A pilot study of risk-based prevention in private practice.
BACKGROUND
Risk-based prevention is a means of ensuring that patients receive preventive treatment appropriate for their risk of disease. While straightforward, its application in private practice has not been examined.


METHODS
Volunteer clinicians in 15 offices participated in a six-month pilot study to test methods for a larger, risk-based prevention demonstration study operated by a dental insurer. Concomitant with oral examinations for patients of this insurer, clinicians identified patients at elevated risk of developing dental caries and periodontitis. For these patients, the reasons for elevated risk (risk indicators), as well as planned preventive treatment in response to that risk, were recorded and transmitted to the insurer via the claim form.


RESULTS
The clinicians identified relatively small percentages of patients as being at high risk of developing caries (4 percent) and periodontitis (7 percent), with little variation across the 15 offices. Larger proportions of patients were identified as being at moderate risk of developing caries (29 percent) and periodontitis (30 percent), with more extensive variation across offices. In general, patients classified as being at elevated risk had received more disease-related treatment than patients at low risk before the classification, which provided some validation for the accuracy of risk assessment.


CONCLUSIONS
The results of this pilot study suggest that formal, risk-based prevention can be accomplished in dental offices. Clinicians' reported risk assignments and indicators, together with their planned preventive treatments, demonstrate a good understanding of risk-based prevention.


CONCLUSIONS
Researchers may need to clarify the criteria used to assess moderate risk of developing dental caries, and clinicians may need to emphasize greater use of fluorides and more frequent recall visits for adults at elevated risk of developing dental caries.
Bader
James D
JD
Department of Operative Dentistry, School of Dentistry, The University of North Carolina at Chapel Hill, 27599-7450, USA. jim_bader@unc.edu
Shugars
Daniel A
DA
Kennedy
James E
JE
Hayden
William J
WJ
Baker
Susan
S
D000328:Adult; D002327:Cariostatic Agents / Q000627:therapeutic use; D004245:DMF Index; D003731:Dental Caries / Q000517:prevention & control*; D003733:Dental Caries Susceptibility; D003793:Dental Restoration, Permanent; D004198:Disease Susceptibility; D005459:Fluorides / Q000627:therapeutic use; D006801:Humans; D009910:Oral Hygiene; D010347:Patient Care Planning; D010512:Periodontal Index; D010518:Periodontitis / Q000517:prevention & control*; D010865:Pilot Projects; D011331:Private Practice; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking
D002327:Cariostatic Agents; D005459:Fluorides