Good clinical outcomes depend on accurate diagnosis, and an accurate diagnosis is based on comprehensive and complete information. Therefore, the first step in formulating a treatment plan is to obtain a detailed history from the patient. This essential step in patient assessment, when followed by detailed examination and diagnosis, guides the clinician in formulating an appropriate treatment plan that addresses the patient's needs.

After completing this ITI Academy Module, you should be able to, define anamnesis and explain why a detailed patient history is required in the process of determining a diagnosis; distinguish between patient-reported symptoms and clinical signs; and list the required components of the anamnesis and the reasons for obtaining this information.

Anamnesis is the complete relevant history as recalled and recounted by a patient. It reveals information that is necessary in determining a diagnosis and formulating a comprehensive treatment plan. Understanding of the patient's needs, social and family background, and medical and dental condition is a prerequisite for a successful and predictable treatment outcome of implant therapy. Moreover, the patient history interview is an opportunity to build rapport with the patient in advance of treatment.

A comprehensive anamnesis should always include the patient's chief complaint and expectations, social and family history, medical history, dental history, and habits as well as motivation and compliance.

Definition and Relevance, Key Learning Points: The anamnesis provides information that will guide the clinician in formulating a treatment plan that is appropriate for the patient's needs. A thorough anamnesis is a prerequisite to achieve a predictable treatment outcome of implant therapy.

When analyzing the patient's history it is important to understand the difference between a "symptom" and a "clinical sign". A symptom is an observation reported by a patient that indicates the presence of a disease or abnormality. In contrast, a clinical sign is any evidence of a disease identified by the clinician. The purpose of the anamnesis is to identify and collate the symptoms, which will then guide the clinical examination process to identify the relevant clinical signs.

Anamnestic questionnaires are very helpful in getting an overview of the patient's symptoms. A questionnaire should be written in simple and understandable language so that the patients can fill it out by themselves. It should include open-ended questions when appropriate, as patients may not reveal all relevant information when the choice of answers is limited. The questionnaire can be forwarded to the patient to complete in advance of the first visit, or it can be completed in the waiting room. During the first visit, the dental professional should then review the responses with the patient and revise the information if necessary. Potentially compromising factors should be discussed in detail because they may modify the treatment plan or require medical consultation.

Clinical Signs and Symptoms, Key Learning Points: A symptom is an observation reported by a patient indicating the presence of a disease or abnormality. A clinical sign is any evidence of a disease identified by the clinician. Anamnestic questionnaires are helpful in obtaining an overview of symptoms from the patient in preparation for discussion and revision with the dental professional during the first visit. Potentially compromising factors that may modify the treatment plan should be discussed in detail.

In this next section of the module, the information required to obtain a comprehensive anamnesis will be presented. The following areas will be covered: the patient's chief complaint and expectations, the social and family history, the medical history, the dental history, any habits which may have an impact on dental health, and the degree of motivation and compliance that is demonstrated by the patient.

The initial part of an anamnesis consists of the patient's chief complaint and expectations. By understanding the patient's main complaints, the clinician can gain insight into their motivating reasons for seeking treatment. Equally, a detailed interview of the patient regarding the history of his or her chief complaint should be undertaken. Specific questions relating to the onset, duration, severity, previous treatments, and other relevant information will reveal the history of the chief complaint. This information is essential because it provides relevant clues that underpin the subsequent anamnesis, clinical examination, diagnosis, and treatment planning.

The chief complaint further gives us an idea of how urgent the patient's needs are, and reveals whether there is an acute condition that needs immediate treatment. A thorough anamnesis may need to be delayed until after the acute condition is addressed. The patient in this clinical image presents with an acute abscess due to a fracture of the maxillary right lateral incisor. The patient requires prompt treatment.

If the chief complaint refers to a more chronic condition, you will have time to complete a more thorough evaluation. The missing tooth shown in this clinical image is a chronic condition that may not require immediate treatment. Sometimes patients present with multiple issues. These patients require a thorough evaluation. Having the patient focus on the main issue allows the clinician to understand what is most important to the patient. Understanding the patient's main underlying complaint may also give clues as to the best way of managing the patient, or what might motivate the patient to comply with instructions and home care.

Identifying the patient's expectations of the treatment is important to determine whether they are rational and realistic. Very often patients have unrealistic expectations regarding treatment procedures and results, especially with regard to dentofacial esthetics. The expectations of the patient need to be taken seriously to see if their demands are in line with the objective evaluation of the existing conditions and the anticipated treatment outcome.

The next section of an anamnesis should consist of the social and family history. By inquiring about the patient's social history, the clinician can learn about the patient's professional and social environment and the obligations and priorities in the patient's life.

