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OHIS

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OHIS

  1. 1. The Oral Health Information Suite™ Its Use in the Management of Periodontal Disease
  2. 2. The O ral H ealth I nformation S uite™ <ul><li>What is OHIS™? </li></ul><ul><li>When and How is it used? </li></ul><ul><li>Why should OHIS™ be used? </li></ul><ul><ul><li>Benefits from OHIS™ use </li></ul></ul>
  3. 3. What is OHIS™? <ul><li>A patent protected Internet-accessed information system that is comprised of a suite of related tools for the major oral health conditions including: </li></ul><ul><ul><li>Caries </li></ul></ul><ul><ul><li>Periodontal disease </li></ul></ul><ul><ul><li>Oral cancer </li></ul></ul><ul><li>Each tool includes: </li></ul><ul><ul><li>A scientifically derived mathematic algorithm using objective quantitative measurements to determine risk level </li></ul></ul><ul><ul><li>A list of recommended interventions, stack-ranked by three levels of effectiveness based on the published literature and current standards of care for the patient’s unique conditions </li></ul></ul>
  4. 4. What is OHIS™?, cont. <ul><li>OHIS was designed to be easily incorporated into the normal workflow utilizing information of a traditional examination and accommodating the unique characteristics and needs of the patient, clinician, and treatment procedures. </li></ul><ul><li>Unique for clinical dentistry by virtue of quantifying the risk for future disease in addition to quantifying the current periodontal disease state. </li></ul><ul><ul><li>Provides the means to measure oral health care and determine its value </li></ul></ul><ul><ul><li>Facilitates quality care and continuous improvement </li></ul></ul>
  5. 5. What is the Current Treatment Flow and How Would it Change with OHIS™?
  6. 6. Current Treatment Flow Treatment Plan Finalized Treatment Provided Examination Diagnosis Re-
  7. 7. OHIS™ Treatment Flow OHIS™ is an intelligent self-correcting system, as outcomes information determined in “Analysis” is used to refine risk assessment and appropriate treatment including the rank order of effectiveness. Examination Treatment Plan Finalized Treatment Provided OHIS™ Processing Report Returned to Clinician’s Computer Algorithm Refinements Analysis Diagnosis Re-
  8. 8. OHIS™ and HIPAA Compliance <ul><li>Compliance with HIPAA is accomplished by de-identifying the examination and treatment information sent to OHIS™. </li></ul><ul><li>The clinician’s computer is the only site where information that identifies the patient resides. </li></ul><ul><li>OHIS™ assigns a unique 32-character identification number to locate the records of a patient. </li></ul><ul><ul><li>This creates a secure means to transfer a patient’s entire collection of records, as only the patient and clinician have access to both the identification number and identity of the patient. </li></ul></ul>
  9. 9. Who Developed OHIS? How is it Obtained?
  10. 10. www.previser.com
  11. 12. How Does OHIS™ Technology Enhance Current Practice Methods? <ul><li>Diagnosis </li></ul><ul><li>Risk Assessment </li></ul><ul><ul><li>Disease and Risk </li></ul></ul><ul><li>Treatment Plans </li></ul><ul><ul><li>Incorporating risk concepts </li></ul></ul>
  12. 13. Current Diagnostic Method 28 X 2 = 56 Radiographic bone loss 28 X 4 = 112 Bleeding points 598 TOTAL 28 X 4 = 112 Plaque score 28 + 14 = 42 Attached gingiva 4 X 3 + 6 X 2 = 24 Furcations 28 X 2 = 56 Recession 28 X 1 = 28 Tooth mobility 28 X 6 = 168 Pocket depth Data Points Clinical Condition
  13. 14. The Basis for Text-Linguistic Diagnoses <ul><li>5 Severity States </li></ul><ul><ul><li>Health </li></ul></ul><ul><ul><li>Gingivitis </li></ul></ul><ul><ul><li>Beginning Periodontitis </li></ul></ul><ul><ul><li>Moderate Periodontitis </li></ul></ul><ul><ul><li>Severe Periodontitis </li></ul></ul><ul><li>2 Extent States </li></ul><ul><ul><li>Localized </li></ul></ul><ul><ul><li>Generalized </li></ul></ul><ul><li>Text-Linguistic Connections </li></ul><ul><ul><li>And </li></ul></ul><ul><ul><li>To </li></ul></ul>Yields
