Making a complex dental care tailored to the person: population health in focus of predictive, preventive and personalised (3P) medical approach

EPMA J. 2021 Apr 19;12(2):129-140. doi: 10.1007/s13167-021-00240-7. eCollection 2021 Jun.


An evident underestimation of the targeted prevention of dental diseases is strongly supported by alarming epidemiologic statistics globally. For example, epidemiologists demonstrated 100% prevalence of dental caries in the Russian population followed by clinical manifestation of periodontal diseases. Inadequately provided oral health services in populations are caused by multi-factorial deficits including but not limited to low socio-economic status of affected individuals, lack of insurance in sub-populations, insufficient density of dedicated medical units. Another important aspect is the "participatory" medicine based on the active participation of population in maintaining oral health: healthcare will remain insufficient as long as the patient is not motivated and does not feel responsible for their oral health. To this end, nearly half of chronically diseased people do not comply with adequate medical services suffering from severely progressing pathologies. Noteworthy, the prominent risk factors and comorbidities linked to the severe disease course and poor outcomes in COVID-19-infected individuals, such as elderly, diabetes mellitus, hypertension and cardiovascular disease, are frequently associated with significantly altered oral microbiome profiles, systemic inflammatory processes and poor oral health. Suggested pathomechanisms consider potential preferences in the interaction between the viral particles and the host microbiota including oral cavity, the respiratory and gastrointestinal tracts. Since an aspiration of periodontopathic bacteria induces the expression of angiotensin-converting enzyme 2, the receptor for SARS-CoV-2, and production of inflammatory cytokines in the lower respiratory tract, poor oral hygiene and periodontal disease have been proposed as leading to COVID-19 aggravation. Consequently, the issue-dedicated expert recommendations are focused on the optimal oral hygiene as being crucial for improved individual outcomes and reduced morbidity under the COVID-19 pandemic condition. Current study demonstrated that age, gender, socio-economic status, quality of environment and life-style, oral hygiene quality, regularity of dental services requested, level of motivation and responsibility for own health status and corresponding behavioural patterns are the key parameters for the patient stratification considering person-tailored approach in a complex dental care in the population. Consequently, innovative screening programmes and adapted treatment schemes are crucial for the complex person-tailored dental care to improve individual outcomes and healthcare provided to the population.

Keywords: Age; Aggravation; Bacterial load; Bacterial superinfections; Big data; Bio-banking; COVID-19; Collateral pathologies; Comorbidities; Compliance; Dental diseases; Disease severity; Dry mouth syndrome; Elderly; Gut-lung axis; Health policy; Healthcare; Hygiene; Individualised patient profiling; Inflammation; Influenza; Lower respiratory tract; Machine learning; Microbiome; Morbidity; Motivation; Oral cavity; Pathomechanism; Patient stratification; Periodontitis; Periodontopathic microflora; Predictive preventive personalised medicine (PPPM / 3PM); Probiotics; Psychological aspects; Risk factors; SARS-CoV-2; Socio-economic status; Tailored care; Treatment algorithm; Viral infection.