Schmalz Gerhard, Ziebolz Dirk
Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany.
Adv Prev Med. 2020 May 20;2020:6752342. doi: 10.1155/2020/6752342. eCollection 2020.
Oral diseases are highly prevalent and a global burden. Accordingly, their prevention appears essential. Recently, different strategies have been developed, mainly focusing on the presence of singular oral diseases or conditions. This article aims to construct a contemporary concept of individualized preventive care in dentistry whereby the focus is switched from viewing oral health in isolation to viewing the patient as a whole. The basis for individualized prevention measures is the case-oriented profile, including the synthesis of risk- and need-oriented parameters. The risk profile comprises different risk factors within the fields of systemic diseases, medications, and lifestyle that inherently pose a potential risk of complications (e.g., infectious endocarditis) and/or oral diseases (e.g., periodontitis). The needs profile includes factors originating from the aspects of oral diseases, dental restorations/appliances, and dental results with a potential risk of pathogenesis (e.g., the de novo development of caries) and/or the potential progression of oral diseases (e.g., an existing caries lesion). Based on these parameters, the general framework and content of prevention measures, as well as the maintenance interval, should be adapted to the individual patient. The implications of this concept might increase the safety, effectiveness, and efficiency of prevention in dental care. A further area of focus is primary prevention, that is, a focus on the preservation of oral health instead of a disease-related approach. However, clinical validation is needed to prove the benefits of the model presented. Individualized prevention promotes a shift from a disease-focused model to a whole-patient-focused model and provides a potential approach for establishing a contemporary concept for preventive care in dentistry.
口腔疾病非常普遍，是一项全球性负担。因此，预防这些疾病显得至关重要。最近，人们制定了不同的策略，主要侧重于单一口腔疾病或状况的存在。本文旨在构建一个当代牙科个性化预防保健概念，即将重点从孤立地看待口腔健康转变为将患者视为一个整体。个性化预防措施的基础是以病例为导向的概况，包括风险导向和需求导向参数的综合。风险概况包括全身疾病、药物和生活方式领域内的不同风险因素，这些因素本身就构成并发症（如感染性心内膜炎）和/或口腔疾病（如牙周炎）的潜在风险。需求概况包括源自口腔疾病、牙齿修复/矫治器以及具有发病潜在风险（如龋齿的新发）和/或口腔疾病潜在进展（如现有龋损）的牙齿状况等方面的因素。基于这些参数，预防措施的总体框架、内容以及维护间隔应根据个体患者进行调整。这一概念的意义可能会提高牙科保健预防的安全性、有效性和效率。另一个重点领域是一级预防，即关注口腔健康的维护而非以疾病为导向的方法。然而，需要临床验证来证明所提出模型的益处。个性化预防促进了从以疾病为中心的模式向以患者整体为中心的模式的转变，并为建立当代牙科预防保健概念提供了一种潜在方法。