  14. 15. 17 Text-Linguistic Diagnoses Localized Beginning and Severe Periodontitis Localized Moderate and Severe Periodontitis Localized Severe Periodontitis Generalized Beginning to Severe Periodontitis Generalized Beginning and Localized Severe Periodontitis Generalized Moderate to Severe Periodontitis Generalized Moderate and Localized Severe Periodontitis Generalized Severe Periodontitis Severe Periodontitis Localized Beginning and Moderate Periodontitis Localized Moderate Periodontitis Generalized Beginning to Moderate Periodontitis Generalized Beginning and Localized Moderate Periodontitis Generalized Moderate Periodontitis Moderate Periodontitis Localized Beginning Periodontitis Generalized Beginning Periodontitis Beginning Periodontitis Gingivitis Gingivitis Health Health Text Nomenclature Severity
  15. 16. Can Clinicians Determine a Periodontal Diagnosis Quickly and With a High Level of Agreement? <ul><li>Please determine a periodontal diagnosis from the periodontal charting and full mouth radiographs on the following slides. </li></ul><ul><li>Thank you. </li></ul>
  16. 17. What is Your Diagnosis? 170 Tooth# Facial Lingual Lingual Facial Tooth# 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 433 414 324 414 324 313 322 313 212 213 212 212 212212 212 212 312 312 312 313 323 313 333423 333 424 333 424 424 333 624 523 313 323 313 223 213 222 212 222 212 222 212 222 312 222 313 322 313 323 313 423 425 436 424 433 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 OHIS™ Disease Score = 21 Text-Linguistic Diagnosis = Localized Moderate Periodontitis
  17. 18. What is Your Diagnosis? 207 Tooth# Facial Lingual Lingual Facial Tooth# 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 555 514 555 525 535 425 535 514 515 515 525 535 515 525 515 515 515 515 425 415 545 414 545 514 655 525 456 415 524 544 525 535 415 535 414 435 414 434 414 434 514 534 315 334 313 333 513 524 415 535 525 535 525 535 315 335 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 OHIS™ Disease Score = 36 Text-Linguistic Diagnosis = Generalized Moderate Periodontitis
  18. 19. What is Your Diagnosis? 111A Tooth# Facial Lingual Lingual Facial Tooth# 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 635 635 335 426 333 424 333 424 333 424 333 424 333 424 333 424 333 424 434 424 444 434 545 535 545 535 545 535 635 645 436 446 333 444 434 434 435 435 636 626 425 424 526 525 625 535 536 525 535 535 535 545 735 845 538 558 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 OHIS™ Disease Score = 92 Text-Linguistic Diagnosis = Generalized Moderate to Severe Periodontitis
  19. 20. What is Your Diagnosis? 111B Tooth# Facial Lingual Lingual Facial Tooth# 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 645 635 545 526 535 525 535 525 525 525 525 525 525 525 525 525 525 525 525 525 535 535 535 535 545 535 545 535 735 735 437 337 333 333 434 434 435 434 636 635 425 435 526 535 625 535 536 535 535 435 535 534 735 635 537 537 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 OHIS™ Disease Score = 97 Text-Linguistic Diagnosis = Generalized Severe Periodontitis
  20. 21. Current Diagnostic Method Summary <ul><li>Time-consuming process to document clinical findings, which at a minimum consists of 168 pocket depth measurements </li></ul><ul><li>No standard and simple method exists to describe one set of nearly 600 data points </li></ul><ul><ul><li>Wide variation exists in the determination of a diagnosis </li></ul></ul>
  21. 22. Current Diagnostic Method Summary <ul><li>Text nomenclature for diagnosis is complicated and not very descriptive </li></ul><ul><ul><li>Text-based diagnoses are insufficiently precise to compare a single patient over time or multiple patients, as similar conditions may be described by the same diagnosis </li></ul></ul>
  22. 23. OHIS™ Diagnostic Method <ul><li>OHIS™ presents a standardized, objective, and simplified method for summarizing results of the standard periodontal examination into a clear, 1 – 100 scale describing the disease state </li></ul><ul><li>No special tests are required, and only 13 data points are needed to quantify a periodontal diagnosis </li></ul><ul><li>A numeric and text periodontal diagnosis can be obtained in seconds after the data is recorded </li></ul>Martin JA et al. A numeric method to describe a periodontal disease state. In preparation
