Patient-Centered Explanation of Risk-Based Treatment

1. Patient-Centered Explanation of Risk-Based Treatment Gum Disease

2. Gum Disease Defined • An infection caused by bacteria commonly found in the mouth that destroys the jawbone • Gingivitis and Periodontitis are two different types of gum disease • They are distinguished by the type of bacteria and presence of bone loss • Periodontitis is not more severe Gingivitis

3. Development of Gum Disease 0 1 2 3 4 5 6 ? Timeline (weeks) Initial disease event Gingivitis Periodontitis Teeth Cleaned Every 2 or less days 3 or more days never H e a l t h m a i n t a i n e d H e a l t h

4. “Teeth Cleaned” Clarified • All tooth surfaces including between teeth • Nearly all periodontitis lesions are at the sites between teeth where a tooth brush and oral rinse does not reach • The equivalent of not cleaning between teeth is washing the palm and back of your hands but not between your fingers • Rinsing hands with water is not an effective alternative to scrubbing with soap

5. Diagnosis of Gum Disease

6. Disease State 1-100 scale of current health or disease state based on the number of teeth affected, pocket depth, and amount of bone loss

7. 0 1 hour 6 weeks 30 years Time line Occurrence of Symptoms Heart Attack Anaphylactic Shock Bleeding gums • Each symptom occurs at the end of the colored bar • Each disease process is invisible to diagnostic methods for most or all of the time within the colored bar • Risk predicts chronic disease occurrence

8. The Initial Disease Event is Indistinguishable from Health Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Initial Disease Process Health

9. Risk Defined • Risk is a prediction that disease will occur or progress • Risk is distinct from disease and cannot be accurately predicted from the disease state • Risk is determined by risk factors

10. Risk-Based Treatment Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Initial Disease Process Health

11. Repair and Prevention Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Initial Disease Process Health

12. Routine Care

13. Risk-Based Care

14. Risk-Based Care, cont.

15. Repair and Disease Severity

16. Determining Risk and Treatment

18. Referral Criteria • High risk patients; establish a threshold for your particular practice • Low risk patients; establish a protocol when risk increases by a certain amount

19. Dealing with Objections • I’ll do it later • Risk is an accurate predictor of your future disease state and a worse disease state requires more treatment • My symptoms aren’t bad enough • Symptoms, visible entities, are a poor indicator of disease severity; e.g. the first symptom of heart disease is a heart attack

20. Objections, cont. • It costs too much; My insurance doesn’t cover it • Treatment done later when the disease advances will cost more and more teeth might require extraction • Dentures could ultimately cost more than “saving” your teeth • Insurance doesn’t care if you have dentures • Dentures are OK • Dentures, especially lower ones, are not always successful, which then requires implants

21. Objections, cont. • Treatment hurts • Current treatment methods minimize discomfort • Flossing is too hard; no time to floss • Tying shoelaces for a child is difficult but they learn the skill • Flossing takes only a minute or two after the skill is learned

22. Objections, cont. • I don’t have time for treatment • The time needed when disease advances will be greater and the cost higher • Treatment doesn’t work, I’ll lose my teeth anyway • This is a self-fulfilling prophecy, which will increase failure • Treatment is not successful for only 5% to 10% of patients

23. Objections, cont. • I’ll just have my teeth cleaned every 6 months • This is generally not effective when risk is 3 or higher • I’ll just have the deep cleaning, no surgery • Deep cleaning is generally not effective for pockets that are deeper than 5 mm, especially when risk is 3 or higher