Upload
maxisurgeon
View
1.696
Download
8
Tags:
Embed Size (px)
DESCRIPTION
Citation preview
Risk and Periodontal Risk and Periodontal Disease ManagementDisease Management
Courtesy PreViser Corporation, all rights reserved
Issues to be PresentedIssues to be Presented
Why knowledge of a patient’s risk for Why knowledge of a patient’s risk for periodontitis is required to determine periodontitis is required to determine treatmenttreatment
Why an accurate periodontal diagnosis Why an accurate periodontal diagnosis is insufficient to determine treatmentis insufficient to determine treatment
How risk is determinedHow risk is determined How risk is used to determine How risk is used to determine
treatmenttreatment Periodontal disease managementPeriodontal disease management
Courtesy PreViser Corporation, all rights reserved
Risk and the Natural History of Risk and the Natural History of Periodontal DiseasePeriodontal Disease
HealthInitial
disease stage
Gingivitis Mild periodontiti
s
Risk predicts the progression from health to severe periodontitis
Courtesy PreViser Corporation, all rights reserved
Moderate periodontiti
s
Severe periodontiti
s
Treatment Implications of Treatment Implications of RiskRisk
If risk is low, then treatment may not be If risk is low, then treatment may not be required, as disease is not expected to required, as disease is not expected to progressprogress
If risk is high, then treatment is required, as If risk is high, then treatment is required, as disease is expected to progress to a more disease is expected to progress to a more advanced and possibly terminal stageadvanced and possibly terminal stage Hence, every patient receiving aggressive Hence, every patient receiving aggressive
periodontal treatment has been determined to be periodontal treatment has been determined to be high riskhigh risk
Furthermore, a standard treatment protocol for a Furthermore, a standard treatment protocol for a specific periodontal diagnosis can be established specific periodontal diagnosis can be established when all patients are high riskwhen all patients are high risk
Courtesy PreViser Corporation, all rights reserved
Courtesy PreViser Corporation, all rights reserved
With advancing age the prevalence of gingivitis decreases and periodontitis increases, which has been interpreted that risk for periodontitis is high.
Prevalence of Periodontitis, Prevalence of Periodontitis, 1950’s*1950’s*
* Marshall-Day et al, J Periodontol 1955
GingivitisPeriodontitis
Tooth loss
Are all patients high risk for Are all patients high risk for periodontal disease?periodontal disease?
Using the NHANES III database, Albandar, Using the NHANES III database, Albandar, et al et al ((J PeriodontolJ Periodontol 1999; 70: 13-29) 1999; 70: 13-29) reported the reported the prevalence of Periodontitis in the adult prevalence of Periodontitis in the adult population (30 years and older)population (30 years and older) 65%65% were Healthy were Healthy 22%22% had Mild Periodontitis had Mild Periodontitis 13%13% had Moderate to Severe Periodontitis had Moderate to Severe Periodontitis
When the same data is viewed by age When the same data is viewed by age cohort, …cohort, …
Courtesy PreViser Corporation, all rights reserved
Periodontal Disease RiskPeriodontal Disease Risk
0
10
20
30
40
50
60
70
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-90
Age Cohort
% o
f A
ge C
oh
ort
Periodontitis
Linear trend line
Risk to remain healthy is 40%Risk to remain healthy is 40%
Risk for Periodontitis is 60%Risk for Periodontitis is 60%
Courtesy PreViser Corporation, all rights reserved
Periodontal Disease Risk, Cont.Periodontal Disease Risk, Cont.
