Personalized prevention – the implications of general health factors

Based on the article of the same name by Gerhard Schmalz and Dirk Ziebolz, published in ZWR 2019; 128(6): pp. 295–304

Whether preventative or curative, dental measures need to be individually tailored according to the risk factors identified for each patient. In this context, general health is significantly influenced by three risk factors: general diseases according to the ICD-10 classification, medication intake, and lifestyle. Each of these risk factors is characterized by two sub-aspects. The first of these is the potential ‘risk of complication’, which describes the increased likelihood of injury to the patient during or as a result of a dental intervention (e.g. infection risk: infectious endocarditis in patients with a heart valve replacement). Distinct from this is the 'risk of disease’, which describes the increased likelihood of the development and/or progression of an oral disease (e.g. increased risk of periodontitis in patients with inadequately controlled diabetes). The sum of a patient’s existing risk factors makes up their individual risk profile (Fig. 1). On the basis of these known multifactorial links and potential risks, the content of an affected patient’s dental treatment and preventative care and/or aftercare needs to be adapted according to the patient’s needs.
In the normal course of an invasive or preventative dental procedure, it is recommended that a risk assessment should always be carried out, both for the safety of the patient and to ensure the outcome. The classification system presented in this article assigns ‘risk of complication’ and ‘risk of disease’ to one of three categories (low = green, moderate = yellow, high = red, Table 1). Classifications are made according to defined risk factors: General diseases (e.g. diabetes, heart valve replacement), medication (e.g. cyclosporine A with a risk of gingival overgrowth) and lifestyle (e.g. smoking). In parallel, the ‘infectious risk of complication’ should be taken into account in the classification. Here, the extent of immunocompromisation (dependent on the underlying disease and medication) and anticipated bacteraemia level (dependent on the patient’s oral health and type of intervention) play a role. By using the calculated risk profile, it is therefore possible to deduce the effect that each risk factor will have on each stage of the prevention session.
To ensure that patients can be given safe and effective preventative treatment, it is essential to carry out an adequate risk classification, and to deduce the corresponding clinical consequences for each phase of a prevention session. The classification system presented in this article provides a way to systematically incorporate general diseases, medications and lifestyle habits into structured preventative dentistry. By using an individually tailored, risk-orientated prevention approach, treatment safety can be increased, and long-term treatment success can be ensured.

Table 1: Definition of the three categories within ‘risk of complication’ and ‘risk of disease’

Figure 1: Breakdown of risk factors, which together constitute the patient’s risk profile. This influences the structure and content of the prevention session. Every risk factor entails a potential risk of complication and a potential risk of disease.