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Improving risk assessment

Sept. 29, 2014
Using care tools facilitate prevention strategies

Using care tools facilitate prevention strategies


Statistics related to oral disease in the United States reveal significant unmet needs for individuals in all age, sex, race, and socioeconomic groups. An estimated 8.5% of adults ages 20 to 64 years have periodontal disease, 5% of whom have moderate to severe disease. Older adults ages 65 years and older have a higher incidence of the disease, with 17.2% having periodontitis, and 10.58% with moderate to severe disease.1,2 Half of all adults in the United States have gingivitis.3

Dental caries continues to be a major oral health problem for individuals of all ages. Current national health statistics estimate that:

• 42% of children between the ages of 2 and 11 years have had dental caries in their primary teeth, 23% of whom currently have untreated decay.

• 21% of children between the ages of 6 and 11 years have had dental caries in their permanent teeth, 8% of whom currently have untreated decay.

• 59% of adolescents ages 12 to 19 years have had dental caries in their permanent teeth, 20% of whom currently have untreated decay.

• 92% of adults ages 20 to 64 years have had dental caries in their permanent teeth, 23% of whom currently have untreated decay.

• 92% of adults ages 65 years and older have had dental caries in their permanent teeth, 23% of whom currently have untreated decay.1,2

Oral cancer remains a leading cause of death, and in comparison to other types of cancer, statistics continue to show a large number of new cases with little improvement in long-term survival. An estimated 42,400 new cases of cancer of the oral cavity and pharynx are expected in 2014, with an estimated death rate of 8,390. Current disease estimates are that 10 in 100,000 adults will develop oral cancer in their lifetimes. Risk factors vary by individuals, age, and race. Rates for oral cancer are significantly higher for males, notably Hispanic and black males, as compared to white males and females. Rates increase with age, becoming more rapid after the age of 50, with peak prevalence between the ages of 60 to 70 years.4

Risk assessment using CARE tools

Given the tremendous oral health needs of the country, it is incumbent upon dental hygienists to contribute to the assessment of oral disease in the clinical practice setting. The ADHA Clinical Standards of Dental Hygiene address the need to conduct risk assessment procedures as part of the assessment standard of care.5 Finding the time to conduct meaningful risk assessment may be difficult during an appointment schedule. Fortunately, Philips has created CARE tools that streamline the process and help clinicians address risk assessment for periodontal disease, caries, and oral cancer.6

Following the CARE risk assessment model, clinicians can identify their patients' risk factors, disease indicators, and protective factors that can affect the development and/or progression of oral disease.6 Clinicians should use CARE tools during the patient's initial assessment, but they also can be used during future visits for reevaluation.

The process includes a series of steps and forms that can be completed online while working with the patient, or the forms may be downloaded and printed for manual review. These steps include a patient interview, risk assessment, and a review of clinical guidelines. The program will generate a protocol with suggested interventions to manage risk, including the development of a customized form to be provided to the patient, and a downloadable summary that is tailored to the patient's needs.

During the first step, the clinician performs a patient interview designed to address disease indicators, risk factors, and protective factors for caries, periodontal disease, and oral cancer. Examples of risk and protective factors appear in Table 1.

After the patient interview has been completed, the second step is a risk assessment that is calculated based on the likelihood that the responses to the interview demonstrate low, moderate, high, or extreme risk for caries, periodontal disease, and oral cancer. Explanations are provided to help the patient and clinician understand the deciding factors that led to the determination of level of risk.

Clinical guidelines are provided as Step 3 in the risk assessment process. These guidelines are tailored to each level of risk (low, moderate, high, or extreme) and may focus on recommendations for treatment, counseling, additional testing, lifestyle habits, routine screenings, and additional follow-up procedures.

Once the clinician has reviewed the clinical guidelines, a protocol is established for the patient. This protocol represents a customized patient care recommendation plan that can be provided in a downloadable PDF form that patients can take home or can be kept as a part of the treatment record. This provides both the patient and provider with greater detail about appropriate steps to take to manage and reduce risk.

Benefits of using CARE tools

For the busy clinician, the CARE risk calculator provides a readily accessible, evidence-based solution to aid in decision-making at the point of care. The protocol also offers solutions to patients to help navigate the myriad of products that are available to help lower risks for oral disease. Clinicians will appreciate the effective, time-saving strategy that allows for easy implementation during an appointment. Access to CARE Tools is free. Clinicians can complete the risk assessment online or can print out copies of the forms for use during patient education and for inclusion in the treatment record.

Risk assessment is a critical component of the dental hygiene process of care. Using CARE tools is a simple and effective strategy to support clinical decision-making and to support best practices. Risk prevention strawtegies help to significantly reduce the development of oral disease. Selecting appropriate interventions to reduce risk helps to minimize the extent and severity of disease and slows disease progression.

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and president of the International Federation of Dental Hygienists.

ANN ESHENAUR SPOLARICH, RDH, PhD, is clinical associate professor and associate director of the National Center for Dental Hygiene Research & Practice at the Ostrow School of Dentistry at the University of Southern California, and she practices dental hygiene part-time, specializing in geriatrics.


1. Centers for Disease Control and Prevention. Third National Health and Nutrition Examination Survey. Available at: http://www.cdc.gov/nchs/nhanes.htm Accessed June 10, 2014.
2. National Institute of Dental and Craniofacial Research. Data and Statistics. Available at: http://www.nidcr.nih.gov/DataStatistics/ Accessed June 10, 2014.
3. Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012;91(10):914-920.
4. National Cancer Institute. Surveillance, Epidemiology and End Results Program. Available at: http://www.seer.cancer.gov/ Accessed June 10, 2014.
5. ADHA Standards for Clinical Dental Hygiene Practice. Available at: http://www.adha.org/resources-docs/7261_Standards_Clinical_Practice.pdf Accessed June 10, 2014.
6. Philips Oral Healthcare. Philips CARE tools. Available at: https://www.philipsoralhealthcare.com/en_us/care/assess Accessed June 10, 2014.

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