  23. 24. OHIS™ Diagnostic Method, cont. <ul><li>The method uses the combination of sextant severity diagnoses, which includes: </li></ul><ul><ul><li>Health, Gingivitis, and Beginning, Moderate, and Severe Periodontitis, and where </li></ul></ul><ul><li>Sextant severity diagnosis is based on: </li></ul><ul><ul><li>Deepest pocket </li></ul></ul><ul><ul><li>Greatest radiographic bone height distance from the cemento-enamel junction </li></ul></ul><ul><ul><li>Bleeding on probing </li></ul></ul>
  24. 25. 3 level scale 3 level scale Bitewings are minimally required although some loss of accuracy will occur
  25. 26. Assignment of a Sextant Severity Diagnosis * Bleeding on probing exists Severe Periodontitis Severe Periodontitis Moderate Periodontitis >7mm Severe Periodontitis Moderate Periodontitis Beginning Periodontitis 5-7mm Moderate Periodontitis Beginning Periodontitis Gingivitis* <5mm Pocket Depth >4mm 2-4mm <2mm Bone Height Distance from CEJ
  26. 27. Assignment of a Sextant Severity Diagnosis * Bleeding on probing does not exist Severe Periodontitis Severe Periodontitis Moderate Periodontitis >7mm Severe Periodontitis Moderate Periodontitis Beginning Periodontitis 5-7mm Moderate Periodontitis Beginning Periodontitis Health* <5mm Pocket Depth >4mm 2-4mm <2mm Bone Height Distance from CEJ
  27. 28. Why Sextant Diagnosis is Used <ul><li>28 teeth listed in order of their diagnosis is 5 28 =3.7x10 19 permutations </li></ul><ul><li>28 teeth grouped and counted by diagnosis is 35,960 combinations </li></ul><ul><li>Sextants listed in order of their diagnosis is 5 6 =15,625 permutations </li></ul><ul><li>Sextants grouped and counted by diagnosis is 210 combinations </li></ul><ul><ul><li>Approximately 2 combinations of sextant diagnosis correspond to 1 disease score in the 1-100 scale </li></ul></ul><ul><ul><li>The non-uniformity of the scale occurs as a condition of combinations </li></ul></ul>
  28. 29. Localized Beginning and Severe Periodontitis Localized Moderate and Severe Periodontitis Localized Severe Periodontitis Generalized Beginning to Severe Periodontitis Generalized Beginning and Localized Severe Periodontitis Generalized Moderate to Severe Periodontitis Generalized Moderate and Localized Severe Periodontitis Generalized Severe Periodontitis Severe Periodontitis 37-100 Localized Beginning and Moderate Periodontitis Localized Moderate Periodontitis Generalized Beginning to Moderate Periodontitis Generalized Beginning and Localized Moderate Periodontitis Generalized Moderate Periodontitis Moderate Periodontitis 11-36 Localized Beginning Periodontitis Generalized Beginning Periodontitis Beginning Periodontitis 4-10 Gingivitis Gingivitis 2-3 Health Health 1 Text Nomenclature Severity OHIS™ Disease Score
  29. 30. What Diagnosis Would You Assign? <ul><li>4 sextants have severe periodontitis and 2 have gingivitis </li></ul><ul><ul><li>94 disease score and Generalized severe periodontitis </li></ul></ul><ul><li>3 sextants have severe periodontitis and 3 have gingivitis </li></ul><ul><ul><li>84 disease score and Generalized severe periodontitis </li></ul></ul><ul><li>2 sextants have severe periodontitis, 2 have beginning periodontitis, and 2 have gingivitis </li></ul><ul><ul><li>71 disease score and Generalized beginning to severe periodontitis </li></ul></ul>
  30. 31. Disease Score and its History
  31. 32. OHIS™ Diagnostic Method Summary <ul><li>Streamlines the diagnostic process into a more efficient and effective clinical practice </li></ul><ul><ul><li>The disease score and its history are more readily comprehended than the typical periodontal charting, radiographs, and text nomenclature </li></ul></ul><ul><li>Establishes a standard and objective means that can be applied to all patients </li></ul><ul><li>A change in the disease score reflects an improving, stable or worsening health condition </li></ul>
  32. 33. Is an Accurate Diagnosis All that is Required to Determine Treatment?
