DEPPA FAQs

Denplan and PreViser are not proposing to prescribe care pathways for patients based on DEPPA scores. We believe that this is a matter for the clinical judgement of you and your Team. We do recommend, however, that you develop an oral health policy with your Team which directs appropriate enhanced preventive care programmes to those patients scoring high or very high risk (4 or 5) for any oral condition. Evidence based recommendations for professional interventions and patient advice (depending on the patient’s risk assessment) can be found in ‘Delivering Better Oral Health’ for example. This publication can be found at: http://www.dh.gov.uk/health/category/publications/reports-publications/

The concept of developing oral health policies is covered in Denplan’s private study course: ‘The Pillars of Clinical Management’. This can be found on our web site: http://www.denplan.co.uk

You can retrieve assessments created under V2.0 (release date 16 Nov 2015) from within DEPPA. Assuming you have not changed your Encryption Code assessments created prior to that date can be associated with a patient record using the Attach Legacy Assessment function.

• You can print directly from the web page.
• To save the report electronically, either print and scan to your practice management software, or print to pdf
• To print to pdf from Chrome, select Print then change the Printer Destination (second option) to Save as PDF. Press Save and you will then be asked where you wish to save the file to.
• If you are sending the pdf to the patient, please confirm with them that they are happy for their personal data to be emailed.

You are required, as part of your Denplan Excel Accreditation, to conduct a full DEPPA at least once per year for any patient with moderate or severe disease (scores of 0 or 6 for tooth health or periodontal health), or for any patient graded as high or very high risk (scores of 4 or 5) for any condition. All other patients should have a full DEPPA at least every 2 years. It will be up to your clinical judgement how often you see each patient for oral health reviews between DEPPAs and what re aspects of oral health you review at these interim visits. You are encouraged to use any patient assessment tools for this purpose which you see fit beyond the use of DEPPA (e.g. full occlusal assessments, full diet sheets etc where appropriate).

Responsibility for the confidentiality of your patient data resides with your practice. All patient identifiers in the data you enter into DEPPA are encrypted before transmission to PreViser using a Encryption code that you determine and is only known to you. The Encryption code is stored locally on the devices you use to access DEPPA but may be deleted during computer updates or failures. Should this happen you will be asked to re-enter it so it is essential that you keep it somewhere safe as you will not be able to view your patient names without it. PreViser has no access to either the encryption code nor to any identifiable patient data.

DEPPA is optimised for Google Chrome and Safari (V5.0+) on the iPad. Google Chrome has built-in save to PDF functionality which facilitates saving and emailing patient reports. It can also however be used with the latest versions of Internet Explorer and Firefox.

Most of the adverse effects we see in smoking are un-related to nicotine or cotinine, more to the tar particulates and other soluble factors like acrolein and thiocyanates.  

There is no current evidence that the use of these smoking cessation aids has an impact on oral cancer or perio risk.  

No.  Follow you normal protocols.  Radiographs taken within the last couple of years should be sufficient.

We do not recommend taking any radiographs specifically to complete the DEPPA inputs unless you have assessed that they are necessary in line with current guidance. You may choose to use your most recent radiographs, or you also have the option, on the system, of entering ‘no X ray available’ for anterior sextants.

No, you should not use measurements of pocket depth for implants in data entered for the perio assessment.

Soft tissues are scored by the system on the same basis as previously (scoring possibilities 0 = treatment or referral needed, 4 = observation needed and 8= healthy). This scoring is applied to all soft tissue lesions whatever the aetiology.For example acute pericoronitis would score 0.

Occlusion is scored by the system on the same basis as previously. (scoring possibilities 0 = less than 10 teeth opposing in each jaw and 8 = 10 or more teeth opposing in each jaw). Prosthetic teeth are counted if they are being worn.

Periodontal health is scored by the system from your inputs on the deepest pocket per sextant (using the international consensus threshold of 5mm (>4mm) pocketing for disease), CEJ to bone crest distance, and bleeding.

Professor Iain Chapple says on the subject of the 5mm pocket threshold:
“The accepted consensus in Europe and globally now is that 4mm non-bleeding pockets are “closed pockets” and thus healthy, hence the convention is to regard bleeding sites > 5mm as potentially unstable or diseased. This is explained in Perio 2000 volume 51 (2009) in 2 articles; Chapple (Editorial, PP9-24) and Tomasi & Wennstrom (PP45-62)”

Primary caries is caries occurring in a previously un-restored tooth surface.

Tooth health is now scored based on the inputs you supply on carious lesions, defective restorations and existing restorations.

The system calculates each patient’s score to produce the following bands:

Tooth wear is now just concerned with non carious tooth surface loss and is scored from your inputs on tooth wear as follows:

The weightings for each of the eight aspects of the oral health score remain the same. Because the basis for the Oral Health Score has been modified to bring it in line with the latest evidence base, new scores will not be directly comparable to previous scores using the old system. The pilot study of 680 patients indicated that you might expect average Oral Health Scores to fall by around 5-6 points and be around 79.

