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Medical/developmental review/interview

Martha Ann Keels, DDS, PhD

In order to provide safe, effective, and compassionate care for patients with a developmental disorder (DD), one must carefully ascertain their medical history (Balzer 2007; Crall 2007; Dougherty & MacRae 2006).

Whether a paper charting system or an electronic health record is used, one must ensure that the content of the medical questionnaire is comprehensive and addresses a potentially complex medical history. A separate surgical history form may be indicated to help the parent/caregiver record this data. Having the parent/caregiver complete the medical history prior to the appointment is time saving. Also having access to the patient’s electronic medical health record is ideal. This allows the dentist to validate the information given as well as to ensure critical information was not overlooked. Having the staff who schedule the appointments determine if a new patient has a specific diagnosis (i.e., Hurler’s syndrome, Rett syndrome) is very helpful, as it affords the dentist adequate time to review any materials regarding that condition prior to meeting the patient. Prior review of the medical history by the dentist will allow sufficient time to then educate the dental staff on any special precautions that should be taken with the patient. Useful websites to access information on developmental disorders include PubMed and OMIM (Online Mendelian Inheritance in Man).

It is important to collect a complete medical history in order to guide one’s decision on how to best clinically examine the patient with a developmental disorder. Sometimes it is best to leave the patient in their wheelchair or sitting on the clinic floor, wherever the patient is most comfortable, while the parent/caregiver is being interviewed. This allows the parent to focus on the discussion with the dentist. The medical history will also guide one’s treatment planning decisions on the urgency and extensiveness of dental care needed given the patient’s quality of life and expected longevity (Glassman & Subar 2009). Decisions regarding whether to treat the patient in an outpatient clinic setting or in a hospital setting as well as the need for protective stabilization, sedation, or general anesthesia will also be influenced by the information obtained from the medical history (Waldman et al. 2009). This chapter will highlight areas of the medical history that may be unique to a patient with a developmental disorder.

MEDICAL INFORMATION

The medical history form should enable the dentist to easily ascertain the overall diagnosis and any secondary conditions. Examples may be the child has Down syndrome and secondary conditions of an atrial septal heart defect and autism; a child with cerebral palsy and secondary conditions of a seizure disorder and gastroesophageal reflux; a child with spina bifida and secondary conditions of a latex allergy and a chiari malformation. Table 3.1 provides a comprehensive outline to guide the intake of a medical history. Table 3.2 contains a list of the medical conditions that should be listed in a medical history intake form for a patient with DD (AAPD 2010–2011). Table 3.3 provides a list of common DDs with their potential comorbidities. Patients with DD frequently have had multiple surgeries. Therefore, providing the parents or caregivers with a form that allows them to list these surgical procedures is helpful. Table 3.4 contains a sample surgical history. The documented medical history will guide the dentist in the direction of important verbal questioning. An example of this would be noting the patient has whiplash shaken infant syndrome and then following up with questions regarding the child’s aspiration risk and ability to see and inquiring if the child has an oral facial aversion.

Table 3.1 Medical history intake outline (adapted from AAPD 2011/2012).

Table 3.2 Outline of medical conditions.

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