  33. 34. The Health-Disease Continuum <ul><li>Diagnosis is the determination of the existence of disease </li></ul><ul><li>Disease does not exist until tissue destruction occurs </li></ul><ul><li>Lesions must exceed the threshold of measurement for a diagnosis to be made </li></ul>Loss Health Disease Health-Disease Continuum Stages Invisible Visible Diagnosis Limited or No Signs Signs and Symptoms Disease Severity Initiation Beginning Moderate Severe Progression
  34. 35. The Health-Disease Continuum <ul><li>Diagnosis identifies severity; drives reparative treatment </li></ul><ul><li>A diagnosis describes the current, static, disease state </li></ul><ul><li>However,…….. </li></ul>Loss Health Disease Health-Disease Continuum Stages Invisible Visible Diagnosis Limited or No Signs Signs and Symptoms Disease Severity Initiation Beginning Moderate Severe Progression
  35. 36. The Health-Disease Continuum <ul><li>Disease is a dynamic non-linear process that can cycle between breakdown and healing </li></ul><ul><li>During the earliest stages of the disease process, reversibility or healing may be possible </li></ul>Loss Health Disease Health-Disease Continuum <ul><li>Tooth demineralization ----------------------> </li></ul><ul><li>Sub-clinical inflammatory lesion ---------------> </li></ul><ul><li>Abnormal cell division ---------------------------> </li></ul><ul><li>Coronary artery plaque and inflammation ---> </li></ul>Caries Gingivitis Cancer Myocardial Infarction Stages Invisible Visible Diagnosis Limited or No Signs Signs and Symptoms Disease Severity Initiation Beginning Moderate Severe Progression
  36. 37. The Health-Disease Continuum <ul><li>Diagnosis of a lesion at its earliest stage will be after the initiation of the disease process </li></ul><ul><li>Risk predicts the future disease state; drives preventative treatment </li></ul><ul><li>A healthy patient at-risk for disease would be denied the opportunity to prevent disease if interventions are withheld until a diagnosis is obtained </li></ul>Loss Health Disease Health-Disease Continuum Stages Invisible Visible Diagnosis Limited or No Signs Signs and Symptoms Disease Severity Initiation Beginning Moderate Severe Progression
  37. 38. What is Required to Determine Treatment Needs? <ul><li>Accurate diagnosis </li></ul><ul><li>Accurate risk determination </li></ul><ul><li>Understanding patient desires </li></ul><ul><li>Knowledge of the likelihood that treatment interventions will result in the desired outcome </li></ul>
  38. 39. Is the OHIS™ Risk Assessment Method Valid and Accurate?
  39. 40. Validity and Accuracy of OHIS™ Determined Risk <ul><li>523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study who had only routine care </li></ul><ul><ul><li>Periodontal pocket depth measurements </li></ul></ul><ul><ul><li>Digitized full-mouth radiographs with bitewings </li></ul></ul><ul><ul><li>Medical and dental histories </li></ul></ul><ul><li>Risk was assessed at baseline using OHIS™ </li></ul>Page et al. Validity and accuracy of a risk calculator in predicting periodontal disease. J Am Dent Assoc 2002 Page et al. Longitudinal validation of a risk calculator for periodontal disease. J Clin Periodontol 2003
  40. 41. Validity and Accuracy of OHIS™ Determined Risk, cont. <ul><li>Changes in periodontal status determined by comparing baseline data to data at 3, 9, and 15 years </li></ul><ul><ul><li>Alveolar bone loss (mean bone loss, percentage of sites with bone loss per subject) </li></ul></ul><ul><ul><li>Tooth loss (mean percent tooth loss, percentage of subjects with tooth loss in each risk group) </li></ul></ul>
  41. 42. Mean Bone Loss Risk 5 Risk 4 Risk 3 Risk 2 A measure of disease severity 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% Year 3 Year 9 Year 15 Mean Percent (±SE) Alveolar Bone Loss
  42. 43. Percentage of Sites with Bone Loss A measure of disease extent 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% Year 3 Year 9 Year 15 % Sites with Bone Loss Risk 5 Risk 4 Risk 3 Risk 2
  43. 44. Mean Tooth Loss Risk 5 Risk 4 Risk 3 Risk 2 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Year 3 Year 9 Year 15 Mean % (±SE) Tooth Loss
  44. 45. Percentage of Subjects with Tooth Loss 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Year 3 Year 9 Year 15 % of subjects Risk 5 Risk 4 Risk 3 Risk 2
  45. 46. Mean Number of Teeth Lost Only 26% did not have periodontal disease at baseline 0 1 2 3 4 5 6 7 Total teeth Periodontally affected Periodontally unaffected Number of teeth lost Risk 2 Risk 3 Risk 4 Risk 5
  46. 47. How is Risk Distinguished from Diagnosis?
