The Art of Practice Management's Dental Pearls
The Art of Practice Management
A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.
Marianne Harper How long has it been since you began using your current health history questionnaire? Has it been the same form since the opening of your practice? Have you taken a good look at it to evaluate if it has kept up with the times? These questions need to be considered, as your questionnaire may be obsolete.

We are all well aware of the medical advances  made  over  the  last
decade. As far as dentistry is concerned, there has been on-going research into the systemic link. Although this link has not been proven, the association between the mouth and the body has been. This alone gives us reason to re-evaluate our medical history questionnaires.

It is likely that patients are apt to see their dentists more frequently than their primary care physicians. With our recare system based most often on visits of no more than six months apart, we have the greater opportunity to spot a medical problem. If we spot signs of disease through visual exams or through reading the responses on the patientsí health history questionnaires, we can recommend that the patient see his or her primary care physician. We can truly play a very important role in our patientsí overall health.

The American Dental Association suggests that the medical history form should begin with basic questions about how the patient perceives his or her health status. If your form does not ask these questions, they need to be added:
  • Are you in good health
  • When was your last physical exam
  • Are you under the care of a physician and for what condition(s)
  • Have you had any serious illnesses or operations and ask for details on this
  • Have you been hospitalized within the last five years
I then suggest that the form become much more detailed to include the following:

Do you have, or have you had any of the following diseases or problems?

a. Damaged heart valves or artificial heart valves, including heart murmur Yes  No
b. Congenital heart lesions Yes  No
c. Cardiovascular disease (heart trouble, heart attack, coronary insufficiency,     coronary occlusion, high blood pressure, arteriosclerosis, stroke) Yes  No
      1. Do you have pain in the chest upon exertion? Yes  No
      2. Are you ever short of breath after mild exertion? Yes  No
      3. Do your ankles swell? Yes  No
      4. Do you get short of breath when you lie down or do you require extra pillows           during sleep? Yes  No
      5. Do you have a cardiac pacemaker? Yes  No
d. Allergy Yes  No
e. Sinus trouble Yes  No
f. Asthma or hay fever Yes  No
g. Hives or skin rash Yes  No
h. Fainting spells or seizures Yes  No
i. Diabetes Yes  No
      1. Do you have to urinate (pass water more than six times a day?) Yes  No
      2. Are you thirsty much of the time? Yes  No
      3. Does your mouth frequently become dry? Yes  No
j. Hepatitis, jaundice or liver disease Yes  No
k. Arthritis Yes  No
l. Inflammatory rheumatism (painful swollen joints) Yes  No
m. Stomach ulcers Yes  No
n. Kidney trouble Yes  No
o. Tuberculosis Yes  No
p. Do you have persistent cough or cough up blood? Yes  No
q. Low blood pressure Yes  No
r. Venereal disease Yes  No
s. Epilepsy Yes  No
t. Psychiatric problems Yes  No
u. Cancer Yes  No
v. AIDS or other immunosuppressive disorders Yes  No
w. Other _____________________________________________________________  
Have you had abnormal bleeding associated with previous extractions, surgery or trauma? Yes  No
      a. Do you bleed easily? Yes  No
      b. Have you ever required a blood transfusion? Yes  No
          If so, explain circumstances _________________________________________  
Do you have any respiratory disorders such as asthma? Yes  No
Have you had surgery, x-ray or drug treatment for a tumor, growth, or  condition of head or neck?  Yes  No
As we are all aware, the medications that patients take impacts their health both as its intended purpose but also in the form of side-effects. Some of these medications have been proven to cause problems with a patientís oral health. The following section addresses both prescribed medications and over the counter medications:
Are you taking any drugs or medicine? Yes  No
   If so, what? ________________________________________________________  
Are you taking any of the following
      a. Antibiotics or sulfa drugs Yes  No
      b. Anticoagulants (blood thinners) Yes  No
      c. Medicine for high blood pressure Yes  No
      d. Cortisone (steroids) Yes  No
      e. Tranquilizers Yes  No
      f. Antihistamines Yes  No
      g. Aspirin Yes  No
      h. Insulin, Tolbutamide  (Orinase) or similar drug Yes  No
      i. Digitalis or drugs for heart trouble Yes  No
      j. Nitroglycerin Yes  No
      k. Oral contraceptive or other hormonal therapy Yes  No
      l. Over the counter medications Yes  No
Other _______________________________________________________________  
Allergies must also be addressed:
Are you allergic or have you reacted adversely to:
      a. Local anesthetics Yes  No
      b. Penicillin or other antibiotics Yes  No
      c. Sulfa drugs Yes  No
      d. Barbiturates, sedatives or sleeping pills Yes  No
      e. Aspirin Yes  No
      f. Iodine Yes  No
      g. Codeine or other narcotics Yes  No
      h. Latex Yes  No
      i. Other ___________________________________________________________  
I then suggest that some additional questions be asked that can give you a good idea of where the patient is at present both dentally and medically:
Have you had any serious trouble associated with any previous dental treatment? Yes  No
   If so, explain ________________________________________________________  
Do you have any disease, condition, or problem not listed above that you think I should know about?  Yes  No
   If so, explain ________________________________________________________  
Are you employed in any situation which exposes you regularly to x-rays or other ionizing radiation? Yes  No
Are you wearing contact lenses? Yes  No
Have you had anything to eat or drink in the last 4 hours? Yes  No
Are you wearing removable dental appliances? Yes  No
Do you smoke or use tobacco? Yes  No
Does your physician require you to take antibiotics prior to dental treatment? Yes  No
Is there a family history of diabetes, heart disease, high blood pressure, obesity, or high cholesterol? Yes  No
Special questions need to be asked of our female patients that should include the following:
Are you pregnant? Yes  No
Do you have any problems associated with your menstrual period? Yes  No
Are you nursing? Yes  No
Are you taking birth control medication or hormone replacement medication? Yes  No
Are you taking any bisphosphonate drugs (e.g. Fosamax, Boniva) for osteoporosis? Yes  No
The last suggestion that I make is two-fold. Address any specific dental concerns and ask the patient if he or she has a chief complaint. For those practices that file medical cross coded claims, the answer to the chief complaint is vitally important in determining a patientís diagnosis. In the future, dentistry will also be required to report a patientís diagnosis on a dental claim form. We will have to prove why we performed our procedures ( as is required in the medical field). Watch for more information in future newsletters on this.

