Design Your Medical History Form for Better Oral-Systemic Treatment Planning

Traci Warner, RDH


A dental medical history form can be used to guide a clinician through an understanding of what is relative to oral medicine. It also can be used to start conversations and make connections between oral health and overall health.

For example, does the layout of the form that you are currently using make it easy for the clinician to visualize oral-systemic connections or concerns? Are the inflammatory risk factors grouped together on the form?

Inflammatory risk factors include: heart attack, stroke/transient ischemic attack, osteoporosis, hypertension, diabetes, high stress, smoking in the past 3 years, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), gastrointestinal disorders/irritable bowel syndrome/Crohn’s disease, periodontal disease, high carb diet, lack of exercise, pregnancy, past miscarriage, poor sleep quality, snoring, use of continuous positive airway pressure, and cancer.

Grouping these items together on the form should help the clinician quickly determine the inflammatory burden that a given patient is facing. When patients indicate that they have or have had any of these issues, a systemic inflammatory conversation should begin.

Predisposing genetic background should be established through a medical history form as well. These questions should be grouped together on the form:

  • Has a parent or grandparent had diabetes? Yes or No
  • Has a parent or grandparent had a heart attack or stroke? Yes or No
  • Has a parent or grandparent had periodontal disease? Yes or No
  • Has a parent or grandparent had COPD? Yes or No
  • Has a parent or grandparent had cancer? Yes or No

Once the presence or absence of inflammatory burdens is established, the dentist should determine if the patient is to be considered high risk or low risk. Age is a determining factor in this assessment as well. Any patient who is 50 years or older is considered to have reached an age that disease prevalence increases.

A periodontal evaluation will reveal bleeding sites, suspicion of pathogens, recession, mobility, and bony architecture status. Together, the medical history form and the periodontal evaluation will allow the dental professional to make a complete and comprehensive oral systemic evaluation. Treatment planning can begin to move toward total body health for a given patient.

A medical history form that enables dental professionals to move from inflammatory periodontal discussions to systemic inflammatory dialogue can lead patients toward a potentially healthier life.

Ms. Warner is an oral medicine coach and facilitator and a former adjunct professor at Baker College of Cadillac, Mich. She graduated from the Ferris State University School of Dental Hygiene and completed studies with Dawson Academy’s Dental Institute for Systemic Health. Also, she is a member of the American Academy for Oral Systemic Health. Throughout her 30-year career as a dental hygienist, she observed the connection between oral and systemic health in her patients, proactively partnering with them to better manage their total wellness. Her mission is to raise awareness of oral health as a crucial part of an integrated approach to whole-body wellness. She can be reached at

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