The Denplan Fee Category is calculated on a points basis using your inputs made on tooth status, periodontal status and from the future disease risk scores.

Periodontal status points are allocated as follows:

So, there is a maximum of 35 points for periodontal status. Patients with no natural teeth will be scored as 0.

Disease risk scores for each of, periodontal disease, caries, tooth wear and oral cancer are allocated as follows:

A maximum of 20 points is therefore allocated to disease risk. Patients with no natural teeth are given 0 for periodontal, caries and tooth wear risk

Points are allocated for tooth status as follows:

There is no maximum points score for tooth status

The bandings are then as follows:

This is a new basis for the calculation of the Denplan Fee Category designed to increase the emphasis on periodontal status and to introduce some weighting for the risk of future disease. To some extent this will reduce the influence of restorative status on patient pricing. Some reports may therefore indicate a change of Denplan category. However, members are reminded of their discretionary powers in agreeing fee categories within the rules of Denplan Care. A letter denoting the indicative fee code (A-E) is to found only on the practice copy of the report (which includes also a record of the inputs). The fee category does not appear on the patient’s copy.

In the DEPPA pilot trial (25 dentists and 680 patients) this new system was not found to indicate wholesale changes to patient fee categories. Change was only indicated for a relatively small number of patients, mostly those with moderate to severe periodontal disease.

You first need to create a patient record through the Add Patient option. Subsequently you can locate patients for whom reports have been done through Select Patient

By selecting the Patient Initiated Assessment option from a patient record or by printing out the Patient Questions, DEPPA allows the patient to self-complete the ‘patient questions’ section in reception prior to their appointment. If this is done, we recommend that a team member either supervises this, or certainly checks the entries before you proceed with the clinical examination. There is a ‘save’ bar at the end of the on-line patient questions which indicates to the patient to save their entries and which logs them out of DEPPA so that they do not have access to saved records completed by other patients. The patient answers can then be retrieved in surgery from the Unfinished Assessment page of a computer using the same username, password and encryption code.

Alternatively the full assessment can be completed in the surgery by selecting the Clinical Assessment option

We recommend that you suspend your usual examination protocol for patients when conducting a DEPPA and follow this sequence:

Patient Questions

If the patient has pre-completed these, check the answers and make clinical notes in your records to clarify where necessary. This will be particularly important if patients have indicated a problem when answering questions 1) 2) or 3). Check medical history following your usual methods.

Periodontal Status

Conduct a BPE with a WHO BPE probe. For sextants scoring 3 or 4 update your pocket charting and any other periodontal records you usually maintain in your clinical notes. Then complete the DEPPA inputs in this section while viewing your most recent radiographs where appropriate.

Status of teeth

Examine the teeth in your usual manner and update your dental chart. Then complete the DEPPA inputs in this section while viewing your most recent radiographs as appropriate.

Tooth wear

Summarise the extent of non carious tooth surface loss by making the DEPPA entries. Your dental chart, which you have just updated, will provide more detail.

Occlusion

Summarise the occlusal adequacy by making the DEPPA entry and conduct any more detailed occlusal analysis which you feel is necessary, making entries to the clinical record as necessary

Soft Tissue

Finally conduct your usual soft tissue examination and make any clinical notes in the record as necessary. Summarise your findings by making the DEPPA entry and now submit your assessment by clicking on the ‘submit’ box.

Once you have submitted the data a comprehensive patient report will follow instantly in html format. Show each patient the report on your screen and then e-mail it to them with their consent (by first saving as a PDF), or print out a copy for them. Please explain the report to each patient. You can either save a copy to your records electronically or file a printed copy to give a record of your full assessment. (You will have also updated your usual dental and periodontal ‘charts’ and made any necessary supplementary notes- see above). Whilst the report is maintained within DEPPA it is best practice for you to save it in your patient records. The version of the report you save to your records needs to include a report of the inputs made. Do remember that if your findings are clear from a recorded input, that it is not essential to duplicate this with a clinical note entry. We recommend that the report the patient receives does not include the input page.

The Practice Analysis page of DEPPA shows your average scores submitted in your selected timescale, and the average scores of all other dentists in the programme over the course of one year.(The NRS). This will enable you to compare your oral health scores, disease risk scores, and Denplan fee category percentages with a large sample from around the country. It will also enable you scrutinise the detail behind your score to consider where improvements might be possible.

Table 1 Main averages

Table 2 Percentage of patients in each band of health for each aspect

To set up your myDentalScore, simply follow the instructions within myAccount (linked from the Support Page within DEPPA)

By completing a simple questionnaire patients receive an estimation of their risk and disease severity for gum disease, caries and oral cancer. myDentalScore highlights the preventive focus of your practice and encourages (potential) patients to come to you to have their scores verified.

You are entitled to a personalised version of PreViser’s patient self assessment tool, myDentalScore for your website as part of your DEPPA subscription.