into phases especially in multi

caries teeth

Learning Objectives

Conduct a patient interview, and obtain medical, dental, and

psychosocial histories( in some cases the psychosocial history is

the most important however in certain cases its the medical

history is , and we will learnt how to differentiate between the

importance in each case.


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Understand the significance of certain medical histories

including medications use

Perform a routine extra oral examination, including cranial

nerves and TMJ Perform routine diagnostic tests

AssessmentFirst Semester (40 marks): Midterm online exam: Theory: 20

MCQs. Clinical: 20 MCQs.

Remember (memorization is important)

Second Semester (60 marks): Clinical assessment: 20 marks +

Final online MCQ exam: Theory: 20 MCQs. Clinical: 20 MCQs

**In the first semester you are going to work in each other in

the practical course and in the second semester you are goingto work with real patients.**

- The doctor interviewed the syllabus for us , hopefully you find

it later on elearning.


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Now the lecture begins :

You know that your first mission to do in you clinic is

interveiwning the (The introductory phase/First phase ) By :

Greet the patient by name and take an initial briefing Introduce yourself and establish a rapport with the

patient, be sure to inspire confidence in the patient by

appearing self confident and making eye contact,

(shaking hands with the patient is optional in this society

especially between Males & Females, as well as a source

of cross-contamination- so Handshakes is not arequirement).

You can use introductory comments (small talk) such asthe traffic, weather, recent events etc.

Avoid using dental terminology when discussing thingswith the patient, use common easily understandable

language.

Record the patients first statement as it may be relatedto the chief complaint which very important .

Record or check biographical data(gender.address.occupation)

Listening to the patients account/ Second phase :

ask the patient a useful question as : how can I help youand do not interrupt the patient .

Record the chief complaint in the patients own words ,use the same exact words of the patient but in English

Record the symptoms in order of severity (symptomtaking is guided by asking the patient questions).


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Relate the chief complaint with the patients initialstatement .

Structured questioning/ Third phase :

History of chief complaint

Medical history Previous dental history Family history Social history, and you have to record what you are going

to do in the two following weeks .

** During the initial meeting and information gathering fromthe patient gloves should NOT be worn; but as soon as you

begin to examine the patient (with your hands) you must start

to take the infection control measures. Use universal

precaution measures for all bodily fluids (saliva,

nasal droplets, and blood) and assume that all patients are

Hepatitis and HIV positive.

** Cross Contamination has a specific pathway which may

involve shaking hands with an infected patient writing on the

file with contaminated hands file contamination, and may

end up at your home.

" Therefore you should always follow the infection control

guidelines, and keep in mind that washing hands is THE most

important factor in illuminating cross infection and diseasetransmission. "

- They first discovered the importance of hand washing inBritain in 80's when the first medical schools were opened;

they noticed that women who gave birth under Medical

students had a much higher risk of dying than Women who

gave birth under a Mid Wife, the reason being that mid wivesalways consistently washed their hands.


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-When should you wash your hands:

Hands must be cleaned before and after treating each patient

After handling contaminated items, after blowing your nose or

Using the toilet, and before eating or handling food and any

time your hands are visibly contaminated.

**Any incident that occurs that leads you to suspect

contamination of your hands requires that you wash your

hands.

**If you have lesions on your hand (oozing or non-oozing- ex:

herpetic whitlow) any contact with patients should be avoided

until the lesions have healed.

FingernailsFingernails should be kept short and trimmed

Long natural or artificial nails should be avoided

Freshly applied nail polish on short nails is acceptable

Chipped nail polish should be avoided

** Always remember that you should :

Use gloves, masks, protective eyewear or face shields and

protective clothing, however Protective eyewear is not

required in the Oral Diagnosis clinic since we dont use any

vibrating/ultra-sonic devices .

The mask should be changed whenever it becomes

contaminated , wet or touched with hands

Using extreme caution when passing sharps during four-

handed dentistry.


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- In the Oral Diagnosis clinic the only sharp instruments you

will use are the probe and occasionally a syringe for aspiration,

but you must take safety measure while dealing with these and

be careful not to cut yourself, your assistant or the patient. Any

Needle stick injury should follow the guidelines available in the

clinic; you must document the incident and record the hepatitis

& HIV status of both the patient and the dentist .

Gloving

Wearing gloves reduces contamination of the hands by florathat can be transmitted from one patient to another, dentists

only started wearing gloves in the early 90s.

The same pair of gloves should not be worn for the care of

more than one patient.

Gloves should not be washed or reused.

Gloves should be removed after caring for a patient.

Dental RecordThe dental record is the file that records everything that is

related to the patient, including any communication,

compliance, advice, radiographs, lab exams, drug prescriptions

s and the detailed document of the history of the illness,

physical examination, diagnosis, treatment, and management

of a patient and all patient-related communications .

Now most clinics are starting to use electronic dental records

for easier access and faster retrieval, but the clinic in Irbid still

uses paper records. These records should be in a place easily

accessible by the dental staff; but not accessible by anyone else

in order to protect the confidentiality of the patients.


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Dental records are very important for several reasons:

Evidence (corpse identification), Legal Implications for

insurance and mal-practice suits(double checking if the

procedure you carried out is the same that the patient

wanted).

The dental record contains the patients information,

medical history, medication, clinical examination, teeth

charting, new diagnosis, treatment plan and documentation of

informed consent (informed consent involves informing the

patient of all complications and possible results of an operation

that you will perform).

Note :

due to the very bad record of this lecture , I referred back to

2009's script and the slides , dont worry both lectures are

almost the same , Sorry for any mistakes found .

Sundos Abu-Zaid

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1st diagnosis lec _ introduction

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