The concept of risk assessment in managing chronic diseases has been around for many years. For example, it was first introduced by Canadian employers in the 1980s as a way of changing the behaviour of employees.

The early experience of health risk assessment was often disappointing. Without financial incentives and clear alternatives to treatment, behaviour of the patient, and often the provider, rarely changed sufficiently to make a difference.

Unless the patient can see a direct self-interest, an affordable alternative to treatment and/or a financial gain to change, old habits eventually resume.

So why bother doing a short risk assessment of your adult patients for caries? There are several reasons:

1. Many of your patients expect it and want it. (Ask yourself: would you want your physician to evaluate your risks of other chronic diseases such as osteoporosis?)
2. Many gain new information to choose the kind and level of care they need and want. (In my case, for example, I found out for the first time, that I was at high risk of root caries because of 5 sites of significant gingival recession.)
3. It is the crux of informed consent.
4. With Prevora, there is now an alternative treatment to ongoing restoration. This choice eases the bad news for the patient.

The reforms of the NHS dental program promise to institutionalize risk assessment in UK dentistry, much like it has become standard practice in other managed care programs. In these reforms, it appears both the dentist and the patient will be financially incented to participate in taking stock of health prospects.

In these times of austerity and cost containment, other dental programs could well mimic these reforms.

A health risk assessment of adult caries is quick and easy, and indeed, far less laborious than that routinely conducted for adult periodontitis. The key risk factors are discussed in some detail in the short webinar in the UK chapter of Prevora.com.

Ross Perry