Medical history forms that include this much information can be daunting to some patients. I suggest that either a front desk staff member offer assistance to those that seem to be having difficulties in completing it or possibly the dental assistant who will accompany the patient to the operatory.

A questionnaire as thorough as this will undoubtedly give us the full dental and medical picture of our patient. This can only result in your practice helping your patients to reach their optimum level of health.
Time Line
Red Flags Rule – November 1 is the latest deadline for compliance with the Red Flags Rule. Be sure that your practice is prepared with a written plan. For additional information regarding Red Flags Rule, please refer back to my last two newsletters (the July newsletter and the July special edition newsletter)
Medical Cross Coding – October 1 marked the effective date for the current update to the medical diagnosis codes (ICD-9-CM). If you file medical claims for certain dental procedures, you must obtain the latest coding manual. If you purchased my medical cross coding manual, please contact me to obtain your updates. Protect the investment that you made in the manual by keeping it current. Also, help prevent denials by using the up-to-date codes.
September 23, 2009 was the effective date for the Breach regulations. The FTC created the Breach regulations to require that health providers create a plan for notifying patients of a breach of their personal health records. Information regarding this can be obtained online or through companies such as Total Medical Compliance.

For our patients – Is your practice cautioning patients about how acidic drinks and candy can be damaging to teeth? We have concentrated so long on the sugar content of our foods and drinks, but we should also be advising patients that acidic foods and drinks are corrosive to tooth enamel. The journal of General Dentistry published an article that suggested that, after consuming citrus-fruit juices and sodas (that contain citric acid and phosphoric acid) that one should wait an hour before brushing. According to Kenton A. Ross of the Academy of General Dentistry, “The acid in the drink weakens the enamel, and brushing can then remove microscopic amounts of that important enamel layer.” We should let our patients know of this study and possibly suggest that the patient rinse with water after consuming these beverages to dilute the acid.
(Martha Stewart Living, May 2009, p. 39)

My Favorite Quotes:
"Life is an opportunity, benefit from it.
Life is beauty, admire it.
Life is bliss, taste it.
Life is a dream, realize it.
Life is a challenge, meet it.
Life is a duty, complete it.
Life is a game, play it.
Life is a promise, fulfill it.
Life is sorrow, overcome it.
Life is a song, sing it.
Life is a struggle, accept it.
Life is a tragedy, confront it.
Life is an adventure, dare it.
Life is luck, make it.
Life is too precious, do not destroy it.
Life is life, fight for it. "

~Mother Teresa~

Dental Humor for the quarter:

"At 5 P.M. one Halloween afternoon, my dental hygienist realized that she wouldn't make it to the store in time to get snacks for trick-or-treaters. So she took home some free samples from the office supply cabinet. That night she handed out dozens of toothbrushes, toothpaste, and dental floss. The next year, although she had bags of chips and popcorn, not one child came knocking at her door."

Is there someone you think would be interested in this newsletter?
Please feel free to forward this email to them. Thank you!

The Art of Practice Management
2217 Fox Horn Road  •  New Bern, NC 28562  •  Phone: 1-252-637-6259   •
About us   |   Privacy policy © Copyright 2009 - Marianne Harper

The contents of this publication reflect the opinion of the author only. This publication is for informational purposes only.
Any reference to a company or product is done only to provide information about the same and does not reflect any connection between the author and the company.