  47. 48. Diagnosis vs. Risk Diagnosis describes Risk predicts Based on: Signs and Symptoms Risk Factors Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Health Current Future Time Worse Better Same
  48. 49. Signs and Symptoms vs. Risk Factors <ul><li>Signs and Symptoms </li></ul><ul><li>Bleeding on probing </li></ul><ul><li>Pockets </li></ul><ul><li>Bone loss </li></ul><ul><li>Pain </li></ul><ul><li>Swelling </li></ul><ul><li>Risk Factors </li></ul><ul><li>Smoking </li></ul><ul><li>Diabetes </li></ul><ul><li>Pathogenic bacteria </li></ul><ul><li>Pockets </li></ul>
  49. 50. What is a Risk Factor? <ul><li>Risk factor is often used as a general term meaning those characteristics that strongly associate with groups of individuals who have disease compared to those who do not. Risk terminology includes: </li></ul><ul><ul><li>Risk Factor </li></ul></ul><ul><ul><li>Background Characteristic </li></ul></ul><ul><ul><li>Risk Indicator </li></ul></ul><ul><ul><li>Risk Markers or Risk Predictors </li></ul></ul>
  50. 51. Risk Factor Definition <ul><li>An environmental, behavioral, or biologic factor confirmed by temporal sequence, usually in longitudinal studies, which if present directly increases the probability of a disease occurring, and if absent or removed reduces the probability. Risk factors are part of the causal chain, or expose the host to the causal chain. Once disease occurs, removal of a risk factor may not result in a cure. </li></ul><ul><li>Beck JD. Community Dent Oral Epidemiol 1998 </li></ul>
  51. 52. Background Characteristics Definition <ul><li>Associated with a higher probability of disease, but cannot be modified. Also referred to as a determinant. </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Socioeconomic Status </li></ul></ul><ul><ul><li>Familial history and genetic factors </li></ul></ul>
  52. 53. Risk Indicator Definition <ul><li>A possible risk factor not yet confirmed in published studies. A plausible correlate of disease identified in cross-sectional studies. </li></ul><ul><ul><li>Osteoporosis </li></ul></ul><ul><ul><li>HIV and AIDS </li></ul></ul><ul><ul><li>Frequency of visits to the dentist </li></ul></ul>
  53. 54. Risk Markers and Predictors Definition <ul><li>A characteristic strongly correlated with an increased probability of future disease but is not part of the causal chain. </li></ul><ul><ul><li>Bleeding on probing </li></ul></ul><ul><ul><li>Clinical attachment loss </li></ul></ul>
  54. 55. Risk Assessment <ul><li>Risk cannot be determined from disease severity </li></ul><ul><ul><li>Every patient who has disease was, at a prior time, healthy, hence - </li></ul></ul><ul><ul><li>It is possible to be high risk AND low disease severity </li></ul></ul><ul><li>Risk assessment is used to develop a preventive intervention program to prevent disease before it occurs </li></ul><ul><li>Risk Level modulates the aggressiveness and frequency of treatment </li></ul>
  55. 56. OHIS™ Risk Assessment <ul><li>A future disease state is effected when treatment is applied or withheld </li></ul><ul><li>OHIS™ risk assessment predicts the on-set and progression of periodontal disease for patients who have no more than routine dental care </li></ul><ul><li>Predicting treatment effectiveness is a different type of risk assessment not currently determined by OHIS™ </li></ul><ul><li>The OHIS™ risk score ranges from 1 for very low risk to 5 for very high risk </li></ul>
  56. 57. Current Risk Assessment Method <ul><li>By subjective judgment </li></ul><ul><li>Based primarily on disease severity and extent </li></ul><ul><li>This is understandable, as the literature only provides a laundry list of risk factors with no guidance how to determine risk </li></ul><ul><li>It is not surprising that the current method of risk assessment is generally an unreliable predictor of the future disease state </li></ul>
  57. 58. OHIS™ Risk Assessment Criteria <ul><li>Accurate and valid predictor of a future disease state when no more than routine dental care is provided </li></ul><ul><li>Time required for data collection and input must add no more than 5 minutes to a traditional periodontal examination and the procedure must be easily incorporated into the normal pattern of work flow </li></ul><ul><li>Risk assessment information must be useful to create treatment recommendations that reduce risk and prevent disease incidence and progression </li></ul>Martin et al. The development and utility of an assessment tool for risk of periodontal disease. In preparation.
