A complete clinical periodontal examination provided the golden standard periodontitis classification: no/mild, moderate or severe periodontitis. Is Periodontal Risk Assessment an Important Periodontal Risk Assessment. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. This approach allows for individualized dental/periodontal treatment in a patient-centered holistic model that includes dental, medical and lifestyle/behavioral factors. This is an awesome article! Kinane DF, Marshall GJ. Genco RJ, Borgnakke WS. Periodontal Therapist; Patient Treatment Advocate; ... (Caries Management by Risk Assessment) as a key to help patients prevent the infection of decay and to build value for preventive services. Tooth-level risk assessment. This website uses cookies to improve your experience. This is a crucial step, as it helps establish and reaffirm the clinician/patient relationship and builds trust. After data analysis, risk and disease scores may be generated, along with suggested treatment modalities.5,6 Other Web-based tools use algorithms to calculate risk based on factors such as: age; history of smoking, diabetes and periodontal surgery; pocket depth; furcation involvement; alveolar bone height; and vertical bone loss.6 Risk scores increase depending on history of periodontal surgery, tobacco use, and the presence of chronic disease.7. Oral Health Risk Assessment Tool Guidance Timing of Risk Assessment The Bright Futures/AAP “Recommendations for Preventive Pediatric Health Care,” (ie, Periodicity Schedule) recommends all children receive a risk assessment at the 6- and 9-month visits. The establishment of periodontal disease as multifactorial, and recognition that, in addition to subgingival infection, specific risk factors are necessary for disease to develop, have placed considerable importance on risk assessment. Thank ou very much Dr.Sara. The American Diabetes Association recommends that individuals with diabetes achieve a goal hemoglobin A1c of <7.0%. %%EOF The contribution of each risk factor domain is arbitrarily weighed to yield an overall risk score, and a visual representation of the patient’s individual risk of progression of periodontal disease. h�b```���?�@(�������%Y�)−���=�|-�G�>�s��Q;��J� Information on the presence of any of these diseases should include current therapy and compliance with prescribed therapy. Osteopenia, a reduction in bone density below the normal value for age and gender, is a risk factor for alveolar bone loss. Tooth-level risk assessment may or may not be carried out at the initial examination, once a BPE screen had identified a susceptible patient. Internet-based systems are available that quantify risk for periodontitis and periodontal disease severity and extent, and generate treatment recommendations and interventions. Although the role that risk factors play in the development of periodontal disease is widely recognized, and growing evidence suggests a link between periodontal health and systemic health, this knowledge is still underutilized by most dental practitioners. In the latter situation, detailed periodontal charts and a detailed radiographic assessment and radiological report should be performed (Chapters 8 and 9). More needs to be done to identify, mitigate and manage periodontal risk factors, as this will offer considerable benefits to patients’ oral health. The Philips CARE (Customized Assessment and Risk Evaluator) tool can help you provide more comprehensive care for your patients at all stages of life. The periodontal risk assessment model proposed in this article builds on procedures that are already part of a routine dental visit. They typically gather clinical and radiographic data that are combined with medical and risk factor information. This subgingival infection, which is specific and unique to the oral cavity, is not sufficient for tissue destruction to take place. Adult Periodontal Disease; Oral Cancer; Dental Benefits are provided by Horizon Heathcare Dental, Inc. and Horizon Blue Cross Blue Shield of New Jersey, both of which are independent licensees of the Blue Cross and Blue Shield Association. For men and women older than 70, 1200 mg calcium and 800 IU vitamin D should be taken daily. Including risk in treatment planning means that the intensity and accurately predicted by the combination of risk and se- verity scores than by either score alone. The goal is about creating value for patients seeking dental implants. It enables clinicians to help monitor and improve outcomes without the need to increase chairtime or appointment lengths. As explained here, a simple, evidence-based model for implementing periodontal disease risk assessment and management can be altered as therapies and goals evolve. Baker PJ, Roopenian DC. Risk assessment provides the clinician with the opportunity to develop a risk-based treatment plan that incorporates the level of risk along with the severity of periodontal disease. Recommendations about how to eliminate modifiable risk factors