Individual Prophy Cycle: The patient-oriented prevention concept

As a solutions provider, W&H works closely with dentists and offers a diverse product portfolio to help meet the treatment requirements and recommendations arising from the personalised, case-specific patient profile.

In the past, many various well-known treatment concepts have focused on treating a single oral disease to restore or maintain oral health. These concepts fail to recognise that many aspects of general health have a major influence on oral health, and can even cause or exacerbate oral diseases1. Hence, a paradigm shift is needed away from this one-dimensional approach to oral health.

With the Individual Prophy Cycle (IPC), which W&H developed in collaboration with dentists, clinicians are now provided with a personalised treatment recommendation which is centred around the close analysis of the patient’s medical history, combined with a precise diagnostic assessment of their general and oral health. This affects the individual steps taken during the prophylaxis or treatment session5.

Advantages of IPC include:

  • Suitable for every dental practice and patient
  • Personalised and patient-oriented
  • Needs-based treatment according to oral health and taking account of the general health factors relevant to dental care
  • No standardised treatments

Case-specific patient profile: The aim of the patient’s profile is to produce a personalised treatment recommendation to improve the safety of procedures and increase the efficiency of treatment2. The patient’s medical history and a diagnostic assessment of their oral health, for example with respect to cavities, periodontal health and other aspects, form the basis for oral health treatment and prophylaxis procedures1,3.

The difference with this approach is that aspects of general health that influence oral health are also taken into account to develop a personalised, case-specific patient profile. Each factor is assessed in terms of its degree of influence on oral health4, which helps to inform the subsequent personalised treatment recommendation. This process is facilitated by a validated medical history form, which has been developed specifically for this purpose.

The following case studies serve to illustrate the interaction between the need and risk factors defined for the IPC, as well as the effects of individual factors.

The diabetic patient with good oral health

A 51-year-old diabetic patient presented with good oral health at a prevention session (Figs. 1a-c). Her blood sugar levels were stable at HbA1c=6.2%, and thus her condition was thought to be sufficiently managed with the antidiabetic drug metformin. The patient had no existing restorations or early oral disease. Using the dental results, it is possible to determine gingivitis in spite of an otherwise stable condition.

Although the oral and general health parameters were stable, the patient’s underlying health condition requires her to attend a personalised prevention session. Diabetes mellitus is always associated with an increased risk of periodontitis12. However, this can be controlled with good medicinal treatment. Regular monitoring of the HbA1c provides information about the course of the blood sugar level over the last eight to 12 weeks, with an HbA1c greater or equal than 6.5% indicating the presence of diabetes mellitus.

Medical history and diagnosis: Because diabetes is so closely associated with periodontitis and has a significant impact on its development and progression, careful documentation is essential. Due to its significance, as described above, the patient should be asked for their current HbA1c value at every session.

Instruct and motivate: The links between diabetes mellitus and the risk of periodontitis can be clearly explained during the consultation12, 15, as well as the impacts of a permanently elevated blood sugar level (hyperglycaemia) on the course and progression of periodontitis16.

Summary and recall: Even if the patient’s oral health gives no indication of any particular need for a shorter recall interval, twice-yearly prophylactic sessions were recommended due to the risks that come with diabetes mellitus and its association with an increased risk of periodontitis.

Continue reading here. Published in Dental Asia January/February 2022 issue.