1. PERIODONTAL HEALTH WITH A HIGH ORALFITNESS SCORE

• CLINICAL OBSERVATIONS: Although the patient may appear healthy during the examination, there is some reason for the mismatch between the clinical findings and the Oral Fitness Score. Therefore, shortening the recare frequency and oral hygiene review will allow us to eliminate an oral reason for the mismatch between the OralFitness Score and our clinical findings. While no further treatment may be indicated, one must consider the possibility of a systemic link to the higher score. This is also an excellent time to discuss the oral-systemic link with the patient.

  If the Oral Fitness Score does not reach a healthy level after one or perhaps two visits (if the number comes down significantly but has yet to reach a healthy level), we need to suggest a medical evaluation. A letter should be sent to the physician, with the patient, very briefly explaining the Oral Fitness test and that our oral therapy has not been able to reduce the biomarker number. Explain that there is often a link between systemic conditions and oral manifestations.

• RECOMMENDATION: Prophylaxis and oral hygiene review are suggested, but a shortened recare interval and retesting are to be considered. If the score does not significantly reduce after the first prophylaxis, then referral to the physician is indicated, with correspondence. If the score is still high at retest but has reduced significantly but not to the normal range, then a second prophylaxis and retest could be suggested.

• PATIENT SCRIPTING: “Although your gums appear healthy, the Oral Fitness Score indicates that breakdown is occurring; we just cannot see it. This test makes it visible, like a blood test for diabetes and other conditions. So, we would like to make your prophylaxis appointment more frequent and retest you in 3 months. We also know that conditions in the mouth can affect our body, and systemic conditions may affect the mouth area. Since you have [diabetes or other systemic disease], we should closely monitor your oral health. Let us see how you do in 3 months.”