OHIS

The Oral Health Information The Oral Health Information Suite™Suite™

The Oral Health Information The Oral Health Information Suite™Suite™

Its Use in the Management of Its Use in the Management of

Periodontal DiseasePeriodontal Disease

The The OOral ral HHealth ealth IInformation nformation SSuite™uite™

What is OHIS™?What is OHIS™?

When and How is it used?When and How is it used?

Why should OHIS™ be used?Why should OHIS™ be used? Benefits from OHIS™ useBenefits from OHIS™ use

WhatWhat is OHIS™? is OHIS™? A patent protected Internet-accessed information A patent protected Internet-accessed information

system that is comprised of a suite of related tools system that is comprised of a suite of related tools for the major oral health conditions including:for the major oral health conditions including: CariesCaries Periodontal diseasePeriodontal disease Oral cancerOral cancer

Each tool includes:Each tool includes: A scientifically derived mathematic algorithm using A scientifically derived mathematic algorithm using

objective quantitative measurements to determine risk level objective quantitative measurements to determine risk level A list of recommended interventions, stack-ranked by three A list of recommended interventions, stack-ranked by three

levels of effectiveness based on the published literature and levels of effectiveness based on the published literature and current standards of care for the patient’s unique conditions current standards of care for the patient’s unique conditions

WhatWhat is OHIS™?, cont. is OHIS™?, cont. OHIS was designed to be easily incorporated OHIS was designed to be easily incorporated

into the normal workflow utilizing information into the normal workflow utilizing information of a traditional examination and of a traditional examination and accommodating the unique characteristics accommodating the unique characteristics and needs of the patient, clinician, and and needs of the patient, clinician, and treatment procedures.treatment procedures.

Unique for clinical dentistry by virtue of Unique for clinical dentistry by virtue of quantifying the risk for future disease in quantifying the risk for future disease in addition to quantifying the current periodontal addition to quantifying the current periodontal disease state.disease state. Provides the means to measure oral health care Provides the means to measure oral health care

and determine its valueand determine its value Facilitates quality care and continuous Facilitates quality care and continuous

improvement improvement

What is the Current What is the Current Treatment Flow and How Treatment Flow and How

Would it Change with Would it Change with OHIS™?OHIS™?

Current Treatment FlowCurrent Treatment Flow

Treatment Plan Finalized

Treatment Provided

Examination

Diagnosis

Re-

OHIS™ Treatment FlowOHIS™ 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™ Processin

g

Report Returned to Clinician’s Computer

Algorithm Refinement

sAnalysis

Diagnosis

Re-

OHIS™ and HIPAA OHIS™ and HIPAA ComplianceCompliance

Compliance with HIPAA is accomplished by Compliance with HIPAA is accomplished by de-identifying the examination and de-identifying the examination and treatment information sent to OHIS™. treatment information sent to OHIS™.

The clinician’s computer is the only site The clinician’s computer is the only site where information that identifies the patient where information that identifies the patient resides. resides.

OHIS™ assigns a unique 32-character OHIS™ assigns a unique 32-character identification number to locate the records identification number to locate the records of a patient. of a patient. This creates a secure means to transfer a This creates a secure means to transfer a

patient’s entire collection of records, as only the patient’s entire collection of records, as only the patient and clinician have access to both the patient and clinician have access to both the identification number and identity of the patient.identification number and identity of the patient.

Who Developed OHIS?Who Developed OHIS?

How is it Obtained?How is it Obtained?

www.previser.comwww.previser.com

How Does OHIS™ Technology How Does OHIS™ Technology Enhance Current Practice Enhance Current Practice

Methods?Methods? DiagnosisDiagnosis

Risk AssessmentRisk Assessment Disease and RiskDisease and Risk

Treatment PlansTreatment Plans Incorporating risk conceptsIncorporating risk concepts

Current Diagnostic MethodCurrent Diagnostic Method

Clinical ConditionClinical Condition Data PointsData Points

Pocket depthPocket depth 28 X 6 = 28 X 6 = 168168

Tooth mobilityTooth mobility 28 X 1 = 28 X 1 = 2828

RecessionRecession 28 X 2 = 28 X 2 = 5656

FurcationsFurcations 4 X 3 + 6 X 2 = 4 X 3 + 6 X 2 = 2424

Attached gingivaAttached gingiva 28 + 14 = 28 + 14 = 4242

Plaque scorePlaque score 28 X 4 = 28 X 4 = 112112

Bleeding pointsBleeding points 28 X 4 = 28 X 4 = 112112

Radiographic bone lossRadiographic bone loss 28 X 2 = 28 X 2 = 5656

TOTALTOTAL 598598

The Basis for Text-Linguistic The Basis for Text-Linguistic DiagnosesDiagnoses

5 Severity States5 Severity States HealthHealth GingivitisGingivitis Beginning PeriodontitisBeginning Periodontitis Moderate PeriodontitisModerate Periodontitis Severe PeriodontitisSevere Periodontitis