0
5
10
15
20
25
30
35
40
45
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-90
Age Cohort
% o
f A
ge C
oh
ort
Linear trend line
Moderate to Severe Periodontitis
Beginning Periodontitis
Risk for Mild Periodontitis is 35%Risk for Mild Periodontitis is 35%
Risk for Moderate to Severe Periodontitis is 25%Risk for Moderate to Severe Periodontitis is 25%
Courtesy PreViser Corporation, all rights reserved
Distribution of Risk for Distribution of Risk for PeriodontitisPeriodontitis
High Risk25%
Low Risk40%
Moderate Risk35%
Courtesy PreViser Corporation, all rights reserved
SummarySummary
Risk predicts the progression of Risk predicts the progression of diseasedisease
Risk justifies treatmentRisk justifies treatment Risk for periodontitis is stratified Risk for periodontitis is stratified
across the US populationacross the US population Treatment must be personalized for Treatment must be personalized for
each patient and it must be based on each patient and it must be based on the patient’s unique risk profile and the patient’s unique risk profile and disease severitydisease severity
Courtesy PreViser Corporation, all rights reserved
Do Dentists Accurately Do Dentists Accurately Determine the Risk for Determine the Risk for
Periodontitis?Periodontitis? Study group of 107 patients with Study group of 107 patients with
broad range of risk for periodontitisbroad range of risk for periodontitis Full mouth periodontal chartingFull mouth periodontal charting Medical and dental historiesMedical and dental histories Full mouth periapical radiographs with Full mouth periapical radiographs with
bitewingsbitewings Clinical photographsClinical photographs
Persson GR et al. Assessing periodontal disease risk. J Am Dent Assoc 2003
Courtesy PreViser Corporation, all rights reserved
Persson StudyPersson Study
3 Groups of expert evaluators3 Groups of expert evaluators 6 periodontists with national and 6 periodontists with national and
international clinical, academic, and international clinical, academic, and military experiencemilitary experience
10 periodontists who participated in the 10 periodontists who participated in the development of the OHIS™ tooldevelopment of the OHIS™ tool
36 private practice general dentists who 36 private practice general dentists who referred patients to periodontistsreferred patients to periodontists
Risk was assessed on a 1 (low) to 5 Risk was assessed on a 1 (low) to 5 (high) scale by clinicians and OHIS™(high) scale by clinicians and OHIS™
Courtesy PreViser Corporation, all rights reserved
107 Patient Records, Risk Assessed using OHIS™
Three Expert Groups Subjectively Assess Same Patients
6 Practicing Experts
OHIS™
10 PreViser Founders
36 General Dentists “Periodontally Aware”0%
10%
20%
30%
40%
50%
60%
GROUP
5
A B CGROUP
3
A B CGROUP
2
A B CGROUP
1
A B CGROUP
4
A B C
Risk Calculator
Courtesy PreViser Corporation, all rights reserved
RiskCalculatorScore = 3
General Dentist(5 Patient Evaluations…
Expert Periodontists(5 Patient Evaluations per data point)
Previser Founder’s(5 Patient Evaluations…)
Practitioner evaluation
over-estimating risk by 2 scores
Practitioner evaluation
under-estimating risk by 1
score
Over-Estimated
Risk = Inappropriate
Treatment
Under-Estimated
Risk = Inappropriate
Treatment
Practitioner evaluation
over-estimating risk by 1
score
Practitioner evaluation
under-estimating risk by 2 scores
20% Agreement with OHIS™
For OHIS™
assessed patients with Risk Score of 3..
Conclusion: Clinicians
can’t assess the risk of
future diseaseCourtesy PreViser Corporation, all rights reserved
Current Risk Assessment Current Risk Assessment MethodMethod
Current method is subjective Current method is subjective judgmentjudgment
The literature only provides a The literature only provides a laundry list of risk factors with no laundry list of risk factors with no guidance how to determine riskguidance how to determine risk
Hence, it is not surprising that the Hence, it is not surprising that the current method of risk assessment current method of risk assessment is generally an unreliable predictor is generally an unreliable predictor of the future disease stateof the future disease state
Courtesy PreViser Corporation, all rights reserved
DiagnosisDiagnosis
HealthInitial
disease stage
Gingivitis Mild periodontiti
s
Courtesy PreViser Corporation, all rights reserved
Moderate periodontiti
s
Severe periodontiti
s
A periodontal diagnosis describes the current periodontal status, which is limited in accuracy by the sensitivity of the measurement systems and the dynamic non-linear disease process that can cycle between breakdown and healing. It does not predict future periodontal status.
Disease StateDisease State
Severe PeriodontitisSevere Periodontitis
Moderate PeriodontitisModerate Periodontitis
Mild PeriodontitisMild Periodontitis
GingivitisGingivitis
HealthHealth
Diagnosis vs. RiskDiagnosis vs. Risk
Current Current FutureFuture
TimeTime
Worse
Better
Same
Diagnosisdescribes
Riskpredicts
Based on:Based on: Signs and Symptoms Signs and Symptoms Risk Risk FactorsFactors
Courtesy PreViser Corporation, all rights reserved
Determining Diagnosis and Determining Diagnosis and RiskRisk
Signs and SymptomsSigns and Symptoms Bleeding on Bleeding on
probingprobing Periodontal Periodontal
pocketspockets Alveolar bone lossAlveolar bone loss PainPain Gingival swellingGingival swelling
Risk FactorsRisk Factors Cigarette smoking Cigarette smoking DiabetesDiabetes StressStress Poor oral hygienePoor oral hygiene Periodontal Periodontal
pocketspockets HeredityHeredity
Courtesy PreViser Corporation, all rights reserved
What is a Risk Factor?What is a Risk Factor?
