New Technologies for Risk Assessment

Paul G. Luepke, DDS, MSMarquette University

RiskCalculatorScore = 3

General Dentist(5 Patient Evaluations…

Expert Periodontists(5 Patient Evaluations per data point)

Previser Founder’s(5 Patient Evaluations…)

Practitioner evaluation over-

estimating risk by 2 scores

Practitioner evaluation

under-estimating risk by 1 score

Over-Estimated

Risk =Inappropriate

Treatment

Under-Estimated

Risk =Inappropriate

Treatment

Practitioner evaluation over-estimating risk

by 1 score

Practitioner evaluation under-estimating risk by

2 scores

20% Agreement with OHIS™

For OHIS™assessed patients with Risk Score of 3..

Conclusion: Clinicians can’t

assess the risk offuture disease

Courtesy PreViser Corporation, all rights reserved

Periodontal Risk Calculator• Based on nine factors

– Age– Smoking history– Diagnosis of diabetes– History of Periodontal surgery– Pocket depth– Furcation involvements– Restorations or calculus below gingival

margin– Radiographic bone height– Vertical bone lesions

• Weighted mathematical algorithm– Classifies from 1 (least risk) to 5

(highest risk)– Quantifies Disease level 1 -100 Scale

(1= health – 100 = severe disease)• Web accessible

– www.previser.com– FREE to MUSoD!

Flaws in the Roll Out or Delivery

• D-3 or Junior year• At the same time as AxiUm (electronic record)• Did not have the idea discussed or a reason

justified• Value• BL: Overloaded the students and faculty

D-1 (First Year Students)-Introduced in 6 General Dentistry Courses-Incorporated in 4 Clinical and Surgical Courses

D-2 (Second Year Students)-Actual Tutorial on Risk Assessment and Calibration-Incorporated in 6 more courses

D-3 (Third Year Students)-Clinical Instruction-Rounds

D-4 (Fourth Year Students)-Clinical Instruction-Rounds

Modified Curriculum to incorporate Risk Assessment

D2 PRC Training and Calibration

• Scheduled as part of clinical training

• Scheduled w/ hands on computer time

• Supervised by clinical faculty

• Continued until proficient.

CEJ to first discernable PDL space.

Note vertical bone lesions between premolars

Radiographic Assessment: Picking the deepest site

Human Behavior

We are Not:Always Rational, Non-emotional, like Spock

We are:Irrational, emotional, easily distracted, like Dental Students

Barriers?

Faculty:

- Too Hard for the Patient to understand- Clutters up my printer- An extra step for something we already do

Students:- Do I really need to do this- It seems like a waste of time- Is there a charge?

Determining Student Participation

Impact

Resistance to Change

Quote:“I’m reluctant to change. So, I need to hear something new often enough that, at somepoint, it gets past my critical, distrusting mind,becomes more familiar, and touches my heart. Then it becomes a part of me.

My personal source: My student’s are doing impressions of me with the risk assessment.

Will Risk Assessment be worth your change in behavior?

If you think it is important you have to put in the time

Bring home the message in a variety of methods

Don’t just Lecture it………Live it……..

Passion is the Key