1. The Oral Health Information Suite™ Its Use in the Management of Periodontal Disease

2. The Oral Health Information Suite™ 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™ use Benefits from OHIS™ use

3. What is OHIS™? A patent protected Internet-accessed information system that is comprised of a suite of related tools for the major oral health conditions including: A patent protected Internet-accessed information system that is comprised of a suite of related tools for the major oral health conditions including: Caries Caries Periodontal disease Periodontal disease Oral cancer Oral cancer Each tool includes: Each tool includes: A scientifically derived mathematic algorithm using objective quantitative measurements to determine risk level A scientifically derived mathematic algorithm using objective quantitative measurements to determine risk level A list of recommended interventions, stack-ranked by three levels of effectiveness based on the published literature and current standards of care for the patient’s unique conditions A list of recommended interventions, stack-ranked by three levels of effectiveness based on the published literature and current standards of care for the patient’s unique conditions

4. What is OHIS™?, cont. OHIS was designed to be easily incorporated into the normal workflow utilizing information of a traditional examination and accommodating the unique characteristics and needs of the patient, clinician, and treatment procedures. OHIS was designed to be easily incorporated into the normal workflow utilizing information of a traditional examination and accommodating the unique characteristics and needs of the patient, clinician, and treatment procedures. Unique for clinical dentistry by virtue of quantifying the risk for future disease in addition to quantifying the current periodontal disease state. Unique for clinical dentistry by virtue of quantifying the risk for future disease in addition to quantifying the current periodontal disease state. Provides the means to measure oral health care and determine its value Provides the means to measure oral health care and determine its value Facilitates quality care and continuous improvement Facilitates quality care and continuous improvement

5. What is the Current Treatment Flow and How Would it Change with OHIS™?

6. Current Treatment Flow Treatment Plan Finalized Treatment Provided Examination Diagnosis Re-

7. OHIS™ 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™ Processing Report Returned to Clinician’s Computer Algorithm Refinements Analysis Diagnosis Re-

8. OHIS™ and HIPAA Compliance Compliance with HIPAA is accomplished by de- identifying the examination and treatment information sent to OHIS™. Compliance with HIPAA is accomplished by de- identifying the examination and treatment information sent to OHIS™. The clinician’s computer is the only site where information that identifies the patient resides. The clinician’s computer is the only site where information that identifies the patient resides. OHIS™ assigns a unique 32-character identification number to locate the records of a patient. OHIS™ assigns a unique 32-character identification number to locate the records of a patient. This creates a secure means to transfer a patient’s entire collection of records, as only the patient and clinician have access to both the identification number and identity of the patient. This creates a secure means to transfer a patient’s entire collection of records, as only the patient and clinician have access to both the identification number and identity of the patient.

9. Who Developed OHIS? How is it Obtained?

10. www.previser.com

12. How Does OHIS™ Technology Enhance Current Practice Methods? Diagnosis Diagnosis Risk Assessment Risk Assessment Disease and Risk Disease and Risk Treatment Plans Treatment Plans Incorporating risk concepts Incorporating risk concepts

13. Current Diagnostic Method Clinical Condition Data Points Pocket depth 28 X 6 = 168 28 X 6 = 168 Tooth mobility 28 X 1 = 28 28 X 1 = 28 Recession 28 X 2 = 56 28 X 2 = 56 Furcations 4 X 3 + 6 X 2 = 24 4 X 3 + 6 X 2 = 24 Attached gingiva 28 + 14 = 42 28 + 14 = 42 Plaque score 28 X 4 = 112 28 X 4 = 112 Bleeding points 28 X 4 = 112 28 X 4 = 112 Radiographic bone loss 28 X 2 = 56 28 X 2 = 56 TOTAL598

14. The Basis for Text-Linguistic Diagnoses 5 Severity States 5 Severity States Health Health Gingivitis Gingivitis Beginning Periodontitis Beginning Periodontitis Moderate Periodontitis Moderate Periodontitis Severe Periodontitis Severe Periodontitis 2 Extent States 2 Extent States Localized Localized Generalized Generalized Text-Linguistic Connections Text-Linguistic Connections And And To To Yields