Risk factor is often used as a general term Risk factor is often used as a general term meaning those characteristics that strongly meaning those characteristics that strongly associate with groups of individuals who associate with groups of individuals who have disease compared to those who do have disease compared to those who do not. Risk terminology includes:not. Risk terminology includes: Risk FactorRisk Factor Background CharacteristicBackground Characteristic Risk IndicatorRisk Indicator Risk Markers or Risk PredictorsRisk Markers or Risk Predictors
Courtesy PreViser Corporation, all rights reserved
Risk Factor DefinitionRisk Factor Definition
An environmental, behavioral, or biologic An environmental, behavioral, or biologic factor confirmed by temporal sequence, factor confirmed by temporal sequence, usually in longitudinal studies, which if usually in longitudinal studies, which if present directly increases the probability of a present directly increases the probability of a disease occurring, and if absent or removed disease occurring, and if absent or removed reduces the probability. Risk factors are part reduces the probability. Risk factors are part of the causal chain, or expose the host to the of the causal chain, or expose the host to the causal chain. Once disease occurs, removal causal chain. Once disease occurs, removal of a risk factor may not result in a cure. of a risk factor may not result in a cure.
Beck JD. Community Dent Oral Epidemiol 1998
Courtesy PreViser Corporation, all rights reserved
Background Characteristics Background Characteristics DefinitionDefinition
Associated with a higher probability Associated with a higher probability of disease, but cannot be modified. of disease, but cannot be modified. Also referred to as a determinant.Also referred to as a determinant. AgeAge GenderGender Socioeconomic StatusSocioeconomic Status Familial history and genetic factorsFamilial history and genetic factors
Courtesy PreViser Corporation, all rights reserved
Risk Indicator DefinitionRisk Indicator Definition
A possible risk factor not yet A possible risk factor not yet confirmed in published studies. A confirmed in published studies. A plausible correlate of disease plausible correlate of disease identified in cross-sectional studies.identified in cross-sectional studies. OsteoporosisOsteoporosis HIV and AIDSHIV and AIDS Frequency of visits to the dentistFrequency of visits to the dentist
Courtesy PreViser Corporation, all rights reserved
Risk Markers and Predictors Risk Markers and Predictors DefinitionDefinition
A characteristic strongly correlated A characteristic strongly correlated with an increased probability of with an increased probability of future disease but is not part of the future disease but is not part of the causal chain.causal chain. Bleeding on probingBleeding on probing Clinical attachment lossClinical attachment loss
Courtesy PreViser Corporation, all rights reserved
Risk and Disease - Distinct Risk and Disease - Distinct EntitiesEntities
Risk-Disease Risk-Disease GridGrid
Periodontal StatusPeriodontal Status
HealthHealthMild Mild
PeriodontitiPeriodontitiss
Moderate to Moderate to Severe Severe
PeriodontitisPeriodontitis
RiskRisk
LevelLevel
LowLow YesYes YesYes NoNo
ModerateModerate YesYes YesYes NoNo
HighHigh YesYes YesYes YesYes
Courtesy PreViser Corporation, all rights reserved
Validity and Accuracy of Validity and Accuracy of OHIS™ Determined RiskOHIS™ Determined Risk
523 subjects enrolled in the Veterans 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study who had Affairs Dental Longitudinal Study who had only routine careonly routine care
Periodontal pocket depth measurementsPeriodontal pocket depth measurements Digitized full-mouth radiographs with bitewingsDigitized full-mouth radiographs with bitewings Medical and dental historiesMedical and dental histories
Risk was assessed at baseline using OHIS™Risk was assessed at baseline using OHIS™
Page et al. Validity and accuracy of a risk calculator in predicting periodontal disease. J Am Dent Assoc 2002
Page et al. Longitudinal validation of a risk calculator for periodontal disease. J Clin Periodontol 2003
Courtesy PreViser Corporation, all rights reserved
Validity and Accuracy of Validity and Accuracy of OHIS™ Determined Risk, cont.OHIS™ Determined Risk, cont.