  58. 59. OHIS™ Criteria for Use of Factors <ul><li>Scientific basis supported by publication in refereed scientific journal </li></ul><ul><li>Information obtainable during traditional periodontal examination without use of special or laboratory testing </li></ul><ul><li>Sufficiently high weight to impact risk score </li></ul><ul><li>Useful to create treatment recommendations that reduce risk and prevent disease incidence and progression </li></ul>
  59. 60. Factors Used by OHIS™ to Determine Risk and Recommend Treatment <ul><li>Smoking </li></ul><ul><li>Diabetes </li></ul><ul><li>Subgingival calculus </li></ul><ul><li>Subgingival restorations </li></ul><ul><li>Pockets </li></ul><ul><li>Furcation involvements </li></ul><ul><li>Vertical bone lesions </li></ul><ul><li>Age </li></ul><ul><li>Radiographic bone height </li></ul><ul><li>History of periodontal surgery for pockets </li></ul><ul><li>Oral hygiene </li></ul><ul><li>Dental care frequency </li></ul>
  60. 61. Why Were Some Factors Not Used?
  61. 62. Scientific Basis Not Supported by a Refereed Publication <ul><li>Race </li></ul><ul><li>Gender </li></ul><ul><li>Gingival crevicular components </li></ul><ul><li>Bleeding points </li></ul><ul><li>Oral hygiene indices </li></ul><ul><li>Suppuration </li></ul><ul><li>Gingival redness </li></ul><ul><li>Lamina dura </li></ul>
  62. 63. Information Not Typically Obtained <ul><li>Genetic testing (PST®) </li></ul><ul><li>Polymorphoneuclear leucocyte disorders </li></ul><ul><li>Gingival crevicular components </li></ul><ul><li>Bleeding points </li></ul><ul><li>Oral hygiene indices </li></ul><ul><li>Clinical attachment loss </li></ul><ul><li>Bacteria Culturing </li></ul>
  63. 64. Low Prevalence, Which Would Not Affect Accuracy of the Risk Score for a Large Population <ul><li>Occlusion-related pathology </li></ul><ul><li>HIV and AIDS </li></ul><ul><li>Medications </li></ul><ul><li>Pregnancy </li></ul><ul><li>Osteoporosis </li></ul>
  64. 65. Not Useful to Create Treatment Recommendations <ul><li>Race </li></ul><ul><li>Socio-economic status </li></ul><ul><li>Clinical attachment loss </li></ul>
  65. 66. OHIS™ Risk Assessment Method Summary <ul><li>OHIS™ presents a standardized, valid, and accurate method to determine risk level </li></ul><ul><ul><li>Risk levels range from 1 for very low risk to 5 for very high risk </li></ul></ul><ul><li>The time required for data collection and input adds no more than 5 minutes to a traditional periodontal examination and is easily incorporated into the normal work flow </li></ul><ul><li>Risk level and disease state are determined from only 23 data points </li></ul>
  66. 67. What Data does OHIS™ Require and How is it Entered into the System?
