Th 250383

Risk assessment tools

June 1, 2007
Some of you probably wonder aloud to yourself, “How in the world I am supposed to keep up with all of the technological changes in dentistry?”

by Tricia Osuna, RDH, BS

Some of you probably wonder aloud to yourself, “How in the world I am supposed to keep up with all of the technological changes in dentistry?” I do not know the answer; however, I am learning that each month there is something new, creative, and awesome to better assist us in providing treatment to our patients.

Are these products challenging?

Is time required to educate ourselves and understand the nuances of this technology?

Click here to enlarge image

Is well worth the investment of your time?
You betcha!

We now have amazing options for patient treatment, assessment, and diagnosis. Products on the market provide DNA testing, saliva testing, and caries, oral cancer, and periodontal risk assessments - all hoping to reveal what the future may hold for our patients.

Click here to enlarge image

One current “hot” product is PreViser’s Oral Health Information Suite. PreViser assists clinicians in creating appropriate treatment plans following evaluation of patients’ risks for caries, oral cancer, and periodontal disease. For years, we operated using a “cookie cutter” program of treatment for the majority of patients. PreViser allows us to input specific patient information, which results in a report that can be used as a guide for treatment options, and the report is based on that one individual’s personal risk.

Click here to enlarge image

Dentistry has operated as two separate entities within one practice - preventive and restorative. PreViser allows us to work on the preventive mode as a team to best treat our patients for long-term health. This scientific “crystal ball” helps us map out future dental outcomes for patients.

The PreViser Oral Health Information Suite is not meant to be used as a tool to dictate treatment. Instead, it provides objective, standardized scoring of all patients by using the same guidelines. Clinicians then use this information to assess their treatment with this objective information. You can see in the diagram at left how easily this works as an effective patient education and motivational tool. It’s also a business tool that increases productivity, and all professionals speak the same language with a standardized product.

By the simple use of a downloaded program on the office computer, which takes about 30 seconds, a total of nine criteria are entered into PreViser. The information entered is the same information that we are currently gathering from each patient. But the information is now simply placed in one location for a plan of action and communication tool. The information entered is:

  • Patient’s age
  • Smoking history
  • History of diabetes
  • History of periodontal surgery, pocket depths, furcation involvement, restorations, or calculus below the gingival margin, radiographic bone height, and vertical bone loss.

This information enables us to determine two extremely important scores for each patient: his or her risk score and disease severity score.

The risk score advises the clinician as well as the patient on the work necessary to control disease. In essence, it allows us to predict the risk for each patient and what lies in their dental future. Utilizing evidence-based, scientifically validated scores using a patented mathematic algorithm, PreViser provides these scores that can then be used for education and treatment.

The disease severity scores are reflected with numbers from 1 to 100 (with 1 being the lowest and 100 the highest) indicating advanced periodontitis. This shows us their current disease state.

By using these two scores the clinician can determine, with patient input, a treatment plan for successful outcomes. (see Figure 1) Within seconds, the information is sent over high-speed Internet access, and you receive a report to share with the patient immediately. Patients are made aware of their scores, and, when they return for follow-up care or regular recare appointments, they are involved and inquire about their scores.

One way to understand how this affects patient participation is that, by the use of numbers instead of scientific terminology, patients gain an immediate understanding of high risk vs. low risk (see Figure 2).

The importance of this risk assessment tool cannot be understated. Dental hygienists now can stand as a true “specialist” in the office, serving to enhance patient treatment and overall health. We are able to predict actual health outcomes instead of trying to predict outcomes for patients as a group instead of on an individual basis. The dental hygienist is able to implement immediate treatment protocols based on the patient’s future risk and where he or she actually are today with a disease process. A patient can present with a high risk; however, they show no current signs of disease and we may choose to ignore that. With PreViser, an awareness is created. We look at both scores and plan, plan, plan!

The ease of use crosses over to many aspects of the dental practice. At future dental hygiene appointments, less examination time by the doctor is required as the team is aware of the 1-5 risk assessment code, using this as a communication tool. By stating the code, the entire team is aware - as is the patient - that the new information has been integrated into the system. We use an updated number that reflects where the patient is in “real time.” The entire team understands the need for future patient education and follow-up for a successful outcome.

Ease of use and low cost are possibly two advertising statements that might catch your eye as well. The product is downloaded onto your computer (which must have Internet capabilty) in about 30 seconds and you are good to go. PreViser offers a free 30-day trial to input an unlimited amount of patients information. Following this trial period, there is a small fee per patient for continued use.

The use of one simple and inexpensive risk assessment program with numerous benefits for clinicians as well as patients is at our fingertips. PreViser can also inform you what disease currently exists in the practice and potential productivity with an optional report called the PAR (Practice Analysis Report). Once a certain amount of patient assessments are entered, the report is sent to the practice. The report advises the owner on the amount of patients who would benefit from further treatment that you may not be aware of - be it quadrant scalings to locally delivered antimicrobials/antibiotics. Patient compliance and retention is enhanced, and offices attract new patients interested in cutting-edge technology. In addition, the PreViser process informs the patient by providing them with a copy, which satisfies informed consent requirements.

Tricia Osuna, RDH, BS, is a clinician, educator, author, consultant, public speaker, and business owner. Her company, Professional Insights, Inc., provides market research, product evaluations and consulting services. An active member of ADHA, she is the current president elect of the American Academy of Dental Hygiene, as well as past president of the California Dental Hygienists’ Association. Tricia can be contacted at [email protected].