质疑牙周风险评估的传统智慧。

IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
Eero Raittio, Rodrigo Lopez, Vibeke Baelum
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引用次数: 0

摘要

多年来,已经发表了多篇关于牙周风险评估工具的综述。然而,在反复尝试使用这些工具进行预后风险预测的过程中,仍然存在着很大的误区。在此,我们回顾了风险预测的原理,并讨论了在牙周病学中使用预测模型的价值和挑战。大多数牙周风险预测模型都没有根据风险预测模型开发指南进行正确开发。这一缺陷导致了一些问题,包括任意创建风险评分。这些分数往往被贴上 "高风险 "的标签,而对患者重要结果的基本连续风险估计却没有明确的界限或阈值。此外,尽管预测模型不能作为因果模型使用,但临床医生和研究人员显然经常将其误解为因果模型。文献中没有考虑到其他挑战,如对这些预测模型的可移植性和适用性进行严格评估,以及它们对临床实践和患者预后的影响。尽管如此,这些工具在推广时都声称能够提供更个性化、更精确的牙周炎治疗和预防,从而改善患者的治疗效果。然而,无论是否患有牙周炎,人们都应该获得有关其发生诸如牙齿脱落或疼痛等对患者至关重要的后果的风险的正确信息。传播此类信息的主要目的不应是强调假定的治疗效果、炒作个性化护理或促进商业利益。相反,传播的重点应该是根据容易获得的有效关键预测因素(如年龄和吸烟),为个人提供经过当地验证并定期更新的特定风险预测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Contesting the conventional wisdom of periodontal risk assessment

Contesting the conventional wisdom of periodontal risk assessment

Over the years, several reviews of periodontal risk assessment tools have been published. However, major misunderstandings still prevail in repeated attempts to use these tools for prognostic risk prediction. Here we review the principles of risk prediction and discuss the value and the challenges of using prediction models in periodontology. Most periodontal risk prediction models have not been properly developed according to guidance given for the risk prediction model development. This shortcoming has led to several problems, including the creation of arbitrary risk scores. These scores are often labelled as ‘high risk’ without explicit boundaries or thresholds for the underlying continuous risk estimates of patient-important outcomes. Moreover, it is apparent that prediction models are often misinterpreted as causal models by clinicians and researchers although they cannot be used as such. Additional challenges like the critical assessment of transportability and applicability of these prediction models, as well as their impact on clinical practice and patient outcomes, are not considered in the literature. Nevertheless, these instruments are promoted with claims regarding their ability to deliver more individualized and precise periodontitis treatment and prevention, purportedly resulting in improved patient outcomes. However, people with or without periodontitis deserve proper information about their risk of developing patient-important outcomes such as tooth loss or pain. The primary objective of disseminating such information should not be to emphasize assumed treatment efficacy, hype individualization of care, or promote business interests. Instead, the focus should be on providing individuals with locally validated and regularly updated predictions of specific risks based on readily accessible and valid key predictors (e.g. age and smoking).

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来源期刊
Community dentistry and oral epidemiology
Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.40
自引率
8.70%
发文量
82
审稿时长
6 months
期刊介绍: The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.
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