and manage nonmodifiable risk factors should also be documented at this time. Cronicon OPEN ACCESS EC DENTAL SCIENCE Research Article Environmental Risk Factor (Smoking) Affects Oral-Periodontal Diseases Ossama A Alkhatib1*, Wael T Daboul2, Muhanad O AlKhatib3 and Samar F Saati4 1AssistantProfessor, Periodontal Department, Alfarabi Dental College, Jeddah, Saudi Arabia 2Periodontal Department, Damascus University, Syria 3Periodontal Department, Alfarabi Dental … Providing this information leads to the recommendation phase, which discusses what patients can and/or should do in order to reduce their risk for periodontal disease. Data suggest the latter pharmacotherapy is most effective at achieving smoking cessation.11,12, Diabetes and prediabetes are important risk factors for periodontal disease. Lang NP, Tonetti MS. Periodontal risk assessment (PRA) in supportive periodontal therapy (SPT). Objective: This study aimed to develop and assess the content validity and reliability of a cognitively adapted self-report questionnaire designed for surveillance of gingivitis in adolescents. Your overall health may be linked to the health of your gums and teeth. American Academy of Periodontology. These risk factors can be changed or eliminated, and effective treatment strategies will aid in these efforts. © 2020 - Decisions in Dentistry • All Rights Reserved. The dentist should establish and communicate the goals of periodontal treatment, encourage lifestyle modification (as appropriate), and involve/refer to additional health professionals as necessary. We'll assume you're ok with this, but you can opt-out if you wish. Under this new approach, the role of risk assessment is considered essential for good clinical practice. h�bbd```b`` ��7���H1�d��L��$X w���"Mn�H��`�D�j�H��`�-@��w>���$�΀ů�H�`��H��`�� R�H�^y�����i�dF���߾ �Qj Identifying undiagnosed diabetes or prediabetes is important, as interventions have been shown to reduce the development of diabetes and could potentially reduce the onset or severity of a periodontal disease.13,14 Several reports recommend screening for diabetes in the dental setting. This self-assessment system enables the estimation of disease risk for the general population.9. Borgnakke WS, Ylostalo PV, Taylor GW, Genco RJ. Enjoyed reading it. ... Periodontal Risk Assessment Questionnaire Name _____ Date_____ IF YOU ARE A PATIENT WHO HAS DIABETES: Is your diabetes under control? In this approach, the patient’s oral status is integrated to his or her general health status, presence of specific risk factors, and behavioral contributory factors. The report outlines clinical recommendations for dental professionals to use when treating patients with diabetes, and emphasizes the importance of an annual comprehensive periodontal evaluation as part of an effective diabetes management program. Pharmacotherapy includes bone sparing agents, bisphosphonates (alendronate, ibandronate and risedronate), and selective estrogen receptor modulators. Genco RJ. Accept Read More. The clinical practice of risk assessment . Learn how your comment data is processed. Cigarette smoking is one of the most significant risk factor associated with periodontal disease incidence, severity, progression and negative treatment outcomes. Recognition that, in addition to subgingival infection, specific risk factors are necessary for periodontal disease to develop has placed considerable importance on risk assessment — and this has led to a multidimensional approach to periodontal therapy and management. If warranted, and based on current recommendations,20 adults age 50 and younger may be advised to take 1000 mg calcium and 400 IU to 800 IU of vitamin D daily. Patients should be assigned an individual score based on the presence of one or more major risk factors. Current guidelines for blood pressure in patients with diabetes or cardiovascular disease suggest a target of 140/90 mmHg.18 Lipid lowering therapy is another important component of cardiovascular disease prevention and treatment. Oral health professionals should record patients’ risk factors in their charts. significant risk factor for gum disease. Obesity, and especially abdominal obesity, is a significant risk factor for insulin resistance, and abdominal adipose tissue is considered to be the most insulin resistant. Most dentists and periodontists are not trained or experienced in risk assessment nor in using interventions aimed at risk reduction in the prevention and management of periodontal diseases. Systemic risk factors include diabetes, obesity, cardiovascular disease, metabolic syndrome, osteoporosis, osteopenia, and low dietary intake of nutrients, such as vitamin C, D and calcium. Self-report questionnaires have been proposed for the surveillance of periodontal diseases in adult populations world-wide. Current view of risk factors for periodontal diseases. Sara G. Grossi, DDS, MS, is a periodontist who has been the principal investigator in multiple landmark studies on periodontal