2 Extent States2 Extent States LocalizedLocalized GeneralizedGeneralized

Text-Linguistic ConnectionsText-Linguistic Connections AndAnd ToTo Yields

17 Text-Linguistic 17 Text-Linguistic DiagnosesDiagnoses

SeveritySeverity Text NomenclatureText Nomenclature

HealthHealth HealthHealth

GingivitisGingivitis GingivitisGingivitis

BeginningBeginning

PeriodontitisPeriodontitisLocalized Beginning PeriodontitisLocalized Beginning Periodontitis

Generalized Beginning PeriodontitisGeneralized Beginning Periodontitis

ModerateModerate

PeriodontitisPeriodontitisLocalized Beginning and Moderate PeriodontitisLocalized Beginning and Moderate Periodontitis

Localized Moderate PeriodontitisLocalized Moderate Periodontitis

Generalized Beginning to Moderate PeriodontitisGeneralized Beginning to Moderate Periodontitis

Generalized Beginning and Localized Moderate PeriodontitisGeneralized Beginning and Localized Moderate Periodontitis

Generalized Moderate PeriodontitisGeneralized Moderate Periodontitis

SevereSevere

PeriodontitisPeriodontitisLocalized Beginning and Severe PeriodontitisLocalized Beginning and Severe Periodontitis

Localized Moderate and Severe PeriodontitisLocalized Moderate and Severe Periodontitis

Localized Severe PeriodontitisLocalized Severe Periodontitis

Generalized Beginning to Severe PeriodontitisGeneralized Beginning to Severe Periodontitis

Generalized Beginning and Localized Severe PeriodontitisGeneralized Beginning and Localized Severe Periodontitis

Generalized Moderate to Severe PeriodontitisGeneralized Moderate to Severe Periodontitis

Generalized Moderate and Localized Severe PeriodontitisGeneralized Moderate and Localized Severe Periodontitis

Generalized Severe PeriodontitisGeneralized Severe Periodontitis

Can Clinicians Determine a Can Clinicians Determine a Periodontal Diagnosis Quickly Periodontal Diagnosis Quickly

and With a High Level of and With a High Level of Agreement?Agreement?

Please determine a periodontal diagnosis Please determine a periodontal diagnosis from the periodontal charting and full from the periodontal charting and full mouth radiographs on the following mouth radiographs on the following slides. slides.

Thank you.Thank you.

What is Your Diagnosis?What is Your Diagnosis?

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FacialLingual

LingualFacial

Tooth#

OHIS™ Disease Score = 21

Text-Linguistic Diagnosis = Localized Moderate Periodontitis


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Text-Linguistic Diagnosis = Generalized Moderate Periodontitis


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Text-Linguistic Diagnosis = Generalized Moderate to Severe Periodontitis


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Text-Linguistic Diagnosis = Generalized Severe Periodontitis

Current Diagnostic Method Current Diagnostic Method SummarySummary

Time-consuming process to document Time-consuming process to document clinical findings, which at a minimum clinical findings, which at a minimum consists of 168 pocket depth consists of 168 pocket depth measurementsmeasurements

No standard and simple method exists to No standard and simple method exists to describe one set of nearly 600 data pointsdescribe one set of nearly 600 data points Wide variation exists in the determination of Wide variation exists in the determination of

a diagnosisa diagnosis

Current Diagnostic Method Current Diagnostic Method SummarySummary

Text nomenclature for diagnosis is Text nomenclature for diagnosis is complicated and not very complicated and not very descriptivedescriptive Text-based diagnoses are insufficiently Text-based diagnoses are insufficiently

precise to compare a single patient precise to compare a single patient over time or multiple patients, as over time or multiple patients, as similar conditions may be described by similar conditions may be described by the same diagnosisthe same diagnosis

OHIS™ Diagnostic MethodOHIS™ Diagnostic Method OHIS™ presents a standardized, objective, and OHIS™ presents a standardized, objective, and

simplified method for summarizing results of the simplified method for summarizing results of the standard periodontal examination into a clear, 1 standard periodontal examination into a clear, 1 – 100 scale describing the disease state– 100 scale describing the disease state

No special tests are required, and only 13 data No special tests are required, and only 13 data points are needed to quantify a periodontal points are needed to quantify a periodontal diagnosisdiagnosis

A numeric and text periodontal diagnosis can be A numeric and text periodontal diagnosis can be obtained in seconds after the data is recordedobtained in seconds after the data is recorded

Martin JA et al. A numeric method to describe a periodontal disease state. In preparation

OHIS™ Diagnostic Method, OHIS™ Diagnostic Method, cont.cont.

The method uses the combination of The method uses the combination of sextant severity diagnoses, which includes:sextant severity diagnoses, which includes: Health, Gingivitis, and Beginning, Moderate, and Health, Gingivitis, and Beginning, Moderate, and

Severe Periodontitis, and whereSevere Periodontitis, and where Sextant severity diagnosis is based on:Sextant severity diagnosis is based on:

Deepest pocketDeepest pocket Greatest radiographic bone height distance from Greatest radiographic bone height distance from

the cemento-enamel junctionthe cemento-enamel junction Bleeding on probingBleeding on probing

3 level scale 3 level scale

Bitewings are minimally required although some loss of accuracy will occur

Assignment of a Assignment of a Sextant Severity DiagnosisSextant Severity Diagnosis

