title: Patient stratification for preventive care in dentistry.
abstract: Prevention reduces tooth loss, but little evidence supports biannual preventive care for all adults. We used risk-based approaches to test tooth loss association with 1 vs. 2 annual preventive visits in high-risk (HiR) and low-risk (LoR) patients. Insurance claims for 16 years for 5,117 adults were evaluated retrospectively for tooth extraction events. Patients were classified as HiR for progressive periodontitis if they had ≥ 1 of the risk factors (RFs) smoking, diabetes, interleukin-1 genotype; or as LoR if no RFs. LoR event rates were 13.8% and 16.4% for 2 or 1 annual preventive visits (absolute risk reduction, 2.6%; 95%CI, 0.5% to 5.8%; p = .092). HiR event rates were 16.9% and 22.1% for 2 and 1 preventive visits (absolute risk reduction, 5.2%; 95%CI, 1.8% to 8.4%; p = .002). Increasing RFs increased events (p < .001). Oral health care costs were not increased by any single RF, regardless of prevention frequency (p > .41), but multiple RFs increased costs vs. no (p < .001) or 1 RF (p = .001). For LoR individuals, the association between preventive dental visits and tooth loss was not significantly different whether the frequency was once or twice annually. A personalized medicine approach combining gene biomarkers with conventional risk factors to stratify populations may be useful in resource allocation for preventive dentistry (ClinicalTrials.gov, NCT01584479).
authors.affiliation: Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, MI, USA. william.giannobile@umich.edu
authors.forename: W V
authors.initials: WV
authors.lastname: Giannobile
authors.forename: T M
authors.initials: TM
authors.lastname: Braun
authors.forename: A K
authors.initials: AK
authors.lastname: Caplis
authors.forename: L
authors.initials: L
authors.lastname: Doucette-Stamm
authors.forename: G W
authors.initials: GW
authors.lastname: Duff
authors.forename: K S
authors.initials: KS
authors.lastname: Kornman
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D002908:Chronic Disease; D015331:Cohort Studies; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D005838:Genotype; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007347:Insurance, Dental / Q000706:statistics & numerical data; D007375:Interleukin-1 / Q000235:genetics; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010518:Periodontitis / Q000453:epidemiology; D011313:Preventive Dentistry / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014081:Tooth Extraction / Q000706:statistics & numerical data; D016388:Tooth Loss / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D007375:Interleukin-1
keywords: comparative effectiveness research; health care delivery; interleukin polymorphisms; oral health; periodontal disease; personalized medicine