to the child before involving the parent as this establishes the child's importance in the
process, though the dentist should be prepared to receive different answers from these
two sources.
Where a child presents in pain or has a particular concern, this should be recorded in
the child's own words and, if relevant, the history of the present complaint (e.g.
duration, mode of onset, progression) should be documented. It should be recognized
that, even where other (perhaps more important) treatment is required, failure to take
into consideration the patient's/parent's needs or wishes at this stage may be
detrimental to both the development of the dentist/patient/parent relationship and the
outcome of care.
3.3.3 Social (family) history
A child is a product of his or her environment. Factors such as whether both parents
are alive and well, the number and age of siblings, the parents' occupations, ease of
travel, as well as attendance at school or day-care facilities are all important if a
realistic treatment plan is to be arrived at. However, since some parents will consider
this kind of information confidential, the dentist may need to exercise considerable
tact in order to obtain it.
This stage of history-taking also presents an opportunity to engage the child in
conversation. In this way, the dentist gains an insight into the child's interests (e.g.
pets, favourite subjects at school, favourite pastimes) and is able to record potential
topics of conversation that can act as 'ice-breakers' in future appointments.
3.3.4 Medical history
Various diseases or functional disturbances may directly or indirectly cause or
predispose to oral problems. Likewise, they may affect the delivery of oral and dental
care. Conditions that will be of significance include allergies, severe asthma, diabetes,
cerebral palsy, cardiac conditions, haematological disorders, and oncology.
Wherever possible, a comprehensive medical history should commence with
information relating to pregnancy and birth, the neonatal period, and early childhood.
Indeed, asking a mother about her child's health since birth will not infrequently
stimulate the production of a complete medical history! Previous and current
problems associated with each of the major systems should be elicited through careful
questioning, and here a proforma may well be helpful. Details about previous
hospitalizations, operations (or planned operations), illnesses, allergies (particularly
adverse reactions to drugs), and traumatic injuries should be recorded, as well as those
relating to previous and current medical treatment.
Key Point
If any relevant conditions become apparent, these may need to be investigated in
greater detail, contacting the child's general medical practitioner or hospital consultant
where necessary.
It is useful to end by asking the parent whether there is anything else that they think
the dentist should know about their child. (Sometimes, important details are not