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May I commend Mark Greenwood's excellent article on the ‘Essentials of Medical History-Taking in Dental Patients' in May's Dental Update.
However, I was surprised that he gave only a few lines of mention on the issue of psychiatric history, implying that this is not really relevant. The rate of depressive illnesses and associated disorders has increased at an alarming rate in the last 10–15 years.
In 32 years of practice, 12 patients have caused me grief by way of complaints and difficulty managing them. Nine of these patients had underlying undetected depression, anxiety-related disorders.
These disorders often lead to dental treatment management problems. These include conflicting/incorrect perceptions of treatment needs, elevated expectations and excessive demands on the practitioner. These patients often don't admit to their underlying illnesses as they think it is not relevant to dentistry and also try to hide it from clinicians because of shame, stigma or embarrassment. It also varies between different ethnic groups, who will avoid discussing these conditions, especially in the close knit community groups I see here in South London, eg South-east Asians, Arabs and East Africans.
I think dental schools should prepare students more for looking after patients presenting with psychiatric conditions who need our care to be delivered in a careful way to avoid pitfalls in delivery.
I have now included three separate questions on my patient Medical questionnaire to aid identification of psychiatric and psychological disorders in my assessment:
Understanding the needs of this category of patients will enable us to deliver careful, empathetic and compassionate care.