Bone Height Distance from CEJBone Height Distance from CEJ

<2mm<2mm 2-4mm2-4mm >4mm>4mm

PockePocket t

DepthDepth

<5mm<5mm Gingivitis*Beginning

PeriodontitisModerate

Periodontitis

5-7mm5-7mm Beginning Periodontitis

Moderate Periodontitis

Severe Periodontitis

>7mm>7mm Moderate Periodontitis



* Bleeding on probing exists * Bleeding on probing exists

Assignment of a Assignment of a Sextant Severity DiagnosisSextant Severity Diagnosis

Bone Height Distance from CEJBone Height Distance from CEJ

<2mm<2mm 2-4mm2-4mm >4mm>4mm

PockePocket t

DepthDepth

<5mm<5mm Health*Beginning

PeriodontitisModerate

Periodontitis

5-7mm5-7mm Beginning Periodontitis



>7mm>7mm Moderate Periodontitis



* Bleeding on probing does not exist* Bleeding on probing does not exist

Why Sextant Diagnosis is Why Sextant Diagnosis is UsedUsed

28 teeth listed in order of their diagnosis is 28 teeth listed in order of their diagnosis is 552828=3.7x10=3.7x101919 permutations permutations

28 teeth grouped and counted by 28 teeth grouped and counted by diagnosis is diagnosis is 35,96035,960 combinations combinations

Sextants listed in order of their diagnosis Sextants listed in order of their diagnosis is is 5566=15,625=15,625 permutations permutations

Sextants grouped and counted by Sextants grouped and counted by diagnosis is diagnosis is 210210 combinations combinations Approximately Approximately 22 combinations of sextant combinations of sextant

diagnosis correspond to diagnosis correspond to 11 disease score in the disease score in the 1-100 scale1-100 scale

The non-uniformity of the scale occurs as a The non-uniformity of the scale occurs as a condition of combinationscondition of combinations

OHIS™OHIS™

DiseasDisease e

ScoreScore

SeveritySeverity Text NomenclatureText Nomenclature

11 HealthHealth HealthHealth

2-32-3 GingivitisGingivitis GingivitisGingivitis

4-104-10 BeginningBeginning

PeriodontitPeriodontitisis

Localized Beginning PeriodontitisLocalized Beginning Periodontitis

Generalized Beginning PeriodontitisGeneralized Beginning Periodontitis

11-3611-36 ModerateModerate


Localized Beginning and Moderate PeriodontitisLocalized Beginning and Moderate Periodontitis

Localized Moderate PeriodontitisLocalized Moderate Periodontitis

Generalized Beginning to Moderate PeriodontitisGeneralized Beginning to Moderate Periodontitis

Generalized Beginning and Localized Moderate Generalized Beginning and Localized Moderate PeriodontitisPeriodontitis

Generalized Moderate PeriodontitisGeneralized Moderate Periodontitis

37-10037-100 SevereSevere


Localized Beginning and Severe PeriodontitisLocalized Beginning and Severe Periodontitis

Localized Moderate and Severe PeriodontitisLocalized Moderate and Severe Periodontitis

Localized Severe PeriodontitisLocalized Severe Periodontitis

Generalized Beginning to Severe PeriodontitisGeneralized Beginning to Severe Periodontitis

Generalized Beginning and Localized Severe Generalized Beginning and Localized Severe PeriodontitisPeriodontitis

Generalized Moderate to Severe PeriodontitisGeneralized Moderate to Severe Periodontitis

Generalized Moderate and Localized Severe Generalized Moderate and Localized Severe PeriodontitisPeriodontitis

Generalized Severe PeriodontitisGeneralized Severe Periodontitis

What Diagnosis Would You What Diagnosis Would You Assign?Assign?

4 sextants have severe periodontitis and 2 have 4 sextants have severe periodontitis and 2 have gingivitisgingivitis 94 disease score and Generalized severe 94 disease score and Generalized severe

periodontitisperiodontitis 3 sextants have severe periodontitis and 3 have 3 sextants have severe periodontitis and 3 have

gingivitis gingivitis 84 disease score and Generalized severe 84 disease score and Generalized severe

periodontitisperiodontitis 2 sextants have severe periodontitis, 2 have 2 sextants have severe periodontitis, 2 have

beginning periodontitis, and 2 have gingivitisbeginning periodontitis, and 2 have gingivitis 71 disease score and Generalized beginning to 71 disease score and Generalized beginning to

severe periodontitissevere periodontitis

Disease Score and its Disease Score and its HistoryHistory

OHIS™ Diagnostic OHIS™ Diagnostic Method SummaryMethod Summary

Streamlines the diagnostic process into a Streamlines the diagnostic process into a more efficient and effective clinical practicemore efficient and effective clinical practice The disease score and its history are more readily The disease score and its history are more readily

comprehended than the typical periodontal comprehended than the typical periodontal charting, radiographs, and text nomenclaturecharting, radiographs, and text nomenclature

Establishes a standard and objective means Establishes a standard and objective means that can be applied to all patientsthat can be applied to all patients

A change in the disease score reflects an A change in the disease score reflects an improving, stable or worsening health improving, stable or worsening health conditioncondition

Is an Accurate Diagnosis All Is an Accurate Diagnosis All that is Required to Determine that is Required to Determine

Treatment?Treatment?

