Oral Health Assessment and Review - Quick Reference Guide Oral Health Assessment and Review - Quick Reference

Oral Health Assessment and Review - Quick Reference Guide

Scottish Dental
Clinical Effectiveness Programme SDcep
Risk Assessment Personal Care Planning

Assigning a risk for the development of oral disease Points to consider in the development of a personal care plan
Oral Health Assessment and Review
Are any non-protective Disease Diagnosis Quick Reference Guide
modifying factors present? and Extent and Rate Clinical Findings
of Progression
Overview
YES NO

Risk Assessment Patient’s General Oral Health Focussed Oral

Are the modifying factors Personal Care Health
of clinical concern?
Assessment Health Review
Plan comprehensive specific elements only

YES NO
Assessment of
Care Options Patient Histories
Risk-based (e.g. patient advice, Personal details
Is disease present? Is disease present? Review Interval prevention, treatment, Social history
maintenance, referral) Dental history
Patient
Medical history
Preferences and Anxiety level
Expectations
YES NO YES NO
Assessment of Oral
Health Status
Is the disease of Is the disease of Variation in personal care plans for the three overall risk levels every 24 months Head and neck
Oral mucosal tissue at risk-based
clinical concern? clinical concern? for adults or
Periodontal tissue intervals
12 months for
Teeth between OHAs
High Risk Medium Risk Low Risk children Other (e.g. dentures)
YES NO

Enhanced Prevention Enhanced Prevention Standard Prevention

Diagnosis and Risk
YES
Interventive treatment Interventive treatment Assessment
and/or referral, if required and/or referral, if required Form diagnosis
Analyse risk information
NO

Short interval Medium interval

Focussed Oral Health Focussed Oral Health
Reviews to check risk areas, Reviews to check risk areas,
High Risk Medium Risk Low Risk compliance and review compliance and review Personal Care Plan
recall interval recall interval that is specific for the patient
Minimum interval of Minimum interval of and includes a risk-based
3 months 6 months interval for a Focussed Oral
between reviews between reviews Health Review

© Scottish Dental Clinical Effectiveness Programme Oral Health Assessment Oral Health Assessment Oral Health Assessment
at 24 months for adult, at 24 months for adult, at 24 months for adult,
Scottish Dental Clinical Effectiveness Programme 12 months for child 12 months for child 12 months for child
Dundee Dental Education Centre, Frankland Building, Small’s Wynd, Dundee DD1 4HN

Email scottishdental.cep@nes.scot.nhs.uk
Tel 01382 425751 / 425771 Note that for a new patient assessed as low risk, a conservative interval for Focussed Oral Health Reviews is advised For further details, refer to the Guidance in Brief and full guidance available at
Website www.scottishdental.org/cep initially which can be extended incrementally if no new problems are encountered. www.scottishdental.org/cep

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 Modifying Factors
Oral Health Assessment and Review - Quick Reference Guide

Modifying factors include risk and protective factors, behaviours and clinical findings that
• Low saliva flow rate (dry mouth) Tooth Surface Loss
may be identified from patient histories or the assessment of oral health status. These factors
• Mucosal lesion present • Bruxism
are associated with the development of oral disease and conditions and should be considered
when determining the risk-based frequency of Focussed Oral Health Reviews. • Outdoor workers • Clinical evidence of tooth wear
• Tobacco use • High and/or frequent dietary acid intake (e.g. high consumption of acidic drinks such as
Patient Histories carbonated drinks, citrus fruit and fruit juices)
Periodontal Tissue
• Predisposing medical and drug factors: for example, impaired salivary production or
• Conditions that increase a patient’s risk of developing dental disease (e.g. diabetes, • Bony loss observed on sequential radiographs buffering ability; gastric reflux (often associated with Hiatus hernia); eating disorders
xerostomia as a result of, for example, Sjogrens syndrome, certain drugs or head and • BPE scores of 3,4,* in patients under 35 years of age such as anorexia nervosa, bulimia and pica; and the frequent use of some medicines
neck radiation therapy) • Concurrent medical factor that is directly affecting the periodontal tissues (e.g. and supplements such as steroid-containing asthma inhalers, vitamin C tablets and
• Conditions that might complicate dental treatment or the patient’s ability to maintain diabetes, stress, certain medication) effervescent preparations
their oral health (e.g. special needs or anxious, nervous, phobic conditions) • Evidence of gingivitis • Rapid progression of tooth wear
• Conditions where dental disease could put the patient’s general health at increased risk • Family history of chronic or aggressive (early onset/juvenile) periodontitis • Stress and/or anxiety
(e.g. patients on warfarin, immunosuppression)
• Family history of early tooth loss due to periodontal disease Tooth Abnormalities
• Excessive alcohol use (>21 units of alcohol per week for men; >14 units of alcohol per
• High % of bleeding on probing in relation to a low plaque index
week for women)
• Poor level of oral hygiene • Family history
• Family history of chronic or aggressive (early onset/juvenile) periodontitis
• Presence of plaque-retaining factors • Tooth abnormalities (tooth number, size, shape, colour)
• Ghukta, Paan (betel quid with tobacco), Areca nut use
• Previous history of treatment for periodontal disease
• High and/or frequent dietary acid intake Fluorosis
• Rapid periodontal breakdown >2mm attachment loss per year
• High and/or frequent sugar intake
• Root morphology that affects prognosis • Eating/licking toothpaste habit
• High caries rates in mother and siblings (applies to children only)
• Smoking 10+ cigarettes a day • Exposure to fluoridated water, in conjunction with other factors, up to 3 years of age
• Poor level of oral hygiene
• Inappropriate use of fluoride supplements or toothpaste
• Residence in a deprived (low SIMD) area Dental Caries
• Unsupervised toothbrushing (under 6 years)
• Tobacco use
• Anterior caries or restorations
• Use of ≥1000 ppm fluoride toothpaste (protective factor) Orthodontic Status
• Healthcare worker’s opinion (esp. children)
• Use of other sources of fluoride or resident in a water-fluoridated area (protective
• Heavily restored dentition • Canine in the line of the arch but failing to erupt, 10–13 years of age
factor)
• High and/or frequent sugar intake • Failure of teeth to erupt at the expected time
Head and Neck • High caries rates in mother and siblings (applies to children only) • First permanent molars of poor prognosis when hypodontia or skeletal discrepancy
• Low saliva flow rate (dry mouth) present
• Craniofacial abnormalities
• New lesions since last check-up • Palatally ectopic or buccally impacted canines
• Limited mouth opening
• Past root caries or large number of exposed roots • Patients requiring orthodontics as part of a multidisciplinary treatment plan
• Neck (lymph node) swelling
• Suspicious skin lesions (basal or squamous cell carcinomas, melanomas) • Poor dietary behaviours Dentures
• TMJ problems • Poor level of oral hygiene
• Premature extractions because of caries • Poor denture and oral hygiene
Oral Mucosal Tissue • Previous carious experience
• Betel quid chewing • Resident in an area of deprivation
• Diets low in fruit and vegetables • Use of ≥1000 ppm fluoride toothpaste (protective factor) Modifying factors are listed in alphabetical order.
• Excessive alcohol use (>21 units of alcohol per week for men; >14 units of alcohol per • Use of other sources of fluoride or resident in a water-fluoridated area (protective
week for women) factor)

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