Implementation of Patient-Based Risk Assessment in Practice

The wide heterogeneity in judgments generated by subjective risk assessment as observed among operators (even specialists in the periodontal field) and its negative impact on estimated treatment call for the use of standardized, objective tools for periodontal risk assessment. The use of such tools is currently recognized as a standard of care in dental practice and is encouraged by the influential institutions in the oral and dental field. Benefits related to their application are perceived by both practitioners (as improvements in the identification of the most relevant risk factors, effectiveness of communication, as well as patients’ education, satisfaction, and acceptance of treatment) and patients (as improved awareness of the nature and severity of their disease and higher intentions to adhere to instructions). To date, the use of four risk assessment tools (PRC, PRA, UniFe/PerioRisk, and DRS) in the periodontal field is supported by the results of longitudinal studies demonstrating the existence of a positive association between risk scores and the extent of disease progression. Although the amount and strength of evidence differ substantially between tools, they are designed for clinicians as validated instruments to apply either at first visit (based on the assumption that no periodontal treatment will be administrated) or during supportive periodontal therapy (assuming that conditions will be supervised through a personalized maintenance program). The extra time required for assessment and lack of sufficient validation to tailor preventive/therapeutic interventions on risk levels still represent major limitations for the application of risk assessment tools in daily practice. However, the use of novel, simplified tools is expected to overcome these barriers in the near future, making risk assessment standard and universally acceptable.