SYSTEMIC AND DENTAL RISK
Inflammatory foci in the oral cavity can begin to damage distant organs or the body in general when the body is weakened, for example due to the decompensation of a chronic disease, the development of a new disease or even by certain treatment. For this reason, the dentist is often asked to “rule out a focal infection of odontogenic origin”. Different pathological conditions of the oral cavity have different risks in terms of the risk of local inflammation or the development of distant infectious complications. Also, different fundamental diseases or different therapeutic approaches present different risks of infectious complications.
To make it easier to navigate, tables are available on this website dividing different diseases and treatments into three categories (low, medium, and high risk) according to their risk in relation to infectious foci. These include the “Dentistry” table, which lists oral pathologies, as well as similar tables for other medical disciplines.
Once a patient has been categorised in terms of both the fundamental disease and the dental findings, several combinations of risks may occur. Guidance on how to proceed in each situation is provided by the "Semaphores" in the "Systemic and Dental Risk" section.
To facilitate communication between the dentist and the referring specialist, a sample referral form for referring a patient to a dentist is available.
Semaphores:
The risk levels for specific diseases or procedures correspond to the colour on the semaphore (high risk = red, medium = yellow, low = green*). For each possible combination, a basic recommendation for the appropriate treatment is attached.
* patients with completely healthy teeth are so called 3 x green - risk free.
Systemic risk
Dental risk
No dental risk:
- All existing teeth are vital, or well endodontically treated without enlarged periodontal aperture
- No gingivitis present
- Good oral hygiene
Any systemic risk:
- The issuance of the approval is entirely within the competence of the treating dentist
Systemic risk
Dental risko
Low dental risk:
- Root canals sufficiently treated - lamina corticalis intact, periapical space up to 2 mm
- Root canals not sufficiently treated - lamina corticalis intact, aperture not widened
- Impacted teeth
- Caries close to the pulp or penetrating the pulp without periapical clearance
- Poor oral hygiene without clinical findings on periodontium
- Gingivitis without pseudo pockets
Low and medium systemic risk:
- The issuance of the approval is entirely within the competence of the treating dentist.
- Appropriate conservative treatment and dental hygiene adjustments are recommended according to the time available.
Systemic risk
Dental risk
High dental risk:
- Active periodontal pocket with inflammatory exudation
- Diffuse (active) periodontitis - Periodontal pockets 5 mm or more, BOP+
- Periodontal abscess in a multirooted tooth
- The risk in these cases is increased by tooth mobility or degree of tooth mobility
- Fistula with inflammatory exudation
- Denticio difficilis
- Acute apical periodontitis
- Chronic apical periodontitis with fistula
- Chronic apical periodontitis not bordered
- Peri-implantitis IMI = 4
Low and medium systemic risk:
- If the fundamental disease or procedure is not acute, dental treatment is indicated. Radicality according to the specific situation.
Systemic risk
Systemic risk
High dental risk:
- Active periodontal pocket with inflammatory exudation
- Diffuse (active) periodontitis - Periodontal pockets 5 mm or more, BOP+
- Periodontal abscess in a multirooted tooth
- The risk in these cases is increased by tooth mobility or degree of tooth mobility
- Fistula with inflammatory exudation
- Denticio difficilis
- Acute apical periodontitis
- Chronic apical periodontitis with fistula
- Chronic apical periodontitis not bordered
- Peri-implantitis IMI = 4
High systemic risk:
- Examination and treatment at a specialized workplace is indicated.
Systemic risk
Dental risk
Medium dental risk:
- Root canals not sufficiently treated - lamina corticalis intact – the focus 2 mm or more
- Semi-impacted teeth
- Cysts
- Peri-implant mucositis IMI = 2, 3
- Caries close to the pulp or penetrating the pulp with periapical clearance
- Initial periodontitis
- Furcation lesions uncleaned or uncleanable
- Periodontal abscess in a single-rooted tooth
- The risk in these cases increases the tooth mobility and grade of tooth mobility
- Chronic plaque-related gingivitis with pseudo pockets
Low and medium systemic risk:
- The issuance of the approval is within the competence of the treating dentist.
- Appropriate conservative treatment and dental hygiene adjustments are recommended according to the time available. In case of any doubts about the prognosis of the tooth, rather a radical procedure is appropriate.
Systemic risk
Dental risk
Low dental risk:
- Endodontic treatment of root canals is sufficient – bordered chronic periodontitis present - lamina corticalis intact, clearance up to 2 mm
- Endodontic treatment of root canals is not sufficient - periapical aperture not widened and lamina corticalis is intact
- Impacted teeth
- Caries close to the pulp or penetrating the pulp++ without periapical clearance
- Poor oral hygiene without clinical findings on periodontium
- Gingivitis without pseudo pockets
High systemic risk:
- If the fundamental disease or procedure is not acute, dental treatment is indicated. Radicality and eventual referral of the patient to a specialised workplace according to the specific situation.
Systemic risk
Dental risk
Medium dental risk:
- Root canals not sufficiently treated - lamina corticalis intact – the focus 2 mm or more
- Semi-impacted teeth
- Cysts
- Peri-implant mucositis IMI = 2, 3
- Caries close to the pulp or penetrating the pulp with periapical clearance
- Initial periodontitis
- Furcation lesions uncleaned or uncleanable
- Periodontal abscess in a single-rooted tooth
- The risk in these cases increases the tooth mobility and grade of tooth mobility
- Chronic plaque-related gingivitis with pseudo pockets
High systemic risk:
- If the fundamental disease or procedure is not acute, dental treatment is indicated. Radicality and eventual referral of the patient to a specialized workplace must be evaluated individually, according to the specific situation.