Changes in periodontal status determined Changes in periodontal status determined by comparing baseline data to data at 3, 9, by comparing baseline data to data at 3, 9, and 15 yearsand 15 years
Alveolar bone loss (mean bone loss, percentage Alveolar bone loss (mean bone loss, percentage of sites with bone loss per subject)of sites with bone loss per subject)
Tooth loss (mean percent tooth loss, percentage Tooth loss (mean percent tooth loss, percentage of subjects with tooth loss in each risk group)of subjects with tooth loss in each risk group)
Courtesy PreViser Corporation, all rights reserved
Mean Bone LossMean Bone Loss
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Year 3 Year 9 Year 15
Mean
Perc
en
t (±
SE)
Alv
eola
r B
on
e L
oss Risk 5
Risk 4
Risk 3
Risk 2
A measure of disease severity
Courtesy PreViser Corporation, all rights reserved
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
Year 3 Year 9 Year 15
% S
ites
wit
h B
on
e L
oss
Risk 5
Risk 4
Risk 3
Risk 2
Percentage of Sites with Bone Percentage of Sites with Bone LossLoss
A measure of disease extent
Courtesy PreViser Corporation, all rights reserved
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Year 3 Year 9 Year 15
Mean
% (
±S
E)
Tooth
Loss Risk 5
Risk 4
Risk 3
Risk 2
Mean Tooth LossMean Tooth Loss
Courtesy PreViser Corporation, all rights reserved
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Year 3 Year 9 Year 15
% o
f su
bje
cts
Risk 5
Risk 4
Risk 3
Risk 2
Percentage of Subjects with Tooth Percentage of Subjects with Tooth LossLoss
Courtesy PreViser Corporation, all rights reserved
0
1
2
3
4
5
6
7
Total teeth Periodontally affected Periodontally unaffected
Nu
mb
er
of
teeth
lost
Risk 2
Risk 3
Risk 4
Risk 5
Mean Number of Teeth LostMean Number of Teeth Lost
Only 26% did not have periodontal disease at baseline
Courtesy PreViser Corporation, all rights reserved
SummarySummary
Risk is distinct from diagnosisRisk is distinct from diagnosis The methods to determine risk and The methods to determine risk and
diagnosis are differentdiagnosis are different Risk cannot be accurately Risk cannot be accurately
determined from diagnosisdetermined from diagnosis OHIS™ accurately determines risk for OHIS™ accurately determines risk for
periodontitisperiodontitis
Courtesy PreViser Corporation, all rights reserved
OHIS™ is Practical for Clinical OHIS™ is Practical for Clinical UseUse
Only 23 data points, all of which are Only 23 data points, all of which are obtained during a routine periodontal obtained during a routine periodontal examinationexamination
Data entry, transmission over the Data entry, transmission over the Internet between the dentist’s Internet between the dentist’s computer and OHIS™ server takes computer and OHIS™ server takes less than 5 minutes and can be done less than 5 minutes and can be done at the convenience of staffat the convenience of staff
Courtesy PreViser Corporation, all rights reserved
Data Required by OHIS™Data Required by OHIS™
SmokingSmoking DiabetesDiabetes Subgingival calculusSubgingival calculus Subgingival Subgingival
restorationsrestorations PocketsPockets Furcation Furcation
involvementsinvolvements Vertical bone lesionsVertical bone lesions
AgeAge Radiographic bone Radiographic bone
heightheight History of periodontal History of periodontal
surgery for pocketssurgery for pockets Oral hygieneOral hygiene Dental care frequencyDental care frequency Bleeding on probingBleeding on probing
Courtesy PreViser Corporation, all rights reserved
OHIS™ Disease ScoreOHIS™ Disease Score
OHIS™ calculates a score that is OHIS™ calculates a score that is representative of the severity and extent of representative of the severity and extent of periodontal disease based the deepest pocket periodontal disease based the deepest pocket and greatest bone loss for each sextantand greatest bone loss for each sextant
The score ranges from 1 for health to 100 for The score ranges from 1 for health to 100 for severe periodontitissevere periodontitis
An increase in the score is indicative of An increase in the score is indicative of worsening disease status, whereas a worsening disease status, whereas a decrease is indicative of improvementdecrease is indicative of improvement
Courtesy PreViser Corporation, all rights reserved
OHIS™ Disease ScoreOHIS™ Disease Score
11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616
424244
434333
424255
434366
313133
424233
313133
323233
313133
323222
313122
222222
212122
222222
212122
222222
212122
222222
212133
222222
313133
222233
313133
323233
626244
525233
424244
333333
333333
424244
333333
424244
333334342323
323233
313133
313122
313133
313122
313122
212122
212122
212122221212
212122
212122
212122
212133
323222
313133
323244
313133
323244
414144
434333
414144