15. 17 Text-Linguistic Diagnoses Severity Text Nomenclature HealthHealth GingivitisGingivitis BeginningPeriodontitis Localized Beginning Periodontitis Generalized Beginning Periodontitis ModeratePeriodontitis Localized Beginning and Moderate Periodontitis Localized Moderate Periodontitis Generalized Beginning to Moderate Periodontitis Generalized Beginning and Localized Moderate Periodontitis Generalized Moderate Periodontitis SeverePeriodontitis Localized Beginning and Severe Periodontitis Localized Moderate and Severe Periodontitis Localized Severe Periodontitis Generalized Beginning to Severe Periodontitis Generalized Beginning and Localized Severe Periodontitis Generalized Moderate to Severe Periodontitis Generalized Moderate and Localized Severe Periodontitis Generalized Severe Periodontitis

16. Can Clinicians Determine a Periodontal Diagnosis Quickly and With a High Level of Agreement? Please determine a periodontal diagnosis from the periodontal charting and full mouth radiographs on the following slides. Thank you.

17. What is Your Diagnosis? 12345678910111213141516424433425436313423313323313322312222212222212222212222213222313223313323624523424333 333424333424 333 423 323313312313312312212212 212 212 212212212213322313324313324414433414 32313029282726252423222120191817 170 Tooth# Facial Lingual Facial Tooth# OHIS™ Disease Score = 21 Text-Linguistic Diagnosis = Localized Moderate Periodontitis

18. What is Your Diagnosis? 12345678910111213141516315335525535525535415535513524313333315334514534414434414434414435415535525535524544 456415655525545514545414425415515515515515515525525535515515535514535425555525555514 32313029282726252423222120191817 207 Tooth# Facial Lingual Facial Tooth# OHIS™ Disease Score = 36 Text-Linguistic Diagnosis = Generalized Moderate Periodontitis

19. What is Your Diagnosis? 12345678910111213141516538558735845535545535535536525625535526525425424636626435435434434333444436446635645 545535545535545535444434434424333424333424333424333424333424333424333424335426635635 32313029282726252423222120191817 111A Tooth# Facial Lingual Facial Tooth# OHIS™ Disease Score = 92 Text-Linguistic Diagnosis = Generalized Moderate to Severe Periodontitis

20. What is Your Diagnosis? 12345678910111213141516537537735635535534535435536535625535526535425435636635435434434434333333437337735735 545535545535535535535535525525525525525525525525525525525525535525535525545526645635 32313029282726252423222120191817 111B Tooth# Facial Lingual Facial Tooth# OHIS™ Disease Score = 97 Text-Linguistic Diagnosis = Generalized Severe Periodontitis

21. Current Diagnostic Method Summary Time-consuming process to document clinical findings, which at a minimum consists of 168 pocket depth measurements Time-consuming process to document clinical findings, which at a minimum consists of 168 pocket depth measurements No standard and simple method exists to describe one set of nearly 600 data points No standard and simple method exists to describe one set of nearly 600 data points Wide variation exists in the determination of a diagnosis Wide variation exists in the determination of a diagnosis

22. Current Diagnostic Method Summary Text nomenclature for diagnosis is complicated and not very descriptive Text nomenclature for diagnosis is complicated and not very descriptive Text-based diagnoses are insufficiently precise to compare a single patient over time or multiple patients, as similar conditions may be described by the same diagnosis Text-based diagnoses are insufficiently precise to compare a single patient over time or multiple patients, as similar conditions may be described by the same diagnosis

23. OHIS™ Diagnostic Method OHIS™ presents a standardized, objective, and simplified method for summarizing results of the standard periodontal examination into a clear, 1 – 100 scale describing the disease state OHIS™ presents a standardized, objective, and simplified method for summarizing results of the standard periodontal examination into a clear, 1 – 100 scale describing the disease state No special tests are required, and only 13 data points are needed to quantify a periodontal diagnosis No special tests are required, and only 13 data points are needed to quantify a periodontal diagnosis A numeric and text periodontal diagnosis can be obtained in seconds after the data is recorded A numeric and text periodontal diagnosis can be obtained in seconds after the data is recorded Martin JA et al. A numeric method to describe a periodontal disease state. In preparation

24. OHIS™ Diagnostic Method, cont. The method uses the combination of sextant severity diagnoses, which includes: The method uses the combination of sextant severity diagnoses, which includes: Health, Gingivitis, and Beginning, Moderate, and Severe Periodontitis, and where Health, Gingivitis, and Beginning, Moderate, and Severe Periodontitis, and where Sextant severity diagnosis is based on: Sextant severity diagnosis is based on: Deepest pocket Deepest pocket Greatest radiographic bone height distance from the cemento-enamel junction Greatest radiographic bone height distance from the cemento-enamel junction Bleeding on probing Bleeding on probing

