Research Summary and Scientific Papers

Research Summary

PreViser technology offers an easy-to-use and clinically validated method for identifying periodontal disease risk and describing a periodontal disease state, as well as a practical method for characterizing risk of caries, tooth wear, and oral cancer.

PreViser research demonstrated the accuracy and validity of the perio risk score in a study of 523 subjects over 15 years (6,7).  Conversely we found that the assessment of perio risk by dentists in the absence of such a tool is subjective and varies widely (5). PreViser’s perio disease score methodology is published and has been found to correlate well with the diagnostic opinions of periodontists (4).

For caries, oral cancer and tooth wear, in the absence of validated algorithms which combine the known risk factors, PreViser uses the latest evidence base.  Caries risk is based on CAMBRA, ADA, AAPD risk factors, and as such, represents a “Best of Breed” approach. For oral cancer and tooth wear we work with leading experts in their fields to ensure that our methodology and communication reflects the current literature.

We know from the studies of Axelsson and others (15) that perio and caries are preventable / controllable. Much has been published on the associations of perio disease with tooth loss and systemic diseases.  A recent paper using DEPPA data presented at IADR 2017 has also demonstrated how current periodontitis, particularly current severe periodontitis is associated with patient reported pain, dietary restriction and poor dental appearance (16). We also know that personalised biofeedback works (17).  An independent study from KCL showed that use of PreViser improves psychological outcomes for the patient (1), and an internal study showed that 99% of patients who received a PreViser report followed through on some or all of the recommendations.  A RCT presented at IADR in 2017 (2)showed how plaque scores, bleeding and self-reported ID cleaning improved significantly vs a control group as a result of communicating risk and disease with PreViser.  There is work ongoing in this area on how we should refine our communications to provide the best foundation to empower / motivate patients to take control of their own health.

In terms of dentist response we have published the (very positive) feedback from Denplan dentists on their use of DEPPA in an initial pilot (10).  A study published in the BDJ in 2017 on patient and practitioner perceptions concluded that ‘Participants expressed a high level of acceptability of the DEPPA tool. In particular, the tool is seen as enhancing the relationship between the patient and practitioner and providing information to support behaviour change’(11).

We are also building up a powerful database of anonymised data on the UK population which is invaluable for analysis of not only health and risk status, but also of the inputs from which these are calculated.  We have demonstrated that DEPPA’s oral health scoring systems provide an oral health profile which is consistent with that of the Adult Dental Health Survey 2009 (9). We have discussed the valuable opportunities DEPPA provides for clinical audit, as live data is provided to the dentist for comparison against a national benchmark (9). We also have also shown that the cost of providing oral health care tends to rise significantly with age and have discussed the significance of this with respect to capitation banding (8).  Our latest paper (12) presents evidence from a large group of patients (attending general dental practices) demonstrating that worsening oral health correlates with worsening general health and provides further evidence from this group on the association between high-risk lifestyle factors such as smoking and heavy drinking and poor oral health outcomes.  Further papers are currently being prepared for publication – please watch this space!

Scientific Papers 

PreViser Papers
DEPPA Papers
Review paper on Periodontal Risk Assessment
Scientific Papers of General Interest

PreViser Papers

1. The effects of providing periodontal disease risk information on psychological outcomes – a randomized controlled trial K Asimakopoulou, T Newton, B Daly, Y Kutzer and M Ide, Journal of Clinical Perio 2015
New study assesses the effects of providing perio disease risk information on psychological outcomes. The RCT compared routine consultations with assessments that included PreViser’s individualised risk based perio assessment and found that with the latter, patients saw perio treatment as more effective, were more confident in their ability to follow a perio treatment regime and reported higher intentions of adhering to perio disease instructions.
View the abstract online

2. The effect of Planning, Goal Setting and Self-monitoring (GPS) on behavioural and Periodontal Outcomes: A Randomised Controlled Trial (RCT) by ASIMAKOPOULOU K, Oral presentation IADR 2017 View the abstract online

3. Quantification of periodontal risk and disease severity and extent using the Oral Health Information Suite (OHIS) Page, RC and Martin JA Perio in Practice 2007; 4(3):163-180
Improved measures to accurately assess risk for periodontal disease and quantify periodontal disease status would benefit all stakeholders of oral health care.
View the Article Online / View the PDF