3232 3131 3030 2929 2828 2727 2626 2525 2424 2323 2222 2121 2020 1919 1818 1717
170
Tooth#
FacialLingual
LingualFacial
Tooth#
OHIS™ Disease Score = 21
Text-Linguistic Diagnosis = Localized Moderate Periodontitis
Courtesy PreViser Corporation, all rights reserved
OHIS™ Disease ScoreOHIS™ Disease Score
11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616
313155
333355
525255
535355
525255
535355
414155
535355
515133
525244
313133
333333
313155
333344
515144
535344
414144
434344
414144
434344
414144
434355
414155
535355
525255
535355
525244
545444
454566
414155
656555
525255
545455
515144
545455
414144
424255
414155
515155
515155
515155
515155
515155
525255
525255
535355
515155
515155
535355
515144
535355
424255
555555
525255
555555
515144
3232 3131 3030 2929 2828 2727 2626 2525 2424 2323 2222 2121 2020 1919 1818 1717
207
Tooth#
FacialLingual
LingualFacial
Tooth#
OHIS™ Disease Score = 36
Text-Linguistic Diagnosis = Generalized Moderate Periodontitis
Courtesy PreViser Corporation, all rights reserved
OHIS™ Disease ScoreOHIS™ Disease Score
11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616
535388
555588
737355
848455
535355
545455
535355
535355
535366
525255
626255
535355
525266
525255
424255
424244
636366
626266
434355
434355
434344
434344
333333
444444
434366
444466
636355
646455
545455
535355
545455
535355
545455
535355
444444
434344
434344
424244
333333
424244
333333
424244
333333
424244
333333
424244
333333
424244
333333
424244
333333
424244
333355
424266
636355
636355
3232 3131 3030 2929 2828 2727 2626 2525 2424 2323 2222 2121 2020 1919 1818 1717
111A
Tooth#
FacialLingual
LingualFacial
Tooth#
OHIS™ Disease Score = 92
Text-Linguistic Diagnosis = Generalized Moderate to Severe Periodontitis
Courtesy PreViser Corporation, all rights reserved
SummarySummary
Risk and disease scores can be used to monitor Risk and disease scores can be used to monitor periodontal status simply and quicklyperiodontal status simply and quickly
A high risk score or an increase predicts A high risk score or an increase predicts worsening disease and a higher disease score worsening disease and a higher disease score and that the current treatment is not and that the current treatment is not effectively managing the risk factorseffectively managing the risk factors
An increase in disease score indicates that the An increase in disease score indicates that the current treatment is not maintaining current treatment is not maintaining periodontal status and a change in treatment is periodontal status and a change in treatment is indicatedindicated
Courtesy PreViser Corporation, all rights reserved
Clinical ImplicationsClinical Implications
Health InitialStage
DetectableStage
ModerateDisease
SevereDisease
TerminalDisease
Diagnosis is used to determine treatment for existing “visible” lesions (Reparative treatment)
Courtesy PreViser Corporation, all rights reserved
Clinical Implications, cont.Clinical Implications, cont.
Health InitialStage
DetectableStage
ModerateDisease
SevereDisease
TerminalDisease
Risk is used to:• Justify treatment• Modulate intensity and aggressiveness• Determine treatment to prevent future lesions (Preventative treatment) Courtesy PreViser Corporation, all rights reserved
Incorporating Risk Concepts Incorporating Risk Concepts into Treatment Planninginto Treatment Planning
Risk is the fundamental principle that should Risk is the fundamental principle that should justify treatmentjustify treatment Low risk means that disease is unlikely to progress Low risk means that disease is unlikely to progress
and justification for treatment is minimally supportedand justification for treatment is minimally supported High risk means that disease is likely to progress and High risk means that disease is likely to progress and
justification for treatment is maximally supportedjustification for treatment is maximally supported Risk is used to determine preventive Risk is used to determine preventive
interventionsinterventions Risk is also used to modulate the intensity and Risk is also used to modulate the intensity and
aggressiveness of reparative treatmentaggressiveness of reparative treatment
Courtesy PreViser Corporation, all rights reserved
Treatment Intensity and Treatment Intensity and AggressivenessAggressiveness
An ExampleAn Example
Treatment for a 75 year old patient with Treatment for a 75 year old patient with generalized 6 mm pockets may be generalized 6 mm pockets may be limited to periodontal maintenance limited to periodontal maintenance whereas surgery may be selected for a whereas surgery may be selected for a 35 year old patient with the same 35 year old patient with the same conditions when the risk level of the conditions when the risk level of the older patient is much lower than the older patient is much lower than the younger patient.younger patient.