25. 3 level scale Bitewings are minimally required although some loss of accuracy will occur

26. Assignment of a Sextant Severity Diagnosis Bone Height Distance from CEJ <2mm2-4mm>4mm Pocket Depth <5mm Gingivitis* Beginning Periodontitis Moderate Periodontitis 5-7mm Beginning Periodontitis Moderate Periodontitis Severe Periodontitis >7mm Moderate Periodontitis Severe Periodontitis * Bleeding on probing exists

27. Assignment of a Sextant Severity Diagnosis Bone Height Distance from CEJ <2mm2-4mm>4mm Pocket Depth <5mm Health* Beginning Periodontitis Moderate Periodontitis 5-7mm Beginning Periodontitis Moderate Periodontitis Severe Periodontitis >7mm Moderate Periodontitis Severe Periodontitis * Bleeding on probing does not exist

28. Why Sextant Diagnosis is Used 28 teeth listed in order of their diagnosis is 5 28 =3.7x10 19 permutations 28 teeth listed in order of their diagnosis is 5 28 =3.7x10 19 permutations 28 teeth grouped and counted by diagnosis is 35,960 combinations 28 teeth grouped and counted by diagnosis is 35,960 combinations Sextants listed in order of their diagnosis is 5 6 =15,625 permutations Sextants listed in order of their diagnosis is 5 6 =15,625 permutations Sextants grouped and counted by diagnosis is 210 combinations Sextants grouped and counted by diagnosis is 210 combinations Approximately 2 combinations of sextant diagnosis correspond to 1 disease score in the 1-100 scale Approximately 2 combinations of sextant diagnosis correspond to 1 disease score in the 1-100 scale The non-uniformity of the scale occurs as a condition of combinations The non-uniformity of the scale occurs as a condition of combinations

29. OHIS™ Disease Score Severity Text Nomenclature 1HealthHealth 2-3GingivitisGingivitis 4-10BeginningPeriodontitis Localized Beginning Periodontitis Generalized Beginning Periodontitis 11-36ModeratePeriodontitis Localized Beginning and Moderate Periodontitis Localized Moderate Periodontitis Generalized Beginning to Moderate Periodontitis Generalized Beginning and Localized Moderate Periodontitis Generalized Moderate Periodontitis 37-100SeverePeriodontitis Localized Beginning and Severe Periodontitis Localized Moderate and Severe Periodontitis Localized Severe Periodontitis Generalized Beginning to Severe Periodontitis Generalized Beginning and Localized Severe Periodontitis Generalized Moderate to Severe Periodontitis Generalized Moderate and Localized Severe Periodontitis Generalized Severe Periodontitis

30. What Diagnosis Would You Assign? 4 sextants have severe periodontitis and 2 have gingivitis 4 sextants have severe periodontitis and 2 have gingivitis 94 disease score and Generalized severe periodontitis 94 disease score and Generalized severe periodontitis 3 sextants have severe periodontitis and 3 have gingivitis 3 sextants have severe periodontitis and 3 have gingivitis 84 disease score and Generalized severe periodontitis 84 disease score and Generalized severe periodontitis 2 sextants have severe periodontitis, 2 have beginning periodontitis, and 2 have gingivitis 2 sextants have severe periodontitis, 2 have beginning periodontitis, and 2 have gingivitis 71 disease score and Generalized beginning to severe periodontitis 71 disease score and Generalized beginning to severe periodontitis

31. Disease Score and its History

32. OHIS™ Diagnostic Method Summary Streamlines the diagnostic process into a more efficient and effective clinical practice Streamlines the diagnostic process into a more efficient and effective clinical practice The disease score and its history are more readily comprehended than the typical periodontal charting, radiographs, and text nomenclature The disease score and its history are more readily comprehended than the typical periodontal charting, radiographs, and text nomenclature Establishes a standard and objective means that can be applied to all patients Establishes a standard and objective means that can be applied to all patients A change in the disease score reflects an improving, stable or worsening health condition A change in the disease score reflects an improving, stable or worsening health condition