  67. 68. Data points 1 to 4
  68. 69. Data points 5 to 11
  69. 70. Data points 12 to 23
  70. 71. Incorporating Risk Concepts into Treatment Planning <ul><li>Risk is the fundamental principle that should justify treatment </li></ul><ul><ul><li>Low risk means that disease is unlikely to progress and justification for treatment is minimally supported </li></ul></ul><ul><ul><li>High risk means that disease is likely to progress and justification for treatment is maximally supported </li></ul></ul><ul><li>Risk is used to determine preventive interventions </li></ul><ul><li>Risk is also used to modulate the intensity and aggressiveness of reparative treatment </li></ul>
  71. 72. Risk and Treatment <ul><li>Treating disease generally involves repair </li></ul><ul><li>Repair may increase the risk of new disease </li></ul><ul><li>Risk should drive preventive treatment </li></ul><ul><li>Reduction in risk is accomplished by managing risk factors </li></ul><ul><li>Risk reduction can intercept invisible disease processes </li></ul>
  72. 73. Both Risk and Disease are Important <ul><li>The severity of disease is used to determine how much and what type of treatment is needed </li></ul><ul><li>Risk is used to determine how conservative or aggressive treatment should be </li></ul><ul><li>With or without disease, risk is used to determine the best treatment to prevent new disease from occurring </li></ul>
  73. 74. Treatment Needs Increase with Advancing Risk and Disease State Very Low Moderate High Very Low High Risk Level Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Health Treatment Intensity and Aggressiveness Treatment Intensity and Aggressiveness
  74. 75. Current vs. OHIS™ Method of Identifying Treatment Need Current Method OHIS™ Method Severity and Extent of Disease Reparative Treatment Standard Preventative Treatment Severity and Extent of Disease Risk factors and risk level Reparative Treatment Preventative Treatment
  75. 76. How Can a Clinician Correlate Diagnosis, Risk, and Treatment Needs
  76. 77. Treatment Stratification Matrix Very low risk Low risk Moderate risk High risk Very high risk Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Health Cannot be currently measured Cannot occur Risk = 2 Disease = 11-36 Risk = 2 Disease = 4-10 Risk = 3 Disease = 4-10 Risk = 3 Disease = 2-3 Risk = 1 Disease = 4-10 Risk = 1 Disease = 2-3   Risk = 1 Disease = 1 Risk = 2 Disease = 2-3 Risk = 2 Disease = 1 Risk = 3 Disease = 1 Risk = 3 Disease = 37-100 Risk = 3 Disease = 11-36 Risk = 4 Disease = 37-100   Risk = 4 Disease = 11-36 Risk = 4 Disease = 4-10 Risk = 5 Disease = 37-100 Risk = 5 Disease = 11-36 Risk = 5 Disease = 4-10 Risk = 1 Disease = 11-36 Risk = 2 Disease = 37-100 Risk = 4 Disease = 2-3 Risk = 4 Disease = 1 Patients in these categories are borderline for treatment complexity   Patients in these categories have routine needs generally requiring basic clinical skills and experience   Patients in these categories have the most complex needs generally requiring advanced clinical skills and experience     It is possible but unlikely to observe patients with these disease and risk profiles
  77. 78. How Can OHIS™ Assist in the Determination of Treatment?
  78. 79. OHIS™ Assisted Treatment Planning <ul><li>A list of commonly used treatment procedures for the patient’s risk factors and conditions grouped by three levels of expected effectiveness is provided as an aid to the dentist in decision making </li></ul><ul><li>Treatment should be targeted to the existing factors and conditions </li></ul><ul><li>Risk is used to modify treatment intensity and aggressiveness </li></ul>
  79. 81. Using the Scores in Treatment Planning <ul><li>Identifies the effectiveness of treatment </li></ul><ul><ul><li>Lower scores are indicative of improvement and the possibility that the current condition can be maintained or continue to improve with the current treatment plan </li></ul></ul><ul><ul><li>Higher scores are indicative of a worse situation and the need for different treatment </li></ul></ul><ul><li>While a lower risk score is desirable, it is possible for a patient’s risk to remain high without the disease worsening </li></ul><ul><li>Risk score change corresponds to an increase or decrease of more than 20% making it less sensitive than the 100-point disease score </li></ul>
  80. 82. Guidelines for Referral to a Periodontist <ul><li>Most patients are referred when disease is severe resulting in more tooth loss and treatment that is complex and expensive </li></ul><ul><li>When treatment is initiated during the early stages of disease, success is more likely, treatment is more conservative, and fewer teeth are lost </li></ul><ul><li>Risk predicts the future severity of disease </li></ul><ul><li>Referral to a periodontist should be based on Risk and Disease </li></ul>
