Changing the Focus to the Whole Patient instead of One Oral Disease: The Concept of Individualized Prevention

Abstract

Oral diseases are highly prevalent and a global burden. Accordingly, their prevention appears essential. Recently, different strategies have been developed, mainly focusing on the presence of singular oral diseases or conditions. This article aims to construct a contemporary concept of individualized preventive care in dentistry whereby the focus is switched from viewing oral health in isolation to viewing the patient as a whole. The basis for individualized prevention measures is the case-oriented profile, including the synthesis of risk- and need-oriented parameters. The risk profile comprises different risk factors within the fields of systemic diseases, medications, and lifestyle that inherently pose a potential risk of complications (e.g., infectious endocarditis) and/or oral diseases (e.g., periodontitis). The needs profile includes factors originating from the aspects of oral diseases, dental restorations/appliances, and dental results with a potential risk of pathogenesis (e.g., the de novo development of caries) and/or the potential progression of oral diseases (e.g., an existing caries lesion). Based on these parameters, the general framework and content of prevention measures, as well as the maintenance interval, should be adapted to the individual patient. The implications of this concept might increase the safety, effectiveness, and efficiency of prevention in dental care. A further area of focus is primary prevention, that is, a focus on the preservation of oral health instead of a disease-related approach. However, clinical validation is needed to prove the benefits of the model presented. Individualized prevention promotes a shift from a disease-focused model to a whole-patient-focused model and provides a potential approach for establishing a contemporary concept for preventive care in dentistry.

Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis

“…Another component of teledentistry to consider is that all the available interventions were nonpersonalized. Preventive activities for oral diseases should be individualized (Inglehart and Tedesco 1995), when possible, based on the patient’s baseline risk and the preservation of oral health as a whole instead of isolated aspects (Schmalz and Ziebolz 2020). Teledentistry can contribute to personalized health education via the use of videoconferences but also with smartphone apps (Underwood et al 2015) or text messages if personalization is properly built into the strategy.…”

Evaluation of an educational concept for risk-oriented prevention in undergraduate dental education

“…In the first seminar, the RCS was explained and applied on example patient cases with the students in small-group work (groups of 3-4 students, randomly composed by drawing of lots). The basis of risk-oriented prevention was the concept of risk classification, as already described by this working group [22]. In brief, two risks are defined for each patient: risk of complications, and risk of oral diseases based on the underlying disease, medication, or lifestyle factor.…”

“…The current research has specifically trained students in their fifth year of dental education in a clinical treatment course with regard to an RCS for systemic diseases, medication, and lifestyle factors. The medical contents of this program have previously been described by this working group [22]. As the main teaching and learning approach, students transferred this RCS to a patient case, which they had chosen by themselves and presented their results within a group discussion with their colleagues.…”

“…The RCS supports the assessment of a risk of complications and a risk of oral diseases of patients in dental prevention. Thereby, one out of three risk classes (low, moderate or high) for each respective general disease, medication or lifestyle parameter is defined according to the risk profile of individualized prevention (supplementary Table 1) [22]. It was hypothesized that the transfer of an RCS in the students' patient treatment could increase their self-perceived skills and the importance of risk patients as well as students' knowledge in risk classification.…”

Special Issue “Oral Health and Systemic Diseases”

“…Different systemic diseases and conditions have the potential to affect a risk of developing oral diseases, especially periodontitis; on the other hand, oral inflammation can have an effect on general health. Moreover, several general diseases are related to a potential risk of complications in dental therapy [ 5 ].…”