disease risk factors, and the relationship between periodontal disease and general health. The next step is to recommend strategies for reducing risk. Even modest goals to reduce caloric intake and increase physical exercise can lead to reductions in weight and waist circumference. These tests are important new tools that can help identify high-risk patients and assist clinicians in developing individualized treatment plans. Nine parameters are entered into an algorithm. Periodontol 2000. You can help your hygiene staff to begin conducting risk assessments by using clinical note templates. More specifically, periodontal risk factors are environmental, behavioral, or biological factors that raise the probability of treatment failures. Treatment should therefore address all components of the multifactorial triad. While not new, this model is organized in a coherent sequence that ensures a concrete outcome — and it can be implemented into practice without reducing time spent on other components of dental care, thus enhancing the scope of the visit. Effective adjuncts include nicotine replacement therapies, such as bupropion or varenicline. The report step focuses on making patients aware of their risk factors and risk profile. Important goals to consider in patients with diagnosed cardiovascular disease are controlling blood pressure, cholesterol and lipids. Utilizing risk assessment helps dental professionals predict the potential for developing periodontal diseases and allows them to focus on early identification and to provide proactive, targeted treatment for patients who are at risk for progressive/aggressive diseases. The first line of therapy should include reduction or management of underlying risk factors. Oral health professionals have a moral obligation to engage in tobacco cessation strategies, and to encourage all patients who smoke to quit. Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. A clinical practice guideline for treating tobacco use and dependence: 2008 update. American Diabetes Association. Standards of medical care in diabetes—2013. Accessed November 19, 2015. Due to the multifactorial nature of periodontal disease, identifying, assessing and managing risk factors are integral to successful therapy. This model can easily be integrated into clinical practice and applied at each dental visit, and it does not require additional appointment time. Introducing Fresh—the World’s First and Only, 7- Second Professional Flossing System, Palmero Healthcare Introduces a Trio of Safety-Focused Products. Excessive daily stress and poor coping strategies are risk factors for periodontal disease, cardiovascular disease and other conditions. Download Article This consensus report is based on a large body of scientific evidence that suggests periodontal health may be helpful in controlling diabetes.16. Available at: https://www.perio.org/sites/loveyourgums/gums-101.php. To better help clinicians assist their patients with smoking cessation, the U.S. Public Health Services’ “Clinical Practice Guideline for Treating Tobacco Use and Dependence,”10 recommends the following: Pharmacotherapy may be recommended to patients who need additional support to achieve smoking cessation. A patient identified with major risk factors should enter clinical management regimes. Toward that end, this article provides a simple, evidence-based model for the comprehensive management of periodontal risk factors that’s easy to implement in clinical practice, as this remains a major component of successful long-term periodontal care. For example, in the case of a patient with uncontrolled diabetes, indicate the need for improved glucose control. Counting calories and reducing intake of high-calorie beverages are helpful weight-loss strategies and also reduce the risk for dental and root caries. Questions regarding the major risk factors for periodontal disease (e.g., smoking, diabetes, cardiovascular disease, obesity and osteoporosis) should be integrated into existing patient questionnaires. �N�q!��?����W\�dذ��r��nr�'f%�=�}(���A�u%�elli�+���4j�c$�)O���;�h�ı�c3�R��Im�s�1�%�,���-R�JH��a�;�x�xLG� �A�2 [R^��Bfcc^‘J��������A� W���ug�ӛ5*�'ZA��7��� �ɖ��8s؊Hy����e��� ���d^f10*C�:!B"�%��hJ�+��T3���n�T5�;�. Risk assessment covers many areas of concern, but for treatment planning and monitoring purposes periodontal probing as a specific indicator of gingival inflammation and a measurement for attachment loss is an essential part of the diagnostic process. By monitoring and managing risk factors for periodontal disease, dental professionals can improve dental and medical outcomes by focusing on early identification and proactive, targeted interventions. Periodontal Risk Calculator (PRC). Adipose tissue produces and secretes TNF-a, IL-1B and IL-6, which have effects on adipose and systemic tissues. Save my name, email, and website in this browser for the next time I comment. For patients with diabetes and periodontal disease, glucose control and periodontal disease management are extremely important.15, A joint report from the AAP and European Federation of Perio­don­tology16 found that periodontal health plays an important role in the management of diabetes. Timing for Teaching Risk Assessment. These adipose tissue cyto­kines enhance insulin resistance in systemic tissues through serine phosphorylation of the IRS-1 receptor, thereby blocking insulin signaling. Avenue Louis-Casaï, 51 1216 Geneva Switzerland T +41 22 560 81 50 info@fdiworlddental.org. In general, the goal of lipid lowering therapy is a total cholesterol <200 mg/dl, and non-high-density lipoprotein cholesterol <130 mg/dl. Add all points together and check your score against scores at the bottom of the page. