ORAL HEALTH ASSESSMENT AND REVIEW

 ORAL HEALTH ASSESSMENT AND REVIEW


Why this guidance has been developed

Following the earlier surgical (or extractive) era, there has been a restorative approach to the provision of dental care in primary practice, with a focus on the assessment of carious cavities in teeth and less emphasis on initial caries, the assessment of periodontal tissue and the overall oral health of the patient. A standard recall interval of 6 months has been advocated for all patients, regardless of the status of the patient’s oral health. However, it is becoming increasingly apparent that there are wide variations between patients in their susceptibility to disease, the likelihood of early disease progressing and the speed of disease progression, if it occurs. A ‘one-size’ fits all approach is therefore not adequate to meet the needs of every patient.

In 2004, the National Institute of Health and Clinical Excellence (NICE)1 issued guidance recommending that a patient’s recall interval for routine care be determined by their overall risk of oral disease and thus be individualised to the needs of each patient. In addition, the Scottish Government has more recently set out a ‘Better Health, Better Care’ Action Plan2 that targets health inequalities and those at greatest risk and aims to improve health and the quality of healthcare by adopting a more preventive, proactive approach. This model is referred to as anticipatory care and aspects of it are already being implemented in dentistry within the Childsmile programme3. The intention is to extend this approach across the whole of primary dental care to move from the more traditional approach towards a more preventive, evidence-based and, where possible, minimally invasive approach to care. This approach is risk-based and long-term and aims to meet the specific needs of individual patients and encourage the involvement of patients in managing their own oral health.

The Scottish Dental Clinical Effectiveness Programme (SDCEP) convened a guidance development group to provide clinical guidance on best practice for the assessment of individual dental patients. The Guidance Development Group defined an oral health assessment (OHA) as assessment of the patient’s histories and their oral health status, leading to diagnosis and risk assessment, followed by personalised care planning and review. Many aspects of the guidance will be familiar to dental teams. However, the ‘newer’ concepts introduced include: assessing modifying factors (including risk and protective factors, behaviours and clinical findings associated with the development of oral disease or conditions) and assigning a ‘risk level’ to each patient in order to facilitate the development of a personal care plan and the identification of a recall interval for review that is specific for each patient (see Sections 5 and 6). This guidance therefore promotes a systematic and comprehensive approach to assessing and managing the overall oral health of each patient. Further details about SDCEP and the development of this guidance are given in Appendix 1.

Why follow this guidance?

If a comprehensive assessment of the patient’s overall oral health status, including assessment of teeth, periodontal tissue, oral mucosal tissues and head and neck, is carried out for all patients, signs of oral disease can be recognised early and appropriate care (both preventive and treatment-based) can be provided to improve the oral health, and in some cases general health, of the patient population in Scotland.

If accurate and comprehensive record keeping is carried out, this will facilitate the provision of high-quality patient care and improve patient safety, particularly in cases where patient care is shared among the dental team4. It also provides a permanent record, which can support the dental team if faced with complaints or litigation.

Scope of this Guidance

This guidance aims to facilitate individualised long-term preventive-orientated care (including recall) to improve and maintain the oral health and general health of each patient by providing advice on patient assessment (see Section 2.1). The guidance is based on existing guidance (NICE Clinical Guideline 19 on dental recall1, FGDP Clinical Examination and Record Keeping guideline5), relevant systematic reviews6-8, research evidence and the opinion of experts and experienced practitioners.

This guidance is directed at the whole primary care dental team. The approach to patient assessment described in this guidance is applicable to all patients, including adults, children and those with special needs, who would normally receive regular care in the primary care sector but needs to be adapted to the particular needs of specific patient groups. With the exception of some differences for the assessment of child patients which are highlighted, details of such adaptations are beyond the scope of this version of the guidance.

For patients who attend only for urgent