33. Is an Accurate Diagnosis All that is Required to Determine Treatment?

34. Stages InvisibleVisible Diagnosis Limited or No Signs Signs and Symptoms Loss Disease Severity Initiation Beginning Moderate Severe Health Disease Progression Health-Disease Continuum The Health-Disease Continuum Diagnosis is the determination of the existence of disease Diagnosis is the determination of the existence of disease Disease does not exist until tissue destruction occurs Disease does not exist until tissue destruction occurs Lesions must exceed the threshold of measurement for a diagnosis to be made Lesions must exceed the threshold of measurement for a diagnosis to be made

35. Stages InvisibleVisible Diagnosis Limited or No Signs Signs and Symptoms Loss Disease Severity Initiation Beginning Moderate Severe Health Disease Progression Health-Disease Continuum The Health-Disease Continuum Diagnosis identifies severity; drives reparative treatment Diagnosis identifies severity; drives reparative treatment A diagnosis describes the current, static, disease state A diagnosis describes the current, static, disease stateHowever,……..

36. Stages InvisibleVisible Diagnosis Limited or No Signs Signs and Symptoms Loss Disease Severity Initiation Beginning Moderate Severe Health Disease Progression Health-Disease Continuum The Health-Disease Continuum Disease is a dynamic non-linear process that can cycle between breakdown and healing Disease is a dynamic non-linear process that can cycle between breakdown and healing During the earliest stages of the disease process, reversibility or healing may be possible During the earliest stages of the disease process, reversibility or healing may be possible Tooth demineralization ----------------------> Sub-clinical inflammatory lesion ---------------> Abnormal cell division ---------------------------> Coronary artery plaque and inflammation ---> Caries Gingivitis Cancer Myocardial Infarction

37. Stages InvisibleVisible Diagnosis Limited or No Signs Signs and Symptoms Loss Disease Severity Initiation Beginning Moderate Severe Health Disease Progression Health-Disease Continuum The Health-Disease Continuum Diagnosis of a lesion at its earliest stage will be after the initiation of the disease process Diagnosis of a lesion at its earliest stage will be after the initiation of the disease process Risk predicts the future disease state; drives preventative treatment Risk predicts the future disease state; drives preventative treatment A healthy patient at-risk for disease would be denied the opportunity to prevent disease if interventions are withheld until a diagnosis is obtained A healthy patient at-risk for disease would be denied the opportunity to prevent disease if interventions are withheld until a diagnosis is obtained

38. What is Required to Determine Treatment Needs? Accurate diagnosis Accurate diagnosis Accurate risk determination Accurate risk determination Understanding patient desires Understanding patient desires Knowledge of the likelihood that treatment interventions will result in the desired outcome Knowledge of the likelihood that treatment interventions will result in the desired outcome

39. Is the OHIS™ Risk Assessment Method Valid and Accurate?

40. Validity and Accuracy of OHIS™ Determined Risk 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study who had only routine care 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study who had only routine care Periodontal pocket depth measurements Periodontal pocket depth measurements Digitized full-mouth radiographs with bitewings Digitized full-mouth radiographs with bitewings Medical and dental histories Medical 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

41. Validity and Accuracy of OHIS™ Determined Risk, cont. Changes in periodontal status determined by comparing baseline data to data at 3, 9, and 15 years Changes in periodontal status determined by comparing baseline data to data at 3, 9, and 15 years Alveolar bone loss (mean bone loss, percentage of sites with bone loss per subject) Alveolar bone loss (mean bone loss, percentage of sites with bone loss per subject) Tooth loss (mean percent tooth loss, percentage of subjects with tooth loss in each risk group) Tooth loss (mean percent tooth loss, percentage of subjects with tooth loss in each risk group)

42. Mean Bone Loss Risk 5 Risk 4 Risk 3 Risk 2 A measure of disease severity

43. Percentage of Sites with Bone Loss A measure of disease extent

44. 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Year 3Year 9Year 15 Mean % (±SE) Tooth Loss Risk 5 Risk 4 Risk 3 Risk 2 Mean Tooth Loss

45. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Year 3Year 9Year 15 % of subjects Risk 5 Risk 4 Risk 3 Risk 2 Percentage of Subjects with Tooth Loss

46. 0 1 2 3 4 5 6 7 Total teethPeriodontally affectedPeriodontally unaffected Number of teeth lost Risk 2 Risk 3 Risk 4 Risk 5 Mean Number of Teeth Lost Only 26% did not have periodontal disease at baseline

