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

3. Development of Gum Disease Teeth Cleaned Every 2 or less days 3 or more days never 0 1 2 3 4 5 6 ? Timeline (weeks) Timeline (weeks) Initial disease event GingivitisPeriodontitis 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 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 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 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 Rinsing hands with water is not an effective alternative to scrubbing with soap

5. Diagnosis of Gum Disease HealthGingivitisPeriodontitis Gums bleed when examined NoYesYes Deep pockets NoPossiblyYes Bone loss visible on x-rays NoNoYes

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 ScoreDiagnosis 1Health 2-3Gingivitis 4-10 Beginning Periodontitis 11-36 Moderate Periodontitis 37-100 Severe Periodontitis

7. Occurrence of Symptoms 0 1 hour 6 weeks 30 years Time line Anaphylactic Shock Bleeding gums Heart Attack 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 Realm of Diagnosis, which requires the disease is sufficiently advanced to be “Visible” The Initial Disease Event is Indistinguishable from Health Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis “Invisible” to diagnostic techniques Health Initial Disease Process

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

10. Risk-based treatment prevents disease progression Risk-Based Treatment Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Risk-based treatment prevents disease occurrence Health Initial Disease Process

11. Repair treats the consequences of disease, which may increase the risk of new disease Repair and Prevention Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis Gingivitis Prevention maintains a clinically healthy state Health Initial Disease Process

12. Routine Care

13. Risk-Based Care

14. Risk-Based Care, cont.

15. Repair and Disease Severity

16. Determining Risk and Treatment About PreViser PreViser Corporation provides web-enabled diagnostic decision support tools for dentists. The tools are simple, inexpensive and easy to use. The first clinically proven application is within dental care, where the use of PreViser technology will assist oral health care professionals to more effectively plan treatment responses to disease. The tools are built under protection of U.S. patent number 6,484,144 with an exclusive license to PreViser Corporation. This intellectual property protects a self- updating system of diagnosis that uses easily collected clinical measurements to calculate the risk of disease development or deterioration of a current disease state, and identifies therapies most likely to reduce risk and disease severity. Find out moreFind out more about the PreViser Risk Calculator Download and Try it for FreeDownload and Try it for Free. All Content © 2003 PreViser | All Rights Reserved | info@PreViser.net Privacy Policy info@PreViser.net Privacy Policy

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

19. Dealing with Objections I’ll do it later I’ll do it later Risk is an accurate predictor of your future disease state and a worse disease state requires more treatment Risk is an accurate predictor of your future disease state and a worse disease state requires more treatment My symptoms aren’t bad enough 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 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 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 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 Dentures could ultimately cost more than “saving” your teeth Insurance doesn’t care if you have dentures Insurance doesn’t care if you have dentures Dentures are OK Dentures are OK Dentures, especially lower ones, are not always successful, which then requires implants Dentures, especially lower ones, are not always successful, which then requires implants

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

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

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