Why dental practices need to conduct risk assessments of patients

Most dental practices assess the dental history of their patients at intake. Some go a step further and take a complete medical history for each patient. However, if your practice is truly concerned with the health and wellness of your patients, you should also be conducting dental risk assessments.

A dental risk assessment goes beyond dental and medical history. It also provides your clinical staff with information on a patient’s lifestyle, habits, background and family history that could affect their risk for dental complications and other health issues.

Some of the questions on a dental risk assessment might include:

• How often you brush, floss and use mouthwash?

• Did your home have fluoridated water as a child? If not, did you receive fluoride supplements?

• Have other members of your family experienced tooth loss?

• Do you chew tobacco or smoke?

• Do you drink bottled or filtered water? How often? From what source?

• Do you bite your nails or chew on other non-food items?

• Has someone told you that you snore?

• How often do you drink carbonated beverages?

• What beverages do you drink with meals?

• How much calcium and vitamin D do you get as part of your diet?

• Do you chew xylitol gum?

Each of these questions has some bearing on a patient’s risk for caries, tooth injury, gum disease or oral cancer, yet none of these are strictly medical questions. However, taken together, these and other questions can give you a more nuanced portrait of an individual patient's risks.

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Creating a dental risk assessment

You have a couple options for creating a dental risk assessment. Risk assessments for specific conditions, like caries or oral cancer, are available online. You can look them over and combine them into a single assessment for your practice. You can also hire a consultant to create a custom risk assessment for your practice. Or, if you have certain criteria that you’re interested in, you can create one on your own. Remember to keep questions short and use simple, non-technical language so that you patients can understand the questions and answer quickly.

Once you’ve created your assessment, remember to revisit it periodically. As research indicates new oral health risk factors, include them on your assessment. Don’t be afraid to remove questions that don’t give you significant or useful information. Tweak your assessment until it fits your style and the needs of your practice.

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Giving a dental risk assessment                                                                                                

You can either have patients fill out the assessment on their own, or have them go over it with staff members. For the first time, it’s probably best to have a staff member go through the assessment with a patient. That way, they can record any extra information that comes out in conversation.

After the initial assessment, have patients go over an assessment and check off any new information at each appointment. This will keep your records up to date and help you keep track of changing patient situations. For instance, a patient who drinks plain city water at one appointment may switch to a reverse osmosis filter before their next visit.

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Using a dental risk assessment

Use the answers on the assessment to assign each patient to a low, moderate, or high category of dental risk.  For each patient, make a list of one-to-three behaviors they can change in the next six months to improve their risk profile.  For instance, a patient who has many family members with caries may want to chew gum with xylitol or drink milk with meals. A patient who drinks soft drinks daily may want to cut back, or cut soft drinks out altogether. A child who drinks water from an RO device may need to take fluoride supplements.

Make sure that the suggestions you give patients are simple, carefully targeted to their risk profiles, and evidence-based. The key is to use your medical and dental knowledge to improve the health and overall well-being of your patients.

In addition, these risk assessments can often be the first step in helping you document medical necessity for certain treatments and helping you plan future treatments for patients. You can give your patients concrete reasons why they may need scaling in the future, or why you think a sleep apnea appliance could improve their overall health and wellbeing. Risk assessments help patients understand why you’re making certain recommendations for their treatment plans.

Tracking change over time

Over time, track your patients as they move between categories. When they eliminate risky behaviors and add healthy ones, congratulate them. Let them know that you care about their oral health and notice when they take steps to improve it. This sort of personalized, supportive care will give your patients the motivation they need to stick to treatment plans, embrace healthier lifestyles and improve their oral health.