47. How is Risk Distinguished from Diagnosis?

48. Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis GingivitisHealth Diagnosis vs. Risk Current Future Time Time Worse Better Same Diagnosis describes Risk predicts Based on: Based on: Signs and Symptoms Risk Factors Signs and Symptoms Risk Factors

49. Signs and Symptoms vs. Risk Factors Signs and Symptoms Bleeding on probing Bleeding on probing Pockets Pockets Bone loss Bone loss Pain Pain Swelling Swelling Risk Factors Smoking Smoking Diabetes Diabetes Pathogenic bacteria Pathogenic bacteria Pockets Pockets

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

51. Risk Factor Definition An environmental, behavioral, or biologic factor confirmed by temporal sequence, usually in longitudinal studies, which if present directly increases the probability of a disease occurring, and if absent or removed reduces the probability. Risk factors are part of the causal chain, or expose the host to the causal chain. Once disease occurs, removal of a risk factor may not result in a cure. Beck JD. Community Dent Oral Epidemiol 1998

52. Background Characteristics Definition Associated with a higher probability of disease, but cannot be modified. Also referred to as a determinant. Associated with a higher probability of disease, but cannot be modified. Also referred to as a determinant. Age Age Gender Gender Socioeconomic Status Socioeconomic Status Familial history and genetic factors Familial history and genetic factors

53. Risk Indicator Definition A possible risk factor not yet confirmed in published studies. A plausible correlate of disease identified in cross-sectional studies. A possible risk factor not yet confirmed in published studies. A plausible correlate of disease identified in cross-sectional studies. Osteoporosis Osteoporosis HIV and AIDS HIV and AIDS Frequency of visits to the dentist Frequency of visits to the dentist

54. Risk Markers and Predictors Definition A characteristic strongly correlated with an increased probability of future disease but is not part of the causal chain. A characteristic strongly correlated with an increased probability of future disease but is not part of the causal chain. Bleeding on probing Bleeding on probing Clinical attachment loss Clinical attachment loss

55. Risk Assessment Risk cannot be determined from disease severity Risk cannot be determined from disease severity Every patient who has disease was, at a prior time, healthy, hence - Every patient who has disease was, at a prior time, healthy, hence - It is possible to be high risk AND low disease severity It is possible to be high risk AND low disease severity Risk assessment is used to develop a preventive intervention program to prevent disease before it occurs Risk assessment is used to develop a preventive intervention program to prevent disease before it occurs Risk Level modulates the aggressiveness and frequency of treatment Risk Level modulates the aggressiveness and frequency of treatment

56. OHIS™ Risk Assessment A future disease state is effected when treatment is applied or withheld A future disease state is effected when treatment is applied or withheld OHIS™ risk assessment predicts the on-set and progression of periodontal disease for patients who have no more than routine dental care OHIS™ risk assessment predicts the on-set and progression of periodontal disease for patients who have no more than routine dental care Predicting treatment effectiveness is a different type of risk assessment not currently determined by OHIS™ Predicting treatment effectiveness is a different type of risk assessment not currently determined by OHIS™ The OHIS™ risk score ranges from 1 for very low risk to 5 for very high risk The OHIS™ risk score ranges from 1 for very low risk to 5 for very high risk

57. Current Risk Assessment Method By subjective judgment By subjective judgment Based primarily on disease severity and extent Based primarily on disease severity and extent This is understandable, as the literature only provides a laundry list of risk factors with no guidance how to determine risk This is understandable, as the literature only provides a laundry list of risk factors with no guidance how to determine risk It is not surprising that the current method of risk assessment is generally an unreliable predictor of the future disease state It is not surprising that the current method of risk assessment is generally an unreliable predictor of the future disease state

58. OHIS™ Risk Assessment Criteria Accurate and valid predictor of a future disease state when no more than routine dental care is provided Accurate and valid predictor of a future disease state when no more than routine dental care is provided Time required for data collection and input must add no more than 5 minutes to a traditional periodontal examination and the procedure must be easily incorporated into the normal pattern of work flow Time required for data collection and input must add no more than 5 minutes to a traditional periodontal examination and the procedure must be easily incorporated into the normal pattern of work flow Risk assessment information must be useful to create treatment recommendations that reduce risk and prevent disease incidence and progression Risk assessment information must be useful to create treatment recommendations that reduce risk and prevent disease incidence and progression Martin et al. The development and utility of an assessment tool for risk of periodontal disease. In preparation.

