Risk Assessment in Periodontal Care: The Principles

  • Iain L. C. ChappleEmail author


There is an increasing evidence base for risk assessment being a central tenet in the development and implementation of personalised care programmes for managing chronic complex diseases like periodontitis. The increasing prevalence of this disease in an ageing population, its negative impact upon tooth loss, self-esteem, nutrition, self-confidence and quality of life, and the associated health economic and systemic disease burden necessitate a move away from traditional repair models of care provision towards risk-driven personalised approaches to prevention. In this chapter, contemporary concepts of periodontal disease pathogenesis and classification are discussed and the role of risk factor identification and management argued as being central to modern healthcare provision. Embedding the identification of risk factors into a diagnostic statement is discussed and the psychological and clinical benefits of personalised risk factor biofeedback are documented.


  1. 1.
    Caton J, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45(suppl 20):S1–8.PubMedGoogle Scholar
  2. 2.
    Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, Geisinger ML, Genco RJ, Glogauer M, Goldstein M, Griffin TJ, Holmstrup P, Johnson GK, Kapila Y, Lang NP, Meyle J, Murakami S, Plemons J, Romito GA, Shapira L, Tatakis DN, Teughels W, Trombelli L, Walter C, Wimmer G, Xenoudi P, Yoshie H. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Clin Periodontol. 2018;45(suppl 20):S68–77.CrossRefGoogle Scholar
  3. 3.
    Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Clin Periodontol. 2018;45(suppl 20):S149–61.CrossRefGoogle Scholar
  4. 4.
    Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, Greenwell H, Herrera D, Kao RT, Kebschull M, Kinane DF, Kirkwood KL, Kocher T, Kornman KS, Kumar PS, Loos BG, Machtei E, Meng H, Mombelli A, Needleman I, Offenbacher S, Seymour GJ, Teles R, Tonetti MS. Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Clin Periodontol. 2018;45(suppl 20):S162–70.CrossRefGoogle Scholar
  5. 5.
    Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Clin Periodontol. 2018;45(suppl 20):S219–29.CrossRefGoogle Scholar
  6. 6.
    Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, Chen S, Cochran D, Derks J, Figuero E, Hämmerle CHF, Heitz-Mayfield LJA, Huynh-Ba G, Iacono V, Koo K-T, Lambert F, McCauley L, Quirynen M, Renvert S, Salvi GE, Schwarz F, Tarnow D, Tomasi C, Wang H, Zitzmann N. Peri-implant diseases and conditions: consensus report of workgroup 4 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Clin Periodontol. 2018;45(suppl 20):S286–91.CrossRefGoogle Scholar
  7. 7.
    Dietrich TD, Ower P, Tank M, West N, Walter C, Needleman I, Hughes FJ, Wadia R, Milward MR, Hodge P, Chapple ILC, British Society of Periodontology. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions – implementation in clinical practice. Br Dent J. 2018;226(1):16–22.CrossRefGoogle Scholar
  8. 8.
    Kinane DF, Attström R. Advances in the pathogenesis of periodontitis. Group B consensus report of the fifth European Workshop in Periodontology. J Clin Periodontol. 2005;32(Suppl. 6):S130–1.CrossRefGoogle Scholar
  9. 9.
    Chapple ILC, Van der Weijden F, Doerfer C, Herrera D, Shapira L, Polak D, Madianos P, Louropoulou A, Machtei E, Donos N, Greenwell H, Van Winkelhoff AJ, Kuru BE, Arweiler N, Tughels W, Aimetti M, Molina A, Montero E, Graziani F. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42(Suppl. 16):S71–6.CrossRefGoogle Scholar
  10. 10.
    World Health Organisation. Spending on health: a global overview. 2012. Accessed 7 Aug 2015.
  11. 11.
    Albander JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol. 1999;70:13–29.CrossRefGoogle Scholar
  12. 12.
    White DA, Tsakos G, Pitts NB, Fuller E, Douglas GVA, Murray JJ, Steele JG. Adult dental health survey 2009: common oral health conditions and their impact on the population. Br Dent J. 2012;213:567–72.CrossRefGoogle Scholar
  13. 13.
    Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJL, Marcenes W. Global burden of severe periodontitis in 1990-2010. A systematic review and meta-regression. J Dent Res. 2014;93:1045–53.CrossRefGoogle Scholar
  14. 14.
    Sharma P, Dietrich T, Ferro CJ, Cockwell P, Chapple ILC. Association between periodontitis and mortality in stages 3–5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol. 2016;43(2):104–13.CrossRefGoogle Scholar
  15. 15.
    Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res. 2015;94:1355–61.CrossRefGoogle Scholar
  16. 16.
    Löe H, Boysen AH, Morrison E. Natural history of periodontal disease in man rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. J Clin Periodontol. 1986;13:431–40.CrossRefGoogle Scholar
  17. 17.
    Rothman KJ. Measuring interactions. In: Rothman KJ, editor. Epidemiology: an introduction. New York: Oxford University Press; 2002. p. 168–80.Google Scholar
  18. 18.
    Chapple ILC, Bouchard P, Cagetti MG, Campus G, Carra MC, Cocco F, Nibali L, Hujoel P, Laine ML, Lingstrom P, Manton DJ, Montero E, Pitts N, Range H, Schlueter N, Teughels W, Twetman S, Van Loveren C, Van der Weijden F, Vieira AR, Schulte AG. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44(suppl 18):S39–51.CrossRefGoogle Scholar
  19. 19.
    Grossi SG, Zambon JJ, Ho AW, Koch D, Dunford RG, Mechtei EE, Norderyd OM, Genco RJ. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol. 1994;65(3):260–7.CrossRefGoogle Scholar
  20. 20.
    Meyle JM, Chapple ILC. Molecular aspects of the pathogenesis of periodontitis. Periodontol. 2015;69:7–17.CrossRefGoogle Scholar
  21. 21.
    Lang NP, Tonetti MS. Periodontal diagnosis in treated periodontitis. Why, when and how to use clinical parameters. J Clin Periodontol. 1996;23:240–50.CrossRefGoogle Scholar
  22. 22.
    Chapple ILC, Gilbert A, Chapple ILC, editors. Understanding periodontal diseases: assessment and diagnostic procedures in dental practice. London: Quintessence; 2002.Google Scholar
  23. 23.
    Kye W, Davidson R, Martin J, Engebretson S. Current status of periodontal risk assessment. J Evid Base Dent Pract. 2012;S1:2–11.CrossRefGoogle Scholar
  24. 24.
    Barnfather KDP, Cope GF, Chapple ILC. Effect of incorporating a 10 minute point of care test for salivary nicotine metabolites into a general practice based smoking cessation programme: randomised controlled trial. BMJ. 2005;331:999. Scholar
  25. 25.
    Asimakopoulou K, Daly B, Kutzer Y, Ide M. The effects of providing periodontal disease risk information on psychological outcomes – a randomized controlled trial. J Clin Periodontol. 2015;42(4):350–5.CrossRefGoogle Scholar
  26. 26.
    Asimakopoulou K, Nolan M, McCarthy C, Newton T. The effect of risk communication on periodontal treatment outcomes: a randomized controlled trial. J Periodontol. 2019.

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental SciencesThe University of BirminghamBirminghamUK

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