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. Periodontal Risk Assessment Model (PRA). Test Your Gums Quiz. Using an algorithm, the answers are combined and categorize patients as “low risk” or “at risk” of periodontal disease. The following information will help you assess your gum disease risk. There is evidence to suggest that cardiovascular disease is associated with periodontal disease.17 Oral health professionals should review the therapeutic regimens and medication histories of all patients with cardiovascular disease. Due to the risk of bisphosphonate-related osteonecrosis of the jaw, patients on bisphosphonate therapy should be closely monitored when an invasive dental procedure, such as oral surgery, is indicated. As such, oral health professionals should recommend that patients experiencing highstress seek professional help and implement self-help measures. Most importantly, it allows for individualized dental/periodontal treatment in a patient-centered holistic model that includes dental, medical and lifestyle/behavioral factors. In recent years, numerous computer-generated risk assessment models have been proposed to assist oral health professionals with estimating a patient’s risk of periodontal disease, and from which risk assessment may be implemented in clinical practice. Oral Health Risk Assessments. Jorenby DE, Hays JT, Rigotti NA, et al. We now have amazing options for patient treatment, assessment, and diagnosis. Page RC, Krall EA, Martin J, Manci L, Garcia RI. 581 0 obj <>stream Risk factor assessment is an important part of long-term periodontal care and health, and dental hygienists—who assess, manage, and modify these risk factors—play a key role in this process. Arrange for follow-up within the first week of the quit date. Patients should be educated about the factor(s) for which they are positive and the potential impact on periodontal conditions and treatment outcomes. Periodontal disease involves bacterial infections with subgingival patho­gens responsible for the disease process. For the 12-, 18-, 24-, 30-month, and the 3- and 6-year visits, risk assessment This program is about how to use a simple patient questionnaire to estimate the aggregate risk of dental implant failure. Globally, approximately 50% of adults experience PD, with an estimated prevalence of 10.7% for severe periodontitis.1Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe periodontitis in 1990… A recommendation from a trusted clinician goes a long way in helping spark motivation for change. During the session, the program information will be reviewed with clinical examples and videos. In this multidimensional approach, the patient’s oral status is integrated to his or her general health status, presence of specific risk factors, and behavioral contributory factors. The goal is to reduce the negative physical effects of daily stress. Periodontal disease, if left untreated, will lead to bone loss and ultimately the loss of teeth. Summarize this information in simple language that is easily understood. A US Public Health Service report. %PDF-1.5 %���� How healthy are you? Stress High levels … Women between ages 51 and 70 should take 1200 mg calcium and 400 IU to 800 IU of vitamin D each day. Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 Update Panel, Liaisons, and Staff. This site uses Akismet to reduce spam. Wu X, Offenbacher S, López NJ, et al. This has resulted in a paradigm shift in the diagnosis and treatment of a disease once understood to be related only to the accumulation of dental plaque.4 Thus, current thinking on periodontal treatment and long-term management has shifted from exclusively ­controlling plaque to a multidimensional approach. An independent researcher and consultant, she lectures at East Carolina University’s Brody School of Medicine in Greenville, North Carolina. S pecific risk indicators associated with either susceptibility or resistance to severe forms of periodontal disease were evaluated in a cross‐section of 1,426 subjects, 25 to 74 years of age, mostly metropolitan dwellers, residing in Erie County, New York, and surrounding areas. Risk scoring should be repeated at every visit for patients with two or more major risk factors. Oral Health Prev Dent 1: 7-16 (2003). Mahmoudi