Inside Dentistry May 2010 : Page 111

NA VIGA TING RISKASSESSMENT By assessing the hidden risk factors your patients may be harboring in six key areas, you may be able to provide a higher standard of intervention that could result in more conservative therapies and better outcomes. By Allison M. DiMatteo, BA, MPS I n dentistry today, assessing patient risk is a critical com- ponent of a well thought-out treatment plan. Generally speaking, risk is defined as the likelihood that injury, damage, or loss will occur. In dentistry, a patient risk assessment can be developed by analyzing a patient’s presenting conditions and assessing the potential ramifi cations of those condi- tions based on the clinician’s knowl- edge and historical documentation, where possible. “As dentists, when wetreatment plan, wereally want to team risk with progno- sis. Prognosis is defi ned as the forecast of the probable result of a disease or course of treatment,” explains Michael R. Sesemann, DDS, sitting president of the American Academy of Cosmetic Den- tistry (2009 to 2010). “When taken to- gether, a practitioner can extrapolate the eff ects of not treating a certain condition and what would occur if the condition were to be treated in one way or another. This analysis forms the rationale of our recommendations to the patient.” After assessing the patient’s present- ing condition(s) and determining the course a condition would take without treatment, dentists then can propose how a particular treatment would aff ect the natural course. In general, clinicians striveto make treatment decisions that will lower the risk for continued dete- rioration of a particular condition. If a suggested treatment is supported by dental science to lower risk, then that treatment is validated, Sesemann says. Conversely,if a treatment is considered that adds to the risk in the general over- all oral health of the patient, then that treatment must be refuted, he says. “Complexities arise when a treat- ment solution achieves one set of ob- jectives, yet the overall oral health of the patient becomes at higher risk in a diff erent area. The trade-off s are not worth implementing the treatment,” Sesemann explains. “For instance, in a practice that has a high volume of pa- tients wanting esthetics, people pres- ent wishing to have certain esthetic objectives fulfi lled. In these cases, the biomechanical implications of various treatment options must be strongly considered. There must be an overall appraisal if a proper risk assessment is to be utilized. By reducing risk across myriad factors, we ultimately want to render treatment that lowers stress and failure and increases treatment prog- nosis and predictability.” Therefore, when it comes to patient risk assessment, Sesemann believes the single most important piece of equip- ment is the practitioner’s brain—which is essentially what patients are buying, not a dental commodity. Con tinuing education after graduation is essential. Further, he adds that in order to re- sponsibly treatment plan, clinicians must havecommand of the risk profi les associated with dental disease in four major categories: dentofacial, biome- chanics, functional, and periodontics. For example, with biomechanics, when patients are at high risk for caries, proper treatment will include certain restoration designs that may diff er from a low-risk patient, Sesemann says. A high-risk caries patient also requires a treatment plan that would include a protocol to lower the future caries risk after restorative treatment; this could include preventive resin restorations (eg, sealing remaining pits and fi ssures, fl uoride treatments, fl uoride varnish, a caries-free rinse protocol, etc). “Knowing the diff erence between a high-risk caries patient and a low-risk caries patient through proper data col- lection and treatment planning can be the diff erence between a long-term, successful dentist/patient relationship without high amounts of restorative dentistry, versus a relationship in a continuous, protracted struggle to keep up with decay,” Sesemann cautions. In periodontics, risk factors in con- junction with bacteria and the host response can aff ect the severity of the disease, patterns of destruction, and the response to therapy. Given the diver- sity among individuals and teeth with respect to susceptibility to periodontal disease, a determination through data collection of specifi cally innate (eg, high natural amounts of pathologic bacteria or extensiveimmune response to bacterial insult), acquired (eg, health changes or medications), and environ- mental (eg, smoking) criteria can help form an overall risk assessment of the individual to periodontal changes, Sesemann elaborates. Based on an understanding of the role each factor plays, treatment plans can be formu- lated to eff ectively combat the disease and contain future risks. Without that determination and inclusion in the di- agnosis, treatment plans may be suc- cessful long-term, or they may not, he emphasizes. This month, Inside Dentistryexplores where dentistry stands in terms of risk assessment by examining what’s taking place in the areas of diagnosing and as- sessing patients for caries, periodontal disease, oral cancer, craniofacial pain and temporomandibular joint disor- der (TMD), erosion, and dry mouth. In particular, we examine what dentistry has done in the past and look to what lies ahead. | May 2010 | INSIDE DENTISTRY 111

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