StagesInvisible Visible

DiagnosisLimited or No Signs

Signs and Symptoms

Loss

Disease Severity Initiation Beginning Moderate Severe

Health Disease Progression

Health-Disease

Continuum

The Health-Disease The Health-Disease ContinuumContinuum

Diagnosis is the determination of the existence of Diagnosis is the determination of the existence of diseasedisease

Disease does not exist until tissue destruction occursDisease does not exist until tissue destruction occurs Lesions must exceed the threshold of measurement Lesions must exceed the threshold of measurement

for a diagnosis to be madefor a diagnosis to be made



Signs and Symptoms

Loss



Health-Disease

Continuum


Diagnosis identifies severity; drives reparative Diagnosis identifies severity; drives reparative treatment treatment

A diagnosis describes the current, static, disease A diagnosis describes the current, static, disease statestate

However,……..However,……..



Signs and Symptoms

Loss



Health-Disease

Continuum


Disease is a dynamic non-linear process that can Disease is a dynamic non-linear process that can cycle between breakdown and healingcycle between breakdown and healing

During the earliest stages of the disease process, During the earliest stages of the disease process, reversibility or healing may be possible reversibility or healing may be possible

• Tooth demineralization ----------------------> • Sub-clinical inflammatory lesion ---------------> • Abnormal cell division ---------------------------> • Coronary artery plaque and inflammation --->

CariesGingivitisCancerMyocardial Infarction



Signs and Symptoms

Loss



Health-Disease

Continuum


Diagnosis of a lesion at its earliest stage will be after Diagnosis of a lesion at its earliest stage will be after the initiation of the disease processthe initiation of the disease process

Risk predicts the future disease state; drives Risk predicts the future disease state; drives preventative treatmentpreventative treatment

A healthy patient at-risk for disease would be denied A healthy patient at-risk for disease would be denied the opportunity to prevent disease if interventions the opportunity to prevent disease if interventions are withheld until a diagnosis is obtainedare withheld until a diagnosis is obtained

What is Required to What is Required to Determine Treatment Determine Treatment

Needs?Needs? Accurate diagnosisAccurate diagnosis Accurate risk determinationAccurate risk determination Understanding patient desiresUnderstanding patient desires Knowledge of the likelihood that Knowledge of the likelihood that

treatment interventions will treatment interventions will result in the desired outcomeresult in the desired outcome

Is the OHIS™ Risk Is the OHIS™ Risk Assessment Method Valid Assessment Method Valid

and Accurate?and Accurate?

Validity and Accuracy of Validity and Accuracy of OHIS™ Determined RiskOHIS™ Determined Risk

523 subjects enrolled in the Veterans 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study who had Affairs Dental Longitudinal Study who had only routine careonly routine care

Periodontal pocket depth measurementsPeriodontal pocket depth measurements Digitized full-mouth radiographs with bitewingsDigitized full-mouth radiographs with bitewings Medical and dental historiesMedical and dental histories

Risk was assessed at baseline using OHIS™Risk was assessed at baseline using OHIS™

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

Validity and Accuracy of Validity and Accuracy of OHIS™ Determined Risk, cont.OHIS™ Determined Risk, cont.

Changes in periodontal status determined Changes in periodontal status determined by comparing baseline data to data at 3, 9, by comparing baseline data to data at 3, 9, and 15 yearsand 15 years

Alveolar bone loss (mean bone loss, percentage Alveolar bone loss (mean bone loss, percentage of sites with bone loss per subject)of sites with bone loss per subject)

Tooth loss (mean percent tooth loss, percentage Tooth loss (mean percent tooth loss, percentage of subjects with tooth loss in each risk group)of subjects with tooth loss in each risk group)

Mean Bone LossMean Bone Loss

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

Perc

en

t (±

SE)

Alv

eola

r B

on

e L

oss Risk 5

Risk 4

Risk 3

Risk 2

A measure of disease severity

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%


% S

ites

wit

h B

on

e L

oss

Risk 5

Risk 4

Risk 3

Risk 2

Percentage of Sites with Bone Percentage of Sites with Bone LossLoss

A measure of disease extent

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%


Mean

% (

±S

E)

Tooth

Loss Risk 5

Risk 4

Risk 3

Risk 2

Mean Tooth LossMean Tooth Loss

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


% o

f su

bje

cts

Risk 5

Risk 4

Risk 3

Risk 2

Percentage of Subjects with Tooth Percentage of Subjects with Tooth LossLoss

0

1

2

3

4

5

6

7

Total teeth Periodontally affected Periodontally unaffected

Nu

mb

er

of

teeth

lost

Risk 2

Risk 3

Risk 4

Risk 5

Mean Number of Teeth LostMean Number of Teeth Lost

Only 26% did not have periodontal disease at baseline

How is Risk Distinguished How is Risk Distinguished from Diagnosis?from Diagnosis?

