Patient profile and decision-making in periodontal practice.

Abstract

Over the past few years, much has been learned of the relationship between risk factors and the development and progression of periodontal diseases (10, 21). Data coming mostly from cross-sectional studies have identified infrequent dental attendance, smoking, diabetes, stress, genetic factors as well as specific bacterial species as possible risk factors or risk indicators for periodontal disease (8, 14, 17, 18, 20, 26). Clinical experience shows that these factors not only increase the probability of developing periodontal disease but that they are critical in the prevention of and in the treatment of the disease. The purpose of this paper is to discuss all the factors that have to be considered in the management of a periodontal patient, factors that influence determination of therapeutic objectives as well as the selection of treatment procedures. Some elements are related to the patient’s profile and include physical, biological as well as behavioral factors such as a patient’s aptitude to undergo active therapy or to accept the burden of treatment. Other elements are related to the professional environment and include technical aspects as well as collaboration with other specialties. In clinical practice, defining the objectives of therapy is a pivotal step in the management of the patient as this drives the entire treatment plan. The objectives of treatment have to be determined on the basis of the patient’s needs and of the patient’s profile. Patient profile may be defined as the sum of all the determinants and attributes that characterize an individual and that serve to evaluate that individual’s aptitude to undergo active therapy. Assessing the patient’s profile is of the utmost importance for the success of therapy. Patient profile The purpose of the initial consultation is to collect all relevant information that can help in defining the patient’s profile. The interview should include information related to a patient’s identity, socioeconomic background, general health, and dental history. The patient’s chief complaint should also be recorded. Diagnostic procedures should enable identification of risk factors or risk indicators that can influence treatment decisions and treatment outcome. The findings should guide the clinician and help to optimize periodontal therapy. The data may serve as the basis for establishing the treatment plan and, after therapy, enable evaluation of the treatment outcome. The data is also useful to monitor patients during periodontal maintenance. The initial consultation should also allow a sound and reliable patient‐ clinician relationship to be established. Assessment of the patient should not be limited to the initial consultation. During the course of therapy, patient status may be subject to changes relative to systemic conditions, use of medicaments, smoking habits, stress, and economics. Therefore, the medical history, the environmental and the behavioral factors should be reevaluated on a regular basis during active treatment as well as during supportive periodontal therapy.