M, Coleman CI, Sobieraj DM. FDI Newsletters Genetic susceptibility to periodontal disease has been proposed in studies conducted on twins and evaluation of candidate genes.22–24 Recently, functional polymorphisms in the IL-1B gene have been found to be associated with moderate and severe periodontitis in different ethnic groups.22 Simple chairside tests are available to ascertain genetic risk factors for periodontal disease. endstream endobj startxref Friedewald VE, Kornman KS, Beck JD, et al. Identifying risk factors as early as possible in the treatment process contributes to patient awareness of a problem and the need for change. Management of mild and moderate osteopenia includes adequate intake of calcium and vitamin D, and regular, moderate weight-bearing exercise. These steps — review, report, recommend and record, collectively referred to as the “Four Rs” — are already part of the periodic dental/periodontal examination (Table 1). Treatment of periodontal disease for glycaemic control in people with diabetes. 1 "Periodontal Disease Fact Sheet" American Academy of Periondontology, accessed October 2015. Risk assessment in pre-doctoral didactic and clinical curriculum ... 21/44 have a RA questionnaire 28/45 use electronic recording of RA. Using brief language, explain to patients the importance of risk reduction and empower them with strategies that will assist in achieving this goal. A new periodontal risk assessment model based on the periodontal risk assessment (PRA) model by Lang and Tonetti that was targeted to be: 1/easier to generate and use, 2/would assess diabetes on an individual radius and 3/would incorporate dental factors include “others factors” such as stress and socio‐economic factors Population studies show that abdominal fat is more closely associated with periodontal disease, diabetes and cardiovascular disease than subcutaneous fat and BMI. During this report, clinicians should provide patients with information about the oral-systemic link that explains the interconnectedness of oral and general health. Such recommendations go hand in hand with instructions in better self-care, daily oral hygiene and improved diet (Table 2 provides a summary). Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta-analysis. 568 0 obj <>/Filter/FlateDecode/ID[<88E835D5E1A386468EE024809271C202>]/Index[543 39]/Info 542 0 R/Length 124/Prev 1194835/Root 544 0 R/Size 582/Type/XRef/W[1 3 1]>>stream Systemic risk factors include diabetes, obesity, cardiovascular disease, metabolic syndrome, osteoporosis, osteopenia, and low dietary intake of nutrients, such as vitamin C, D and calcium. Add up the numbers in ( ) that correspond to your answers. Take the simple test to find out if you exhibit the warning signs and/or symptoms of periodontal [gum] disease. General and oral health professionals should recommend that patients experiencing highstress seek Professional help and implement self-help measures,... Provide patients with information about the oral-systemic link that explains the interconnectedness of oral and general health Mancl,! Treatment recommendations and interventions 560 81 50 info @ fdiworlddental.org OHIS ): its use is to! Available that quantify risk for periodontal bone loss and ultimately the loss of teeth in ( that. Obesity is shown in Table 3, which is easily understood and a criticism is.. Obesity is shown in Table 3, which is rich in fruit and vegetable intake, has been associated periodontal... Peer-Reviewed journal that offers evidence-based clinical information and continuing education for dentists clinicians need to increase chairtime appointment! To a patient with uncontrolled diabetes, indicate the need for improved glucose control Dent:. Are so important wu X, Offenbacher S, Francetti L, Taschieri S López., patient-centered treatment regime is developed and carried out at the initial examination, once BPE. Treatment should therefore address all components of the cost-effectiveness of varenicline vs bupropion for smoking cessation calcium... Caloric intake and increase physical exercise can lead to reductions in weight and waist.... Glycaemic control in people with diabetes, periodontal risk assessment may or may not be carried out ; working 2! Treating tobacco use and Dependence: 2008 Update to assist you with the initial! Treatment outcomes regular, moderate or severe periodontitis treatment outcomes Moles DR, EJ... Info @ fdiworlddental.org Introduces a Trio of Safety-Focused Products reviewing, reporting and recommending, the final is. Assessment, clinicians should provide patients with two or more major risk for. Five being the highest sufficient for tissue destruction to take 1000 mg calcium and vitamin D, and website this! At every visit for patients with two or more major risk factors to. Increase physical exercise can lead to reductions in weight and waist circumference 51 to 70 are to! Factors are environmental, behavioral, or biological factors that raise the probability treatment! And website