Transcript Patient-Centered Risk-Based Treatment Explanation

Patient-Centered Explanation
of Risk-Based Treatment
Gum Disease
Gum Disease Defined
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An infection caused by bacteria commonly
found in the mouth that destroys the
jawbone
Gingivitis and Periodontitis are two
different types of gum disease
They are distinguished by the type of
bacteria and presence of bone loss
Periodontitis is not more severe Gingivitis
Development of Gum Disease
Teeth Cleaned Every
Health
3 or more days
maintained
Health
2 or less days
never
0
Initial disease event
Gingivitis
Periodontitis
1
2
3
4
5
Timeline (weeks)
6
?
“Teeth Cleaned” Clarified
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All tooth surfaces including between teeth
Nearly all periodontitis lesions are at the sites
between teeth where a tooth brush and oral
rinse does not reach
The equivalent of not cleaning between teeth is
washing the palm and back of your hands but
not between your fingers
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Rinsing hands with water is not an effective
alternative to scrubbing with soap
Diagnosis of Gum Disease
Health
Gingivitis Periodontitis
Gums bleed when
examined
No
Yes
Yes
Deep pockets
No
Possibly
Yes
Bone loss visible
on x-rays
No
No
Yes
Disease State
1-100 scale of
current health or
disease state
based on the
number of teeth
affected, pocket
depth, and
amount of bone
loss
Score
1
Diagnosis
Health
2-3
Gingivitis
4-10
Beginning Periodontitis
11-36 Moderate Periodontitis
37-100 Severe Periodontitis
Occurrence of Symptoms
0 1 hour
Anaphylactic
Shock
6 weeks
Time line
Bleeding gums
30 years
Heart Attack
• Each symptom occurs at the end of the colored bar
• Each disease process is invisible to diagnostic methods
for most or all of the time within the colored bar
• Risk predicts chronic disease occurrence
The Initial Disease Event is
Indistinguishable from Health
Disease State
Severe Periodontitis
The Realm of Diagnosis,
which requires the disease is
sufficiently advanced to be
“Visible”
Moderate Periodontitis
Beginning Periodontitis
Gingivitis
“Invisible” to diagnostic
techniques
Initial Disease Process
Health
Risk Defined
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Risk is a prediction that disease will occur
or progress
Risk is distinct from disease and cannot be
accurately predicted from the disease
state
Risk is determined by risk factors
Risk-Based Treatment
Disease State
Severe Periodontitis
Risk-based treatment
prevents disease
progression
Moderate Periodontitis
Beginning Periodontitis
Gingivitis
Risk-based treatment
prevents disease occurrence
Initial Disease Process
Health
Repair and Prevention
Disease State
Severe Periodontitis
Repair treats the
consequences of disease,
which may increase the risk
of new disease
Moderate Periodontitis
Beginning Periodontitis
Gingivitis
Prevention maintains a
clinically healthy state
Initial Disease Process
Health
Routine Care
Tooth loss for 523 patients
during 15 years of routine dental care
risk 2
100%
risk 3
90%
80%
risk 4
70%
risk 5
60%
% of patients
with tooth loss
50%
40%
30%
20%
10%
0%
0
1-3
# of teeth lost
>3
Risk-Based Care
Tooth loss for 230 patients during 16 years of
periodontal treatment by Dr. John Martin
% of patients
with tooth loss
100%
risk 2
90%
risk 3
80%
risk 4
70%
risk 5
60%
50%
40%
30%
20%
10%
0%
0
1-3
# of teeth lost
>3
Risk-Based Care, cont.
Tooth loss rate
6.00
5.00
4.00
# of teeth lost
per
3.00
patient for 15
years
2.00
routine dental care
treatment by Dr.
John Martin
1.00
0.00
risk 2
risk 3
risk 4
Risk group
risk 5
Repair and Disease Severity
Surgical Procedures for Periodontitis
average 3.3 procedures
100%
90%
average 2.2 procedures
80%
70%
60% average 1.7 procedures
% patients
no surgery
50%
1 surgical procedure
40%
30%
2 or more procedures
20%
10%
0%
beginning
periodontitis
moderate
periodontitis
severe
periodontitis
Determining Risk and Treatment
About PreViser
PreViser Corporation provides web-enabled diagnostic
decision support tools for dentists. The tools are simple,
inexpensive and easy to use. The first clinically proven
application is within dental care, where the use of
PreViser technology will assist oral health care
professionals to more effectively plan treatment
responses to disease.
Find out more about the
PreViser Risk Calculator
Download and Try it for Free.
The tools are built under protection of U.S. patent
number 6,484,144 with an exclusive license to PreViser
Corporation. This intellectual property protects a selfupdating system of diagnosis that uses easily collected
clinical measurements to calculate the risk of disease
development or deterioration of a current disease state,
and identifies therapies most likely to reduce risk and
disease severity.
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Referral Criteria
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High risk patients; establish a threshold
for your particular practice
Low risk patients; establish a protocol
when risk increases by a certain amount
Dealing with Objections
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I’ll do it later
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Risk is an accurate predictor of your future
disease state and a worse disease state
requires more treatment
My symptoms aren’t bad enough
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Symptoms, visible entities, are a poor
indicator of disease severity; e.g. the first
symptom of heart disease is a heart attack
Objections, cont.
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It costs too much; My insurance doesn’t cover it
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Treatment done later when the disease advances will
cost more and more teeth might require extraction
Dentures could ultimately cost more than “saving”
your teeth
Insurance doesn’t care if you have dentures
Dentures are OK
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Dentures, especially lower ones, are not always
successful, which then requires implants
Objections, cont.
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Treatment hurts
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Current treatment methods minimize
discomfort
Flossing is too hard; no time to floss
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Tying shoelaces for a child is difficult but they
learn the skill
Flossing takes only a minute or two after the
skill is learned
Objections, cont.
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I don’t have time for treatment
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The time needed when disease advances will
be greater and the cost higher
Treatment doesn’t work, I’ll lose my teeth
anyway
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This is a self-fulfilling prophecy, which will
increase failure
Treatment is not successful for only 5% to
10% of patients
Objections, cont.
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I’ll just have my teeth cleaned every 6
months
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This is generally not effective when risk is 3 or
higher
I’ll just have the deep cleaning, no surgery
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Deep cleaning is generally not effective for
pockets that are deeper than 5 mm, especially
when risk is 3 or higher