Disease StateDisease State

Severe PeriodontitisSevere Periodontitis

Moderate PeriodontitisModerate Periodontitis

Beginning PeriodontitisBeginning Periodontitis

GingivitisGingivitis

HealthHealth

Diagnosis vs. RiskDiagnosis vs. Risk

Current Current FutureFuture

TimeTime

Worse

Better

Same

Diagnosisdescribes

Riskpredicts

Based on:Based on: Signs and Symptoms Signs and Symptoms Risk Risk FactorsFactors

Signs and Symptoms vs. Risk Signs and Symptoms vs. Risk FactorsFactors

Signs and Signs and SymptomsSymptoms

Bleeding on Bleeding on probingprobing

PocketsPockets Bone lossBone loss PainPain SwellingSwelling

Risk FactorsRisk Factors Smoking Smoking DiabetesDiabetes Pathogenic Pathogenic

bacteriabacteria PocketsPockets

What is a Risk Factor?What is a Risk Factor?

Risk factor is often used as a general term Risk factor is often used as a general term meaning those characteristics that strongly meaning those characteristics that strongly associate with groups of individuals who associate with groups of individuals who have disease compared to those who do have disease compared to those who do not. Risk terminology includes:not. Risk terminology includes: Risk FactorRisk Factor Background CharacteristicBackground Characteristic Risk IndicatorRisk Indicator Risk Markers or Risk PredictorsRisk Markers or Risk Predictors

Risk Factor DefinitionRisk Factor Definition

An environmental, behavioral, or biologic An environmental, behavioral, or biologic factor confirmed by temporal sequence, factor confirmed by temporal sequence, usually in longitudinal studies, which if usually in longitudinal studies, which if present directly increases the probability of a present directly increases the probability of a disease occurring, and if absent or removed disease occurring, and if absent or removed reduces the probability. Risk factors are part reduces the probability. Risk factors are part of the causal chain, or expose the host to the of the causal chain, or expose the host to the causal chain. Once disease occurs, removal causal chain. Once disease occurs, removal of a risk factor may not result in a cure. of a risk factor may not result in a cure.

Beck JD. Community Dent Oral Epidemiol 1998

Background Characteristics Background Characteristics DefinitionDefinition

Associated with a higher probability Associated with a higher probability of disease, but cannot be modified. of disease, but cannot be modified. Also referred to as a determinant.Also referred to as a determinant. AgeAge GenderGender Socioeconomic StatusSocioeconomic Status Familial history and genetic factorsFamilial history and genetic factors

Risk Indicator DefinitionRisk Indicator Definition

A possible risk factor not yet A possible risk factor not yet confirmed in published studies. A confirmed in published studies. A plausible correlate of disease plausible correlate of disease identified in cross-sectional studies.identified in cross-sectional studies. OsteoporosisOsteoporosis HIV and AIDSHIV and AIDS Frequency of visits to the dentistFrequency of visits to the dentist

Risk Markers and Predictors Risk Markers and Predictors DefinitionDefinition

A characteristic strongly correlated A characteristic strongly correlated with an increased probability of with an increased probability of future disease but is not part of the future disease but is not part of the causal chain.causal chain. Bleeding on probingBleeding on probing Clinical attachment lossClinical attachment loss

Risk AssessmentRisk Assessment

Risk cannot be determined from disease Risk cannot be determined from disease severityseverity Every patient who has disease was, at a prior time, Every patient who has disease was, at a prior time,

healthy, hence - healthy, hence - It is possible to be high risk AND low disease severityIt is possible to be high risk AND low disease severity

Risk assessment is used to develop a Risk assessment is used to develop a preventive intervention program to prevent preventive intervention program to prevent disease before it occursdisease before it occurs

Risk Level modulates the aggressiveness and Risk Level modulates the aggressiveness and frequency of treatmentfrequency of treatment

OHIS™ Risk AssessmentOHIS™ Risk Assessment A future disease state is effected when A future disease state is effected when

treatment is applied or withheld treatment is applied or withheld

OHIS™ risk assessment predicts the on-set OHIS™ risk assessment predicts the on-set and progression of periodontal disease for and progression of periodontal disease for patients who have no more than routine patients who have no more than routine dental caredental care

Predicting treatment effectiveness is a Predicting treatment effectiveness is a different type of risk assessment not different type of risk assessment not currently determined by OHIS™currently determined by OHIS™

The OHIS™ risk score ranges from 1 for very The OHIS™ risk score ranges from 1 for very low risk to 5 for very high risk low risk to 5 for very high risk

Current Risk Assessment Current Risk Assessment MethodMethod

By subjective judgmentBy subjective judgment Based primarily on disease severity and Based primarily on disease severity and

extentextent This is understandable, as the literature This is understandable, as the literature

only provides a laundry list of risk only provides a laundry list of risk factors with no guidance how to factors with no guidance how to determine riskdetermine risk

It is not surprising that the current It is not surprising that the current method of risk assessment is generally method of risk assessment is generally an unreliable predictor of the future an unreliable predictor of the future disease statedisease state

OHIS™ Risk Assessment OHIS™ Risk Assessment CriteriaCriteria

Accurate and valid predictor of a future disease state Accurate and valid predictor of a future disease state when no more than routine dental care is providedwhen no more than routine dental care is provided

Time required for data collection and input must add Time required for data collection and input must add no more than 5 minutes to a traditional periodontal no more than 5 minutes to a traditional periodontal examination and the procedure must be easily examination and the procedure must be easily incorporated into the normal pattern of work flowincorporated into the normal pattern of work flow

Risk assessment information must be useful to create Risk assessment information must be useful to create treatment recommendations that reduce risk and treatment recommendations that reduce risk and prevent disease incidence and progressionprevent disease incidence and progression

Martin et al. The development and utility of an assessment tool for risk of periodontal disease. In preparation.