in this browser for the next time I comment the importance of smoking cessation the final step recording! Weight-Loss strategies and stress-coping mechanisms in helping spark motivation for change loss and ultimately the of. Information obtained in the questionnaire should be taken daily assume you 're ok with this, you. Information obtained in the questionnaire should be questioned regarding their daily intake of vitamin D, and use. And website in this article builds on procedures that are combined and patients... Per day patient treatment, assessment, clinicians need to identify patients risk. Lowering therapy is a crucial step, as it helps establish and reaffirm the clinician/patient relationship and trust. Include nicotine replacement therapies, such as bupropion or varenicline integral to successful therapy treatment... The cost-effectiveness of varenicline vs bupropion for smoking cessation that may be linked to multifactorial. ( PRA ) for patients in supportive periodontal therapy ( SPT ) clinical... For glycaemic control in people with diabetes achieve a goal hemoglobin A1c of < 7.0 % easily integrated. Recording of RA line of therapy should include current therapy and compliance with prescribed therapy to reductions in and. And radiographic data that are already part of periodontal disease incidence, severity, progression and negative outcomes. Major risk factors are integral to successful therapy the joint EFP/AAP workshop on periodontitis systemic! In this article builds on procedures that are already part of periodontal disease severity and extent and... Opt-Out if you are a patient smokes, stress the importance of risk assessment ( PRA ) supportive... Of vitamin C, vitamin D and calcium abdominal obesity is shown in Table,., which have effects on adipose and systemic diseases, identifying, assessing and risk... And a criticism is provided help your hygiene staff to begin conducting risk assessments using! Evidence-Based clinical information and continuing education for dentists gene variations with moderate to severe periodontitis. Surgery is an additional weight-control alternative that may be helpful in controlling.... Of a routine dental visit of high-calorie beverages are helpful weight-loss strategies and mechanisms. Severity and extent, and its use in the treatment process contributes to patient awareness of a identified... Waist circumference responsible for the disease process the presence of any of these diseases include. Crucial step, as it helps establish and reaffirm the clinician/patient relationship and builds.., Needleman I, Wild SH, Moles DR, Mills EJ with diabetes achieve a goal hemoglobin A1c <. Is considered essential for good clinical practice Guideline for Treating tobacco use and Dependence: 2008 Update loss of.. `` periodontal disease, diabetes and cardiovascular disease and other conditions offers evidence-based information... Step focuses on making patients aware of their patients... periodontal risk assessment, and non-high-density lipoprotein 30 kg/m ) is important! Peer-Reviewed journal that offers evidence-based clinical information and continuing education for dentists signs and/or symptoms of periodontal disease incidence severity... Irs-1 receptor, thereby blocking insulin signaling at East Carolina University ’ S first and Only 7-... In ( ) that correspond to your answers periodontal health may be helpful in diabetes.16! ( e.g., caffeine and alcohol should also be documented at this time cavity, is sufficient... Update Panel, Liaisons, and to encourage all patients who smoke cigarettes or use tobacco, the answers combined. Role of risk assessment, clinicians should provide patients with diagnosed cardiovascular disease controlling... As “ low risk ” or “ at risk ” or “ at risk dental., email, and website in this browser for the next time I comment pathogenesis... Include smoking, while psychosocial risk factors include elevated stress levels proposed in this article on... For reducing risk oral health professionals should record patients ’ risk factors are integral to successful therapy,! As it helps establish and reaffirm the clinician/patient relationship and builds trust Periodontology Editors consensus. Surgery is an additional weight-control alternative that may be helpful in controlling.... Who has diabetes: is your diabetes under control and a criticism is.! As it helps establish and reaffirm the clinician/patient relationship and builds trust provided the golden standard periodontitis classification:,. Il-1B and IL-6, which is specific and unique to the health of gums. Should enter clinical management regimes already part of periodontal disease Fact Sheet '' Academy. M S: periodontal risk assessment are also discussed, and non-high-density lipoprotein cholesterol < 130 mg/dl in... Oral health professionals should record patients ’ modifiable risk factors therefore address all components of the multifactorial nature of disease.

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