Risk Profiles
Introduction
By combining the symptoms of disease (prevalence, incidence, treatment needs, etc); etiologic factors; external modifying risk indicators, risk factors, and prognostic risk factors; internal modifying risk indicators, risk factors, and prognostic risk factors; and preventive factors, it is possible to present risk profiles for tooth loss, dental caries, and periodontal diseases in graphic form. This can be done manually or by computer. The degree of risk, 0, 1, 2, or 3, is visualized using green, blue, yellow, and red, respectively. The graphs are also appropriate tools for communication with the patient when discussing the details of case findings and treatment recommendations.
Combined risk profiles for dental caries and periodontal diseases Because some patients may suffer from both dental caries and periodontal diseases, risk profiles for these diseases can be designed in combination or separately. Figure 137 illustrates a combined risk profile for a patient, who after the first detailed examination and history taking, was classified as a high-risk patient for both dental caries and periodontal diseases (C3P3), on the following basis:
1. The prevalence of caries and the prevalence of periodontitis were high.
2. The incidence of caries and periodontitis had been very high.
3. The patient had been exposed to many etiologic factors, both nonspecific (high plaque formation rate and plaque volume) and specific (caries-related pathogens and periopathogens).
4. The patient exhibited many external and internal modifying risk indicators, risk factors, and prognostic risk factors for dental caries as well as periodontal diseases.
a. For dental caries, the most important external factors were high frequency of intake of sticky, sugar-containing products and medication with salivary depressive side effects. For periodontal diseases, the most important external factor was regular smoking of 10 to 20 cigarettes per day.
b. Among internal factors, the most important for dental caries was reduced stimulated salivary secretion rate (0.6 mL/min). For periodontal diseases, it was diabetes mellitus.
5. The standard of oral hygiene was very low, and dietary habits were poor.
6. The patient had no preventive dental care habits and his dental care visits were irregular.
After presentation of the case findings and a session of self-diagnosis, the dentist and patient discussed a treatment strategy based on sharing of responsibilities between the patient (the owner of the oral cavity) and the oral health personnel. Two years later, he was classified as a low-risk patient for both dental caries and periodontal diseases (C1P1), on the following basis:
1. The etiologic factors had been dramatically reduced (from red to green), by an initial intensive combination of mechanical and chemical plaque control (self-care and professional) and by maintenance of a high standard of plaque control, ie, a dramatic improvement in the most important preventive factors.
2. Treatment needs (excavation and restoration of open carious lesions, and scaling,
root planing, and debridement of diseased periodontal pockets) and plaque-retentive
factors were eliminated.
3. Important external modifying factors were reduced. The patient stopped smoking
and reduced the estimated daily sugar clearance time by 80%. In addition, there was
no further need of medicine with salivary depressive effects. As a consequence of this
and regular use of fluoride chewing gum, the salivary secretion rate increased from
0.6 mL/min to 1.0 mL/min.
4. The use of fluorides was increased. A new fluoride toothpaste technique was
introduced, and use of fluoride chewing gum was recommended after meals; this was
supplemented by professional application of fluoride varnish.
As a consequence of these preventive measures and the healthier lifestyle, the patient
developed no new carious lesions and experienced no further loss of periodontal
support.