OHIS™ Criteria for Use of OHIS™ Criteria for Use of FactorsFactors

Scientific basis supported by publication in Scientific basis supported by publication in refereed scientific journalrefereed scientific journal

Information obtainable during traditional Information obtainable during traditional periodontal examination without use of periodontal examination without use of special or laboratory testingspecial or laboratory testing

Sufficiently high weight to impact risk Sufficiently high weight to impact risk scorescore

Useful to create treatment Useful to create treatment recommendations that reduce risk and recommendations that reduce risk and prevent disease incidence and progressionprevent disease incidence and progression

Factors Used by OHIS™ to Factors Used by OHIS™ to Determine Risk and Recommend Determine Risk and Recommend

TreatmentTreatment

SmokingSmoking DiabetesDiabetes Subgingival calculusSubgingival calculus Subgingival restorationsSubgingival restorations PocketsPockets Furcation involvementsFurcation involvements Vertical bone lesionsVertical bone lesions

AgeAge Radiographic bone Radiographic bone

heightheight History of periodontal History of periodontal

surgery for pocketssurgery for pockets Oral hygieneOral hygiene Dental care frequencyDental care frequency

Why Were Some Why Were Some Factors Not Used?Factors Not Used?

Scientific Basis Not Scientific Basis Not Supported by a Refereed Supported by a Refereed

PublicationPublication RaceRace GenderGender Gingival crevicular componentsGingival crevicular components Bleeding pointsBleeding points Oral hygiene indicesOral hygiene indices SuppurationSuppuration Gingival rednessGingival redness Lamina duraLamina dura

Information Not Typically Information Not Typically ObtainedObtained

Genetic testing (PST®)Genetic testing (PST®) Polymorphoneuclear leucocyte disordersPolymorphoneuclear leucocyte disorders Gingival crevicular componentsGingival crevicular components Bleeding pointsBleeding points Oral hygiene indicesOral hygiene indices Clinical attachment lossClinical attachment loss Bacteria CulturingBacteria Culturing

Low Prevalence, Which Would Low Prevalence, Which Would Not Affect Accuracy of the Risk Not Affect Accuracy of the Risk

Score for a Large PopulationScore for a Large Population

Occlusion-related pathologyOcclusion-related pathology HIV and AIDSHIV and AIDS MedicationsMedications PregnancyPregnancy OsteoporosisOsteoporosis

Not Useful to Create Treatment Not Useful to Create Treatment RecommendationsRecommendations

RaceRace Socio-economic statusSocio-economic status Clinical attachment lossClinical attachment loss

OHIS™ Risk Assessment OHIS™ Risk Assessment Method SummaryMethod Summary

OHIS™ presents a standardized, valid, and OHIS™ presents a standardized, valid, and accurate method to determine risk levelaccurate method to determine risk level

Risk levels range from 1 for very low risk to 5 for Risk levels range from 1 for very low risk to 5 for very high risk very high risk

The time required for data collection and The time required for data collection and input adds no more than 5 minutes to a input adds no more than 5 minutes to a traditional periodontal examination and is traditional periodontal examination and is easily incorporated into the normal work easily incorporated into the normal work flowflow

Risk level and disease state are determined Risk level and disease state are determined from only 23 data pointsfrom only 23 data points

What Data does OHIS™ What Data does OHIS™ Require and How is it Require and How is it

Entered into the System?Entered into the System?

Data points 1 to 4Data points 1 to 4



Incorporating Risk Concepts Incorporating Risk Concepts into Treatment Planninginto Treatment Planning

Risk is the fundamental principle that should Risk is the fundamental principle that should justify treatmentjustify treatment Low risk means that disease is unlikely to progress Low risk means that disease is unlikely to progress

and justification for treatment is minimally supportedand justification for treatment is minimally supported High risk means that disease is likely to progress and High risk means that disease is likely to progress and

justification for treatment is maximally supportedjustification for treatment is maximally supported Risk is used to determine preventive Risk is used to determine preventive

interventionsinterventions Risk is also used to modulate the intensity and Risk is also used to modulate the intensity and

aggressiveness of reparative treatmentaggressiveness of reparative treatment

Risk and TreatmentRisk and Treatment Treating disease generally involves Treating disease generally involves

repairrepair Repair may increase the risk of new Repair may increase the risk of new

diseasedisease Risk should drive preventive treatmentRisk should drive preventive treatment Reduction in risk is accomplished by Reduction in risk is accomplished by

managing risk factorsmanaging risk factors Risk reduction can intercept invisible Risk reduction can intercept invisible

disease processesdisease processes

Both Risk and Disease are Both Risk and Disease are Important Important

The severity of disease is used to The severity of disease is used to determine how much and what type of determine how much and what type of treatment is neededtreatment is needed