The patient's social history gives you an idea of their work environment, working hours, and frequency of work-related trips that might make them unavailable for regular visits. These obligations often influence the treatment plan with respect to timing of the procedures. It may sometimes even be necessary to postpone procedures until the obligations can be synchronized with the treatment requirements.

Furthermore, the patients descriptions of their professional environment introduce you to the type of work they are doing. Sometimes the mere nature of their work influences the treatment. For instance, in woodwind and brass instrument players you must pay special attention to the prosthesis design so that their airflow is not changed, because this would be detrimental to the way of playing their instrument. Their social or work environment may influence the need for a specific temporary provisional prosthesis, for example, if the patient works in the TV media.

The patient's family history is also relevant. The family history may reveal important local and systemic diseases in close relatives. These conditions may not be a part of the patient's own medical history, but the patient may be at risk of developing them in the future, for example, diabetes. The family history also provides an insight into cultural issues. Family members and friends may have had experiences with oral health treatments that can influence the patient's attitude to particular treatment recommendations.

The medical history is another essential component of the anamnesis. It is important to ascertain the medical status and medication history because this may influence how you will manage the patient in a dental setting. Certain medical conditions may also increase the risk of complications in dental implant therapy.

The medical history may reveal conditions that present an absolute or relative risk for implant treatment. In some cases, it may not even be the condition itself that poses a risk, but rather the medical treatment that can complicate implant therapy, such as medications or irradiation. Any condition that has the potential to negatively affect wound healing must be considered. Conditions that create difficulties for regular attendance at the dental clinic - whether for planning, for treatment, or for recall appointments - can also alter the treatment approach. If conditions presenting a risk to implant treatment are identified, they should be subject to consultation with an appropriate medical specialist prior to implant treatment planning.

The dental history is an important part of the anamnesis because it reveals the patient's previous experiences and commitment to regular dental care, and it directs you to the best way of managing the patient.

Information on previous dental care will give you an insight into the dental health attitudes of the patient. This includes the type of dental treatment decided on by the patient in the past, and whether they have undergone implant therapy before. Careful questioning will give you an idea of the patient's commitment to dental recall appointments and compliance with home care instructions. The history and timing of previous tooth loss gives you an understanding of the patient's attitudes and priorities in relation to their oral health.

Consequently, the process of obtaining the dental history should make evident the dental conditions that can pose a risk for implant therapy, such as periodontitis, chronic infections in the vicinity of the future implant site, or a history of temporomandibular joint problems.

The patient's habits are a significant part of their history. It is necessary to identify any habits that might influence the proposed treatment plan or pose a potential risk for implant therapy. Some habits may influence wound healing or the prosthetic treatment, or may interfere with prescribed medication.

Some habits may influence wound healing, such as cigarette smoking, which directly lowers the healing potential of the implant site. Some habits have an indirect effect. For example, alcoholism may affect the patient's health by increasing the likelihood that the nutritional intake will be poor. This can result in a deficit of vitamins and minerals, which will also reduce the body's ability to heal. Furthermore, alcohol or drug abuse may interfere with prescribed premedication or the medication following implant treatment.

An initial evaluation of the patient's motivation and compliance is necessary when deciding on the most appropriate treatment approach. Patients who lack motivation and do not comply with home care and recalls may not be candidates for complex dental treatments. Motivation and compliance could therefore become the deciding factors in which type of prostheses would be most suitable for the patient. They could also determine whether or not to proceed with elective implant therapy.

Components of Anamnesis, Key Learning Points. A thorough and comprehensive anamnesis is an important part in the process of treatment planning and includes the following components: The chief complaint reveals the need for urgent treatment and the patient's priorities. The patient's expectations should be evaluated to see if they are realistic. The patient's social environment and family history provides insight into obligations and priorities and may reveal risk factors as well as cultural issues. The medical history may influence patient management and may disclose absolute or relative risk factors.

The dental history also may reveal risk factors and gives an idea of the patient's commitment. Habits may influence wound healing and prosthetic treatment or may interfere with the prescribed medication. The patient's level of motivation and compliance may be the deciding factor to initiate a complex implant therapy or not.

Patient History (Anamnesis), Module Summary: Anamnesis is the complete relevant history recalled and recounted by a patient. Its purpose is to collect the relevant information needed to formulate an appropriate treatment plan. Anamnesis identifies and collates symptoms, which will then guide the clinical examination process to identify the corresponding relevant clinical signs.

A comprehensive anamnesis should include: the patient's chief complaint and expectations; social and family history; medical history; dental history; habits; and motivation and compliance.