Chapter 2

Medical Histories and Personal Protection

Aims

The first aim of this chapter is to examine the value of the patient’s medical history in preventing the transmission of infection during dental procedures. The second aim is to look at personal protection of dental personnel.

Outcome

After reading this chapter, you should have an understanding of the use of the medical history and how personal protection is important in prevention of the transmission of infection.

Medical Histories

Taking an accurate medical history is essential before any dental procedure, but often is not helpful for determining whether a patient is an infection risk. This is because many of the potentially infectious diseases are “silent” – the patient may not know they have contracted them. Thus, unless the patient reports that they have been diagnosed as carrying a specific infectious disease, the medical history may not be helpful in determining their infectious status. Many potentially infectious diseases are associated with prejudice and stigma, notably HIV, and infected patients may as a consequence be economical with the truth in giving their medical history. In addition, in many countries, patients are not obliged by law to disclose information about certain infectious diseases they know they carry.

One frequently asked question in taking medical histories is to ascertain a history of jaundice. Although this question can be helpful in determining whether a person has liver disease, which can affect, for example, bleeding time, it is rarely helpful in eliciting liver infections, such as hepatitis B or C. A history of jaundice can also be unhelpful, because it could have been caused by hepatitis A or E, conditions which are usually self-limiting and do not pose an infection risk in dentistry. Jaundice is usually a late stage in the progression of hepatitis B and C infections. It is therefore unlikely that carriage of hepatitis B or C would be elicited from a medical history, unless the patient has been diagnosed as having contracted them and reports them truthfully.

It is because the medical history may be non-contributory in determining whether the patient is an infection risk that standard precautions are used for all patients. Even if a patient does not report a significant diagnosed infection when the medical history is taken, if standard precautions are used, these should give protection against infection for all normal dental procedures.

Confidentiality

Any information given to a dental professional during a medical history must be completely confidential. All staff must be awa