Risk is used to determine how Risk is used to determine how conservative or aggressive treatment conservative or aggressive treatment should beshould be

With or without disease, risk is used to With or without disease, risk is used to determine the best treatment to prevent determine the best treatment to prevent new disease from occurringnew disease from occurring

Treatment Needs Increase with Treatment Needs Increase with Advancing Risk and Disease StateAdvancing Risk and Disease State

Very Low Moderate High VeryVery Low Moderate High VeryLow HighLow High

Risk LevelRisk Level

Disease StateDisease State

Severe PeriodontitisSevere Periodontitis

Moderate PeriodontitisModerate Periodontitis

Beginning PeriodontitisBeginning Periodontitis

GingivitisGingivitis

HealthHealth

Treatment Intensity Treatment Intensity and Aggressivenessand Aggressiveness

Tre

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ten

sit

y

Tre

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d A

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Current vs. OHIS™ Method of Current vs. OHIS™ Method of Identifying Treatment NeedIdentifying Treatment Need

Current Method

OHIS™ Method

Severity and Extent of Disease

Reparative TreatmentStandard Preventative

Treatment

Severity and Extent of Disease

Risk factors and risk level

Reparative Treatment

Preventative Treatment

How Can a Clinician How Can a Clinician Correlate Diagnosis, Risk, Correlate Diagnosis, Risk,

and Treatment Needsand Treatment Needs

Treatment Stratification Treatment Stratification MatrixMatrix

Very low risk

Low risk Risk = 2Disease = 11-36

Risk = 2Disease = 4-10





Risk = 1Disease = 1


Risk = 2Disease = 1

Risk = 3Disease = 1

Moderate risk

High risk









Very high risk



Beginning Periodontitis

GingivitisHealth




Risk = 4Disease = 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

Cannot be currently measured

Cannot occur

How Can OHIS™ Assist in How Can OHIS™ Assist in the Determination of the Determination of

Treatment?Treatment?

OHIS™ Assisted Treatment OHIS™ Assisted Treatment PlanningPlanning

A list of commonly used treatment A list of commonly used treatment procedures for the patient’s risk factors procedures for the patient’s risk factors and conditions grouped by three levels of and conditions grouped by three levels of expected effectiveness is provided as an expected effectiveness is provided as an aid to the dentist in decision making aid to the dentist in decision making

Treatment should be targeted to the Treatment should be targeted to the existing factors and conditionsexisting factors and conditions

Risk is used to modify treatment intensity Risk is used to modify treatment intensity and aggressivenessand aggressiveness

Using the Scores in Treatment Using the Scores in Treatment PlanningPlanning

Identifies the effectiveness of treatmentIdentifies the effectiveness of treatment Lower scores are indicative of improvement and Lower scores are indicative of improvement and

the possibility that the current condition can be the possibility that the current condition can be maintained or continue to improve with the current maintained or continue to improve with the current treatment plantreatment plan

Higher scores are indicative of a worse situation Higher scores are indicative of a worse situation and the need for different treatment and the need for different treatment

While a lower risk score is desirable, it is possible While a lower risk score is desirable, it is possible for a patient’s risk to remain high without the for a patient’s risk to remain high without the disease worseningdisease worsening

Risk score change corresponds to an increase or Risk score change corresponds to an increase or decrease of more than 20% making it less sensitive decrease of more than 20% making it less sensitive than the 100-point disease scorethan the 100-point disease score

Guidelines for Referral to a Guidelines for Referral to a PeriodontistPeriodontist

Most patients are referred when disease is Most patients are referred when disease is severe resulting in more tooth loss and severe resulting in more tooth loss and treatment that is complex and expensivetreatment that is complex and expensive

When treatment is initiated during the When treatment is initiated during the early stages of disease, success is more early stages of disease, success is more likely, treatment is more conservative, and likely, treatment is more conservative, and fewer teeth are lostfewer teeth are lost

Risk predicts the future severity of diseaseRisk predicts the future severity of disease Referral to a periodontist should be based Referral to a periodontist should be based

on Risk and Diseaseon Risk and Disease

Guidelines for Referral to a Guidelines for Referral to a Periodontist, cont.Periodontist, cont.

Establish protocol for your practice such Establish protocol for your practice such as:as: A threshold for risk regardless of disease state A threshold for risk regardless of disease state

score (e.g. risk ≥4)score (e.g. risk ≥4) A threshold for an increase in risk (e.g. risk A threshold for an increase in risk (e.g. risk

change ≥1)change ≥1) A threshold for the disease state score (e.g. A threshold for the disease state score (e.g.

disease state ≥11)disease state ≥11) A threshold for an increase in the disease state A threshold for an increase in the disease state

score (e.g. disease state score change ≥10)score (e.g. disease state score change ≥10)

Is OHIS™ Needed?Is OHIS™ Needed? The need and value of OHIS™ is not The need and value of OHIS™ is not

intuitively apparent, as clinicians routinely intuitively apparent, as clinicians routinely diagnose, formulate treatment plans, and diagnose, formulate treatment plans, and predict outcomes. predict outcomes.