4. The Oral Health Information Suite (OHIS): Its Use in the Management of Periodontal Disease. Page, R., Martin, J., and Loeb, C. Journal of Dental Education 2005; 69 (5): 495-619
View the Article Online View as PDF

5. Assessing periodontal disease risk: A comparison of clinicians’ assessment versus a computerized tool. Persson, G.R., et al. Journal of the American Dental Association 2003; Vol. 134: 575-582
The accuracy of subjective risk assessment, even when performed by periodontal experts, has been examined and compared to the validated PreViser technology. The results of this study were reported in the May 2003 issue of JADA.
View the article online

6. Longitudinal validation of a risk calculator for periodontal disease. Page, R. et al. Journal of Clinical Periodontology 2003; 30: 819-827
Risk scores calculated using the PRC and information gathered during a standard periodontal examination predict future periodontal status with a high level of accuracy and validity.
Use of the risk assessment tool over time may be expected to result in more uniform and accurate periodontal clinical decision-making, improved oral health, reduction in the need for complex therapy and reduction in health-care cost.
View the article

7. Validity and accuracy of a risk calculator in predicting periodontal disease. Page, R., et al. Journal of the American Dental Association 2002; Vol. 133: 569-576
Successful application of the wellness model depends on an accurate and valid assessment of disease risk, as well as institution of risk reduction as an integral part of prevention and treatment. A computer based risk assessment tool has been developed. Use of the risk assessment tool over time may result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy, reduction in health care costs and a hastening of the transition from a repair model to a wellness model of care.
View the article online

DEPPA Papers

8. The relationship between oral health risk and disease status and age, and the significance for general dental practice funding by capitation by BUSBY M, MARTIN J, MATTHEWS R, BURKE T, CHAPPLE I. British Dental Journal 217, E19 (2014)
View the abstract online / View the Research Summary (Nairn Wilson)

9. Continuing development of an oral health score for clinical audit by BUSBY M., CHAPPLE L, MATTHEWS R, BURKE T, & CHAPPLE I. British Dental Journal 216, E20 (2014)
View the Abstract online / View the Research Summary (Paul Brunton)

10. Practitioner evaluation of a novel online integrated oral health and risk assessment tool: a practice pilot by BUSBY M, CHAPPLE E, MATTHEWS R, CHAPPLE I. British Dental Journal 215, 115 – 120 (2013)
View the abstract online

11. Perceived acceptability of the DEPPA patient assessment tool: A questionnaire survey of Denplan Excel Patients by NEWTON JT and ASIMAKOUPOLOU K View the abstract online

12. The relationship between general health and lifestyle factors and oral health outcomes by SHARMA P, BUSBY M, CHAPPLE L, MATTHEWS R, CHAPPLE I.  British Dental Journal 221, 65 – 69 (2016)
View the abstract online / View the editorial (Stephen Hancocks)

Review Papers on Perio Risk Assessment

13. Risk factor assessment tools for the prevention of periodontitis progression a systematic review LANG N, SUVAN S, TONETTI, M. Journal of Clinical Periodontology Volume 42, Issue S16 S59–S70 (2015)
View the paper

14. Risk calculation and periodontal outcomes by RAUL I. GARCIA, MARTHA E. NUNN & THOMAS DIETRICH. Periodontology 2000, 50: 65–77 (2009)
View the abstract

Scientific Papers of General Interest

15. “On the Prevention of Caries and Periodontal Disease.”
Results of a 15-year longitudinal study by P. Axelsson, J. Lindhe and B. Nyström.
View the Paper

16. Association Between Periodontal Health/Disease and Patient Reported Outcomes
Sharma et al analysed DEPPA data and showed that current periodontitis, particularly current severe periodontitis is associated with patient reported pain, dietary restriction and poor dental appearance.
View the abstract

17. The Importance of Personalised Biofeedback
Barnfather et al (2005) highlighted the effectiveness of immediate, individualised biofeedback to patients in the primary dental care setting to stimulate behaviour changes directed at improving oral health.
View the Paper