59. OHIS™ Criteria for Use of Factors Scientific basis supported by publication in refereed scientific journal Scientific basis supported by publication in refereed scientific journal Information obtainable during traditional periodontal examination without use of special or laboratory testing Information obtainable during traditional periodontal examination without use of special or laboratory testing Sufficiently high weight to impact risk score Sufficiently high weight to impact risk score Useful to create treatment recommendations that reduce risk and prevent disease incidence and progression Useful to create treatment recommendations that reduce risk and prevent disease incidence and progression

60. Factors Used by OHIS™ to Determine Risk and Recommend Treatment Smoking Smoking Diabetes Diabetes Subgingival calculus Subgingival calculus Subgingival restorations Subgingival restorations Pockets Pockets Furcation involvements Furcation involvements Vertical bone lesions Vertical bone lesions Age Age Radiographic bone height Radiographic bone height History of periodontal surgery for pockets History of periodontal surgery for pockets Oral hygiene Oral hygiene Dental care frequency Dental care frequency

61. Why Were Some Factors Not Used?

62. Scientific Basis Not Supported by a Refereed Publication Race Race Gender Gender Gingival crevicular components Gingival crevicular components Bleeding points Bleeding points Oral hygiene indices Oral hygiene indices Suppuration Suppuration Gingival redness Gingival redness Lamina dura Lamina dura

63. Information Not Typically Obtained Genetic testing (PST®) Genetic testing (PST®) Polymorphoneuclear leucocyte disorders Polymorphoneuclear leucocyte disorders Gingival crevicular components Gingival crevicular components Bleeding points Bleeding points Oral hygiene indices Oral hygiene indices Clinical attachment loss Clinical attachment loss Bacteria Culturing Bacteria Culturing

64. Low Prevalence, Which Would Not Affect Accuracy of the Risk Score for a Large Population Occlusion-related pathology Occlusion-related pathology HIV and AIDS HIV and AIDS Medications Medications Pregnancy Pregnancy Osteoporosis Osteoporosis

65. Not Useful to Create Treatment Recommendations Race Race Socio-economic status Socio-economic status Clinical attachment loss Clinical attachment loss

66. OHIS™ Risk Assessment Method Summary OHIS™ presents a standardized, valid, and accurate method to determine risk level OHIS™ presents a standardized, valid, and accurate method to determine risk level Risk levels range from 1 for very low risk to 5 for very high risk Risk levels range from 1 for very low risk to 5 for very high risk The time required for data collection and input adds no more than 5 minutes to a traditional periodontal examination and is easily incorporated into the normal work flow The time required for data collection and input adds no more than 5 minutes to a traditional periodontal examination and is easily incorporated into the normal work flow Risk level and disease state are determined from only 23 data points Risk level and disease state are determined from only 23 data points

67. What Data does OHIS™ Require and How is it Entered into the System?

68. Data points 1 to 4

69. Data points 5 to 11

70. Data points 12 to 23

71. Incorporating Risk Concepts into Treatment Planning Risk is the fundamental principle that should justify treatment Risk is the fundamental principle that should justify treatment Low risk means that disease is unlikely to progress and justification for treatment is minimally supported Low risk means that disease is unlikely to progress and justification for treatment is minimally supported High risk means that disease is likely to progress and justification for treatment is maximally supported High risk means that disease is likely to progress and justification for treatment is maximally supported Risk is used to determine preventive interventions Risk is used to determine preventive interventions Risk is also used to modulate the intensity and aggressiveness of reparative treatment Risk is also used to modulate the intensity and aggressiveness of reparative treatment

72. Risk and Treatment Treating disease generally involves repair Treating disease generally involves repair Repair may increase the risk of new disease Repair may increase the risk of new disease Risk should drive preventive treatment Risk should drive preventive treatment Reduction in risk is accomplished by managing risk factors Reduction in risk is accomplished by managing risk factors Risk reduction can intercept invisible disease processes Risk reduction can intercept invisible disease processes

73. Both Risk and Disease are Important The severity of disease is used to determine how much and what type of treatment is needed The severity of disease is used to determine how much and what type of treatment is needed Risk is used to determine how conservative or aggressive treatment should be Risk is used to determine how conservative or aggressive treatment should be With or without disease, risk is used to determine the best treatment to prevent new disease from occurring With or without disease, risk is used to determine the best treatment to prevent new disease from occurring