Furthermore there is evidence that oral Furthermore there is evidence that oral health has improved.health has improved.

However, wide variation and inaccuracy However, wide variation and inaccuracy exists for diagnosis and risk assessment, exists for diagnosis and risk assessment, suggestive that some patients receive un-suggestive that some patients receive un-needed care and others fail to receive needed care and others fail to receive needed care.needed care.

Is OHIS™ Needed?, cont.Is OHIS™ Needed?, cont. An information system that determines An information system that determines

outcomes is non-existent, which denies outcomes is non-existent, which denies the clinician and patient from an accurate the clinician and patient from an accurate understanding of oral health changes, understanding of oral health changes, favorable and unfavorable, that are favorable and unfavorable, that are attributable to treatment and behavioral attributable to treatment and behavioral decisions. decisions.

Dentistry has been practiced within this Dentistry has been practiced within this information void for decades resulting in information void for decades resulting in the deterioration of the authority and the deterioration of the authority and profitability of dentists.profitability of dentists.

Is OHIS™ Needed?, cont.Is OHIS™ Needed?, cont. Periodontal treatment can prevent tooth lossPeriodontal treatment can prevent tooth loss A standard uniform application of treatment A standard uniform application of treatment

procedures harms some patientsprocedures harms some patients A decision to determine treatment that does A decision to determine treatment that does

not include an accurate assessment of risk not include an accurate assessment of risk harms patientsharms patients

Risk assessment is distinctly different from Risk assessment is distinctly different from diagnosis and is not determined with diagnosis and is not determined with consistent accuracy by a clinician using consistent accuracy by a clinician using subjective judgmentsubjective judgment

Acceptance of the validity of these statements Acceptance of the validity of these statements means you believe quality care requires use of means you believe quality care requires use of OHIS™OHIS™

OHIS™ BenefitsOHIS™ Benefits

OHIS™ creates an opportunity for clinicians to OHIS™ creates an opportunity for clinicians to establish their method of determining oral establish their method of determining oral health care excellence and the development health care excellence and the development of practice policies based on actual clinical of practice policies based on actual clinical outcomes, which might prevent organizations outcomes, which might prevent organizations from imposing conflicting standards. from imposing conflicting standards.

Dentists who provide exceptional care Dentists who provide exceptional care measured by outcomes could justify higher measured by outcomes could justify higher fees and use the information to market their fees and use the information to market their expertise. expertise.

OHIS™ Benefits, cont.OHIS™ Benefits, cont.

Numeric scores Numeric scores Simplify the clinician’s explanation of Simplify the clinician’s explanation of

disease and risk disease and risk Are more easily and readily understood Are more easily and readily understood

by the patient compared to traditional by the patient compared to traditional text-linguistic descriptionstext-linguistic descriptions

The enhanced understanding would be The enhanced understanding would be expected to result in a higher expected to result in a higher commitment to treatment and greater commitment to treatment and greater participation by the patient in their own participation by the patient in their own disease prevention and health disease prevention and health improvement. improvement.

OHIS™ Benefits, cont.OHIS™ Benefits, cont.

A patient traditionally determines oral A patient traditionally determines oral care excellence from their subjective care excellence from their subjective interpretation of the clinical facility, interpretation of the clinical facility, service experience, resolution of service experience, resolution of symptoms or changes perceived with symptoms or changes perceived with the senses, and the whiteness of their the senses, and the whiteness of their teeth. teeth.

A patient could, for the first time, A patient could, for the first time, determine quality care by the change determine quality care by the change from pre-treatment to post-treatment from pre-treatment to post-treatment scores. scores.

SummarySummary

OHIS™ is an efficient, effective, and OHIS™ is an efficient, effective, and accurate method to:accurate method to: Document a periodontal conditionDocument a periodontal condition Diagnose periodontal diseaseDiagnose periodontal disease Predict a future periodontal disease Predict a future periodontal disease statestate Determine treatment dynamicallyDetermine treatment dynamically Communicate with a patientCommunicate with a patient

Summary, cont.Summary, cont.

OHIS™ was designed for clinical OHIS™ was designed for clinical utility by:utility by: Providing accurate and valid diagnostic, Providing accurate and valid diagnostic,

risk, and treatment informationrisk, and treatment information Utilization takes little time and fits Utilization takes little time and fits

within normal procedures and work flow.within normal procedures and work flow. OHIS™ should be used routinelyOHIS™ should be used routinely OHIS™ can improve oral health care OHIS™ can improve oral health care

quality and preserve the status of quality and preserve the status of the private practice clinicianthe private practice clinician

www.previser.comwww.previser.com

Click to downloadClick to download

Contact Contact InformationInformation

Web site URLWeb site URL www.previser.comwww.previser.com

Online supportOnline support http://http://support.previser.comsupport.previser.com

Support by phoneSupport by phone 360.661.5763360.661.5763

Support by emailSupport by email [email protected]@previser.com

Corporate addressCorporate address

PreViser CorporationPreViser Corporation

20849 Cascade Ridge 20849 Cascade Ridge DriveDrive

Mount Vernon, WA Mount Vernon, WA 9827498274

Corporate phoneCorporate phone 360.941.4715360.941.4715

Documents

OHIS