Courtesy PreViser Corporation, all rights reserved
Doomed by high risk?Doomed by high risk?
It is possible to be at high risk and not suffer It is possible to be at high risk and not suffer the consequences of terminal disease by the consequences of terminal disease by management of the risk factors. For management of the risk factors. For example:example: Drugs to lower blood pressure and cholesterol Drugs to lower blood pressure and cholesterol
can prevent cardiovascular eventscan prevent cardiovascular events Blood-sugar control can prevent diabetic Blood-sugar control can prevent diabetic
complicationscomplications Daily personal oral hygiene controls bacterial Daily personal oral hygiene controls bacterial
plaque preventing caries and periodontitisplaque preventing caries and periodontitis Periodontal surgery that eliminates pockets Periodontal surgery that eliminates pockets
improves plaque control effectiveness to prevent improves plaque control effectiveness to prevent periodontitisperiodontitis
Courtesy PreViser Corporation, all rights reserved
Periodontal Disease Periodontal Disease Management GoalsManagement Goals
Preservation of bone and teethPreservation of bone and teeth Prevent surgeryPrevent surgery Prevent inflammationPrevent inflammation Repair damaging effects of Repair damaging effects of
periodontitisperiodontitis
Courtesy PreViser Corporation, all rights reserved
Periodontal Referrals 1980 vs. Periodontal Referrals 1980 vs. 20002000
Greater loss of teeth at the initial Greater loss of teeth at the initial periodontal examinationperiodontal examination
More severe periodontitis at the More severe periodontitis at the initial periodontal examinationinitial periodontal examination
More teeth were planned for More teeth were planned for extractionextraction
Cobb C et al. J Periodontol 2003; 74: 1470-1474
Courtesy PreViser Corporation, all rights reserved
Severe PeriodontitisSevere Periodontitis
Every patient who has severe periodontitis Every patient who has severe periodontitis had, at a prior time, mild periodontitis, and had, at a prior time, mild periodontitis, and before that was healthy. The progression of before that was healthy. The progression of disease could have been predicted by risk, disease could have been predicted by risk, which would have allowed for more timely which would have allowed for more timely and effective treatment.and effective treatment.
Periodontitis is generally slowly progressive, Periodontitis is generally slowly progressive, which may obscure disease worsening, which may obscure disease worsening, especially when 168 pockets and bone especially when 168 pockets and bone height measurements need to be compared.height measurements need to be compared.
Courtesy PreViser Corporation, all rights reserved
SummarySummaryWithholding preventative treatment from healthy, at-risk patients denies them the opportunity to remain healthy and prevent complex reparative treatment
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<30 30-39 40-49 50-59 >59
Age Cohort
% o
f A
ge C
oh
ort
Healthy, no risk
Healthy, at-risk
Periodontitis
Courtesy PreViser Corporation, all rights reserved
SummarySummary
An accurate determination of risk and its An accurate determination of risk and its change over time is required to properly and change over time is required to properly and dynamically plan treatment for periodontitisdynamically plan treatment for periodontitis
An accurate determination of periodontal An accurate determination of periodontal status including its change over time is status including its change over time is required to dynamically establish proper required to dynamically establish proper treatment recommendationstreatment recommendations
OHIS™ provides a simple and accurate OHIS™ provides a simple and accurate method to document risk, disease status and method to document risk, disease status and any changes that occurany changes that occur
Courtesy PreViser Corporation, all rights reserved
SummarySummary
Risk predicts the progression of diseaseRisk predicts the progression of disease Risk justifies treatmentRisk justifies treatment Risk for periodontitis is stratified across a Risk for periodontitis is stratified across a
populationpopulation Risk cannot be determined from diagnostic Risk cannot be determined from diagnostic
findingsfindings Risk and diagnosis are required to Risk and diagnosis are required to
determine treatmentdetermine treatment Treatment must be personalized for each Treatment must be personalized for each
patientpatient
Courtesy PreViser Corporation, all rights reserved