Reports & Studies

Personalized prevention – case-oriented needs adaptation

Based on the article 'Individualisierte Prävention – fallorientierte Bedarfsadaptation' by Gerhard Schmalz and Dirk Ziebolz, published in ZWR 2020; 129(01/ 02): pp. 33–41

A patient-oriented tailoring of preventative measures seems to be next logical step to counter the complexity of oral diseases for the future. Although existing strategies – for example, caring for periodontitis patients by means of supportive periodontitis treatment (SPT) – can stabilize the treatment outcome of an individual disease, their integration in a case-specific and needs-oriented preventative approach is lacking.
To determine the patient’s individual requirements, three need factors are taken into account: existing oral diseases, existing treatments (fillings, prostheses, orthodontic treatments) and current dental findings (Fig. 1).
These factors are evaluated according to their risk of progression and development. Here, ‘risk of progression’ denotes the increased likelihood of an existing oral disease progressing, and ‘risk of development’ provides important information about the patient’s likelihood of developing a new oral disease. On this basis, the described classification is based on a division into three possible need categories, which define a correspondingly low (green), moderate (yellow) or high (red) risk of progression and/or development (Tab. 1).
As it is difficult to make an assessment on the basis of an individual case, the case-specific, needs-adapted preventative approach requires precise analysis of the specified parameters. Oral diagnostics and a detailed, current and specific patient history, taken as part of the prevention session, are essential. The needs assessment is supplemented by additional recent findings, particularly oral hygiene indices. From this synthesis an individual needs profile can be calculated, which determines the structure and frequency of prevention sessions (Fig. 2).
In doing so, the approach of personalized, needs-orientated prevention aims to provide a complex assessment of the patient’s overall needs. In their article Schmalz and Ziebolz examine this approach in detail with illustrative need factors, taking into account their practical consequences for dental prevention.

Table 1: Definition of the three categories within the needs profile, based on the risk of development and risk of progression

Bedarfsprofil
Klasse Entstehungsrisiko Progressionsrisiko
gering Kein erhöhtes Risiko für die Neuentstehung einer oralen Erkrankung Kein erhöhtes Risiko für das Voranschreiten einer bereits vorliegenden oralen Erkrankung
moderat Nichtbeachtung des Bedarfsfaktors kann zur Neuentstehung oraler Erkrankungen führen Nichtbeachtung des Bedarfsfaktors kann zum Voranschreiten einer bereits bestehenden oralen Erkrankung führen
hoch Nichtbeachtung des Bedarfsfaktors führt mit sehr hoher Wahrscheinlichkeit zur Neuentstehung einer oralen Erkrankung Nichtbeachtung des Bedarfsfaktors führt mit sehr hoher Wahrscheinlichkeit zum Voranschreiten einer bereits bestehenden oralen Erkrankung

Abbildung 1: Aufschlüsselung von Bedarfsfaktoren, welche in der Summe zu einem Bedarfsprofil führen. Dieses nimmt Einfluss auf den Aufbau und den Inhalt der Präventionssitzung. Hierbei wohnt jedem Bedarfsfaktor sowohl ein potenzielles Entstehungs- als auch Progressionsrisiko inne.

Abbildung 2: Mundgesundheitserfahrung, Versorgungszustand und aktuelle Befunde determinieren die bedarfsorientierte Prävention. Für die einzelnen Teilbereiche sind in der Abbildung die wesentlichsten Beispiele zusammengefasst.


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