Communicating effectively to periodontally stable patients with PreViser

By Carl Loeb, CEO PreViser Corp.

PreViser measures the severity and extent as well as the risk of periodontal disease. These measurements are expressed as numeric scores, which make them easy to track over time, as well as serving as an effective means of communicating to patients their disease status, and any changes in that status since the last examination. In addition to the PreViser numeric scores, patient and clinical reports also describe disease severity and extent in words, for example, "localized moderate periodontal disease." Active therapy followed by conscientious periodontal maintenance can take a patient with a very high PreViser disease score to a much lower score, but once bone loss and tissue destruction has occurred, we can never return that patient to perfect health - i.e., a PreViser score of "1".

One question that has been asked by users is what to say to a patient that has been treated and is now stable, but still generates a higher disease score and a written description of severity and extent that still indicates the presence of disease? After all, these users ask, haven't we made these patients "healthy" and if so, why doesn't PreViser reflect this? The answer lies in the nature of gum disease. Like periodontal disease, diabetes can be controlled, but the underlying disease of diabetes remains. Patients with periodontitis who have been treated and currently have no inflammation may still have prior bone loss, and will likely return to a deteriorating state if not maintained appropriately, and PreViser scores and the severity and disease descriptions are intended to reflect this reality.

As a result, our advice to users is to tell a patient who is now stable - which will be reflected quite accurately by stable PreViser disease scores - that they have been made as healthy as they can be, but that careful monitoring, good home care and routine periodontal maintenance in the dentist's office are necessary to maintain that status. For example, a patient may begin therapy with a disease score of 65 and a severity and extent description of localized severe periodontal disease. After therapy that score might be reduced and stabilized at 24 with a severity and extent description of generalized mild to moderate periodontal disease. This patient can be told, "Well, we've been able to reduce your scores from 65 to 24, but if we are going to keep them there, we'll have to stay on a schedule of routine maintenance." In addition, clinicians may choose to de-select the printing of treatment recommendations when the patient report is produced. This is done on the very last screen, just before you transmit the clinical data to PreViser for analysis.

To further reduce any confusion on the subject of how PreViser scores and disease descriptions relate to periodontally stable patients, we will also be modifying the reports in the near future as follows:

1. To clarify that a patient's PreViser score is an accurate measure of severity and extent but may not reflect stability, we are adding the following language to the disease description (change in italics):
   Unless Stable and Without Inflammation, this score would suggest Localized mild and moderate periodontitis
   
2. To clarify that the treatments that would be appropriate for a patient with active disease described by the scores and the description may not be appropriate for patients who are now stable, we are adding the following language to the Active Intervention You May Need section (change in italics):
   Active Intervention You May Need, unless Stable and Without Inflammation
   
   Recognizing the excellence of your care in bringing diseased patients to optimum health is an important element in encouraging continued compliance, and we hope these changes will bring that message home more clearly to patients.

Questions about this or anything else? Please contact us and we'll be happy to answer them.

Note: this article originally appeared in PreViser's The Byte newsletter in December 2008. The report language changes described were made 12.23.08 and are now visible on all PreViser reports generated after that date. ---PreViser Support