Personalized prevention – case-oriented needs adaptation
Based on the article 'Individualisierte Prävention – fallorientierte Bedarfsadaptation' by Gerhard Schmalz and Dirk Ziebolz, published in ZWR 2020; 129(01/ 02): pp. 33–41
A patient-oriented tailoring of preventative measures seems to be next logical step to counter the complexity of oral diseases for the future. Although existing strategies – for example, caring for periodontitis patients by means of supportive periodontitis treatment (SPT) – can stabilize the treatment outcome of an individual disease, their integration in a case-specific and needs-oriented preventative approach is lacking.
To determine the patient’s individual requirements, three need factors are taken into account: existing oral diseases, existing treatments (fillings, prostheses, orthodontic treatments) and current dental findings (Fig. 1).
These factors are evaluated according to their risk of progression and development. Here, ‘risk of progression’ denotes the increased likelihood of an existing oral disease progressing, and ‘risk of development’ provides important information about the patient’s likelihood of developing a new oral disease. On this basis, the described classification is based on a division into three possible need categories, which define a correspondingly low (green), moderate (yellow) or high (red) risk of progression and/or development (Tab. 1).
As it is difficult to make an assessment on the basis of an individual case, the case-specific, needs-adapted preventative approach requires precise analysis of the specified parameters. Oral diagnostics and a detailed, current and specific patient history, taken as part of the prevention session, are essential. The needs assessment is supplemented by additional recent findings, particularly oral hygiene indices. From this synthesis an individual needs profile can be calculated, which determines the structure and frequency of prevention sessions (Fig. 2).
In doing so, the approach of personalized, needs-orientated prevention aims to provide a complex assessment of the patient’s overall needs. In their article Schmalz and Ziebolz examine this approach in detail with illustrative need factors, taking into account their practical consequences for dental prevention.
Table 1: Definition of the three categories within the needs profile, based on the risk of development and risk of progression.
|Category||Risk of development||Risk of progression|
|Low||No increased risk of the development a new oral disease||No increased risk of the progression of an existing oral disease|
|Moderate||Failure to consider the need factor can lead to the development of new oral diseases||Failure to consider the need factor can lead to the progression of an existing oral disease|
|High||Failure to consider the need factor is very likely to lead to the development of a new oral disease||Failure to observe the need factor is very likely to lead to the progression of an existing oral disease|
Figure 1: Breakdown of need factors, the sum of which constitutes the patient’s needs profile. This influences the structure and content of the prevention session. Every need factor inherently poses a potential risk of development and a potential risk of progression risk.
Figure 2: Needs-based prevention is determined by the patient’s oral health history, treatment status and current findings. The most important examples in the individual subdivisions are summarized in the figure.