  81. 83. Guidelines for Referral to a Periodontist, cont. <ul><li>Establish protocol for your practice such as: </li></ul><ul><ul><li>A threshold for risk regardless of disease state score (e.g. risk ≥4) </li></ul></ul><ul><ul><li>A threshold for an increase in risk (e.g. risk change ≥1) </li></ul></ul><ul><ul><li>A threshold for the disease state score (e.g. disease state ≥11) </li></ul></ul><ul><ul><li>A threshold for an increase in the disease state score (e.g. disease state score change ≥10) </li></ul></ul>
  82. 84. Is OHIS™ Needed? <ul><li>The need and value of OHIS™ is not intuitively apparent, as clinicians routinely diagnose, formulate treatment plans, and predict outcomes. </li></ul><ul><li>Furthermore there is evidence that oral health has improved. </li></ul><ul><li>However, wide variation and inaccuracy exists for diagnosis and risk assessment, suggestive that some patients receive un-needed care and others fail to receive needed care. </li></ul>
  83. 85. Is OHIS™ Needed?, cont. <ul><li>An information system that determines outcomes is non-existent, which denies the clinician and patient from an accurate understanding of oral health changes, favorable and unfavorable, that are attributable to treatment and behavioral decisions. </li></ul><ul><li>Dentistry has been practiced within this information void for decades resulting in the deterioration of the authority and profitability of dentists. </li></ul>
  84. 86. Is OHIS™ Needed?, cont. <ul><li>Periodontal treatment can prevent tooth loss </li></ul><ul><li>A standard uniform application of treatment procedures harms some patients </li></ul><ul><li>A decision to determine treatment that does not include an accurate assessment of risk harms patients </li></ul><ul><li>Risk assessment is distinctly different from diagnosis and is not determined with consistent accuracy by a clinician using subjective judgment </li></ul>Acceptance of the validity of these statements means you believe quality care requires use of OHIS™
  85. 87. OHIS™ Benefits <ul><li>OHIS™ creates an opportunity for clinicians to establish their method of determining oral health care excellence and the development of practice policies based on actual clinical outcomes, which might prevent organizations from imposing conflicting standards. </li></ul><ul><li>Dentists who provide exceptional care measured by outcomes could justify higher fees and use the information to market their expertise. </li></ul>
  86. 88. OHIS™ Benefits, cont. <ul><li>Numeric scores </li></ul><ul><ul><li>Simplify the clinician’s explanation of disease and risk </li></ul></ul><ul><ul><li>Are more easily and readily understood by the patient compared to traditional text-linguistic descriptions </li></ul></ul><ul><ul><li>The enhanced understanding would be expected to result in a higher commitment to treatment and greater participation by the patient in their own disease prevention and health improvement. </li></ul></ul>
  87. 89. OHIS™ Benefits, cont. <ul><li>A patient traditionally determines oral care excellence from their subjective interpretation of the clinical facility, service experience, resolution of symptoms or changes perceived with the senses, and the whiteness of their teeth. </li></ul><ul><li>A patient could, for the first time, determine quality care by the change from pre-treatment to post-treatment scores. </li></ul>
  88. 90. Summary <ul><li>OHIS™ is an efficient, effective, and accurate method to: </li></ul><ul><li>Document a periodontal condition </li></ul><ul><li>Diagnose periodontal disease </li></ul><ul><li>Predict a future periodontal disease state </li></ul><ul><li>Determine treatment dynamically </li></ul><ul><li>Communicate with a patient </li></ul>
  89. 91. Summary, cont. <ul><li>OHIS™ was designed for clinical utility by: </li></ul><ul><ul><li>Providing accurate and valid diagnostic, risk, and treatment information </li></ul></ul><ul><ul><li>Utilization takes little time and fits within normal procedures and work flow. </li></ul></ul><ul><li>OHIS™ should be used routinely </li></ul><ul><li>OHIS™ can improve oral health care quality and preserve the status of the private practice clinician </li></ul>
  90. 92. Getting Started
  91. 93. www.previser.com Click to download
  92. 99. Contact Information http://support.previser.com Online support 360.941.4715 Corporate phone PreViser Corporation 20849 Cascade Ridge Drive Mount Vernon, WA 98274 Corporate address [email_address] Support by email 360.661.5763 Support by phone www.previser.com Web site URL
  93. 100. THANKS

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