74. Treatment Needs Increase with Advancing Risk and Disease State Very Low Moderate High Very Low High Risk Level Risk Level Disease State Severe Periodontitis Moderate Periodontitis Beginning Periodontitis GingivitisHealth Treatment Intensity and Aggressiveness Treatment Intensity and Aggressiveness

75. Current vs. OHIS™ Method of Identifying Treatment Need Current Method OHIS™ Method Severity and Extent of Disease Reparative Treatment Standard Preventative Treatment Severity and Extent of Disease Risk factors and risk level Reparative Treatment Preventative Treatment

76. How Can a Clinician Correlate Diagnosis, Risk, and Treatment Needs

77. Treatment Stratification Matrix Very low risk Low risk Risk = 2 Disease = 11-36 Risk = 2 Disease = 4-10 Risk = 3 Disease = 4-10 Risk = 3 Disease = 2-3 Risk = 1 Disease = 4-10 Risk = 1 Disease = 2-3 Risk = 1 Disease = 1 Risk = 2 Disease = 2-3 Risk = 2 Disease = 1 Risk = 3 Disease = 1 Moderate risk High risk Risk = 3 Disease = 37-100 Risk = 3 Disease = 11-36 Risk = 4 Disease = 37-100 Risk = 4 Disease = 11-36 Risk = 4 Disease = 4-10 Risk = 5 Disease = 37-100 Risk = 5 Disease = 11-36 Risk = 5 Disease = 4-10 Very high risk Severe Periodontitis Moderate Periodontitis Beginning Periodontitis GingivitisHealth Risk = 1 Disease = 11-36 Risk = 2 Disease = 37-100 Risk = 4 Disease = 2-3 Risk = 4 Disease = 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

78. How Can OHIS™ Assist in the Determination of Treatment?

79. OHIS™ Assisted Treatment Planning OHIS™ Assisted Treatment Planning A list of commonly used treatment procedures for the patient’s risk factors and conditions grouped by three levels of expected effectiveness is provided as an aid to the dentist in decision making A list of commonly used treatment procedures for the patient’s risk factors and conditions grouped by three levels of expected effectiveness is provided as an aid to the dentist in decision making Treatment should be targeted to the existing factors and conditions Treatment should be targeted to the existing factors and conditions Risk is used to modify treatment intensity and aggressiveness Risk is used to modify treatment intensity and aggressiveness

81. Using the Scores in Treatment Planning Identifies the effectiveness of treatment Identifies the effectiveness of treatment Lower scores are indicative of improvement and the possibility that the current condition can be maintained or continue to improve with the current treatment plan Lower scores are indicative of improvement and the possibility that the current condition can be maintained or continue to improve with the current treatment plan Higher scores are indicative of a worse situation and the need for different treatment Higher scores are indicative of a worse situation and the need for different treatment While a lower risk score is desirable, it is possible for a patient’s risk to remain high without the disease worsening While a lower risk score is desirable, it is possible for a patient’s risk to remain high without the disease worsening Risk score change corresponds to an increase or decrease of more than 20% making it less sensitive than the 100-point disease score Risk score change corresponds to an increase or decrease of more than 20% making it less sensitive than the 100-point disease score

82. Guidelines for Referral to a Periodontist Most patients are referred when disease is severe resulting in more tooth loss and treatment that is complex and expensive Most patients are referred when disease is severe resulting in more tooth loss and treatment that is complex and expensive When treatment is initiated during the early stages of disease, success is more likely, treatment is more conservative, and fewer teeth are lost When treatment is initiated during the early stages of disease, success is more likely, treatment is more conservative, and fewer teeth are lost Risk predicts the future severity of disease Risk predicts the future severity of disease Referral to a periodontist should be based on Risk and Disease Referral to a periodontist should be based on Risk and Disease

83. Guidelines for Referral to a Periodontist, cont. Establish protocol for your practice such as: Establish protocol for your practice such as: A threshold for risk regardless of disease state score (e.g. risk ≥4) A threshold for risk regardless of disease state score (e.g. risk ≥4) A threshold for an increase in risk (e.g. risk change ≥1) A threshold for an increase in risk (e.g. risk change ≥1) A threshold for the disease state score (e.g. disease state ≥11) A threshold for the disease state score (e.g. disease state ≥11) A threshold for an increase in the disease state score (e.g. disease state score change ≥10) A threshold for an increase in the disease state score (e.g. disease state score change ≥10)

84. Is OHIS™ Needed? The The need and value of OHIS™ is not intuitively apparent, as clinicians routinely diagnose, formulate treatment plans, and predict outcomes. Furthermore Furthermore there is evidence that oral health has improved. However, However, wide variation and inaccuracy exists for diagnosis and risk assessment, suggestive that some patients receive un-needed care and others fail to receive needed care.

