Risk assessment and philosophy in oral healthcare

About the project

Numerous risk assessments are performed daily in general dental practice to identify individuals with increased risk of caries and periodontitis. The results of the assessments form the basis for decisions on prevention and treatment as well as on patients’ visiting intervals. Central to clinical risk assessment is the definition of risk. Although risk is commonly mentioned in, for instance guidelines used in the oral health service, the concept of risk in oral healthcare has not been defined. A fundamental step in the Foresight programme is to create and implement a language for thinking, discussing and learning about risk and how risk is assessed and communicated.

The project will focus on the following research questions:

• How is increased risk defined and what are the levels of aspiration?
• How can quality of dental education be enhanced to facilitate students to develop their competence to assess and communicate risk?
• How is increased risk assessed and communicated in clinical practice?

The research questions will be addressed through a set of key actions:

1. Investigating current risk concepts and levels of aspiration

Risk is a multidimensional concept and different values and interests may motivate different or even particular definitions. The discrepancy between levels of aspiration and inaccurate tools for risk assessment is a major challenge when predicting development of caries and periodontitis. Information will be collected firstly from written documents and then from informants. We will use the written documents as an interpretative lens of how risk is defined and how clinicians are instructed to perform risk assessment, interpret and decide based on the results.

2. Enhancing quality of dental education to facilitate students to develop their competence to perform risk assessment and communication

Given the frequency of risk assessment and communication in a clinician’s daily work, one expects that it is an important part of dental education and that learning outcomes and assessment of student performance are well documented. But we are uncertain! Current education will be analysed using a model that we have developed for quality enhancement in higher education. Based on resulting outcomes, we will design a learning framework that combines dental science with science of risk philosophy, communication and   higher education research.

3. Analyzing how increased risk of caries and periodontitis is communicated to patients

Patients with the increased risk of disease are those that are least likely to attend preventive oral health care. One may question whether adequate information would make any difference and if such information exists in the clinical situation. Our hypothesis is that the information to patients is not tailor-made to their needs. To analyze this we will investigate the evidence and experience for risk communication between clinicians and patients. For example how do clinicians evaluate patients’ understanding of risk and measures to be taken?