85. Is OHIS™ Needed?, cont. An information system that determines outcomes is non-existent, which denies the clinician and patient from an accurate understanding of oral health changes, favorable and unfavorable, that are attributable to treatment and behavioral decisions. An information system that determines outcomes is non-existent, which denies the clinician and patient from an accurate understanding of oral health changes, favorable and unfavorable, that are attributable to treatment and behavioral decisions. Dentistry has been practiced within this information void for decades resulting in the deterioration of the authority and profitability of dentists. Dentistry has been practiced within this information void for decades resulting in the deterioration of the authority and profitability of dentists.

86. Is OHIS™ Needed?, cont. Periodontal treatment can prevent tooth loss Periodontal treatment can prevent tooth loss A standard uniform application of treatment procedures harms some patients A standard uniform application of treatment procedures harms some patients A decision to determine treatment that does not include an accurate assessment of risk harms patients A decision to determine treatment that does not include an accurate assessment of risk harms patients Risk assessment is distinctly different from diagnosis and is not determined with consistent accuracy by a clinician using subjective judgment Risk assessment is distinctly different from diagnosis and is not determined with consistent accuracy by a clinician using subjective judgment Acceptance of the validity of these statements means you believe quality care requires use of OHIS™

87. OHIS™ Benefits OHIS™ creates an opportunity for clinicians to establish their method of determining oral health care excellence and the development of practice policies based on actual clinical outcomes, which might prevent organizations from imposing conflicting standards. OHIS™ creates an opportunity for clinicians to establish their method of determining oral health care excellence and the development of practice policies based on actual clinical outcomes, which might prevent organizations from imposing conflicting standards. Dentists who provide exceptional care measured by outcomes could justify higher fees and use the information to market their expertise. Dentists who provide exceptional care measured by outcomes could justify higher fees and use the information to market their expertise.

88. OHIS™ Benefits, cont. Numeric scores Numeric scores Simplify the clinician’s explanation of disease and risk Simplify the clinician’s explanation of disease and risk Are more easily and readily understood by the patient compared to traditional text-linguistic descriptions Are more easily and readily understood by the patient compared to traditional text-linguistic descriptions The enhanced understanding would be expected to result in a higher commitment to treatment and greater participation by the patient in their own disease prevention and health improvement. The enhanced understanding would be expected to result in a higher commitment to treatment and greater participation by the patient in their own disease prevention and health improvement.

89. OHIS™ Benefits, cont. A patient traditionally determines oral care excellence from their subjective interpretation of the clinical facility, service experience, resolution of symptoms or changes perceived with the senses, and the whiteness of their teeth. A patient traditionally determines oral care excellence from their subjective interpretation of the clinical facility, service experience, resolution of symptoms or changes perceived with the senses, and the whiteness of their teeth. A patient could, for the first time, determine quality care by the change from pre-treatment to post-treatment scores. A patient could, for the first time, determine quality care by the change from pre-treatment to post-treatment scores.

90. Summary OHIS™ is an efficient, effective, and accurate method to: Document a periodontal condition Document a periodontal condition Diagnose periodontal disease Diagnose periodontal disease Predict a future periodontal disease state Predict a future periodontal disease state Determine treatment dynamically Determine treatment dynamically Communicate with a patient Communicate with a patient

91. Summary, cont. OHIS™ was designed for clinical utility by: OHIS™ was designed for clinical utility by: Providing accurate and valid diagnostic, risk, and treatment information Providing accurate and valid diagnostic, risk, and treatment information Utilization takes little time and fits within normal procedures and work flow. Utilization takes little time and fits within normal procedures and work flow. OHIS™ should be used routinely OHIS™ should be used routinely OHIS™ can improve oral health care quality and preserve the status of the private practice clinician OHIS™ can improve oral health care quality and preserve the status of the private practice clinician

93. www.previser.com Click to download

99. Contact Information Web site URL www.previser.com Online support http://support.previser.com Support by phone 360.661.5763 Support by email support@previser.com Corporate address PreViser Corporation 20849 Cascade Ridge Drive Mount Vernon, WA 98274 Corporate phone 360.941.4715