Podcast: The Health Risk Score

The Health Risk Score is an innovative way of linking oral health with general health. To learn more, listen to the podcast or read a transcript of the audio.


Hi, my name is Vijay Sikka, and thank you for joining our podcast. Today we will look at a new innovation called Health Risk Score as it links the oral health and general health. One of the greatest management gurus of all time, Peter Drucker, once said, “If you can’t measure it, you can’t improve it.” The key is in knowing the score. For example, if you are trying to lose weight but don’t step on a scale, how will you know that you are succeeding? If you are trying to improve your credit score but don’t check your scores, how will you know if you are improving?

Before we go through the characteristics of this new Health Risk Score from Sikka Software, I would like to give you an introduction about oral health and general health. Many clinical studies show a direct relationship between oral hygiene care and overall body health and mortality. Gum diseases spread harmful bacteria and infections directly to blood, and when they reach to a susceptible heart, they can cause inflammation that calls “Endocarditis” <ˌendōˌkärˈdītis>. Dr. Håheim from the University of Oslo, Norway, performed a review study published in the Epidemiology Research International journal that presents evidence across medical research disciplines for oral infections – and in particular the common periodontal disease – to be considered as one of the risk factors for cardiovascular disease developments. This can be looked at as a serious problem when we know that 35% of the world’s population, according to the World Health Organization, has been shown to have a periodontal infection in some degree.

Pathological observations have identified oral bacteria in heart valves and arterial walls. This indicates that a long-term exposure to active untreated infections of the oral cavity presents an opportunity for bacteria from the mouth to enter into the bloodstream through the gums. Oral bacteria sticks to fatty plaques in the bloodstream, directly contributing to blockages. Oral bacteria triggers an inflammatory response, causing the blood vessels to swell, reducing blood flow and increasing the risk of clots. In fact, one other study found that the presence of gum diseases, cavities, and missing teeth are as good at predicting heart diseases as cholesterol levels. According to the National Center for Health Statistics, heart disease is one of the leading cause of death in the USA with about 630,000 deaths per year.

These clinical findings triggered a bigger study by Sikka Software to develop a Health Risk Score by looking at the history of patient’s dental visits. To construct the Health Risk Score, we performed a classical actuarial mortality analysis and used survival analysis and machine learning techniques, by using tens of millions of de-identified data, to evaluate the extent to which dental care and oral hygiene affect patient’s general health. We are delighted to provide this score based on the large-scale study to our valuable dentists, which, after opt-in, they can use to improve and educate their patients.

The goal of providing a health score is to inform doctors and patients with an easy-to-interpret score that is actionable enough to be managed. The patient Health Score is a guiding indicator that shows how the patient’s well-being is evolving over time. Because if you can measure a Health Score, you can work toward improving that as well. It also helps patients to become more proactive than reactive toward their oral health. For example, if a patient’s Health Risk Score is high, say 75 out of 100, that means the patient needs to become more proactive toward her oral health. Remember this is a Health Risk Score. So a higher Risk Score is worse, not better. Her dentist also knows what risk factors are high in this patient’s portfolio. Therefore, they can make a plan to reduce the associated health risk factors and to enhance the patient’s lifestyle.

Sikka Software’s analysis found that different dental procedures have different risk levels associated with them. The analysis showed that people who have more dental checkups usually have a lower Health Risk Score. Checkup procedures mainly consist of Diagnostic and Preventive categories that are not strongly indicating of a health issue. Moreover, these procedures represent a patient’s lifestyle of being more proactive in their oral health. People who have a higher frequency of these procedures are shown to have a healthier lifestyle and therefore a lower Health Risk Score. Intuitive, right?

On the other hand, Restorative procedures like fillings and root canals which are directly related to the oral health are showing both the positive and negative correlations with the Health Risk Score. People who undergo treatment for periodontal procedures on time (and don’t skip the perio therapy) are seen to have a lower negative health effect, and overall it decreases their Health Risk Score; while patients who are less cautious with their oral health, and their periodontal diseases advance, have already increased their health risk factors including but not limited to increasing the likelihood of developing cardiovascular disease. Our study also found that fixed and removable dentures and other dental attachments are generally indicative of a health-related issues that impacts the Health Risk Score. Oral & Maxillofacial Surgery procedures, such as tooth extractions, in the history of a patient also shows poor oral hygiene and/or a severe accidental event which, in both cases, impacts the Health Risk Score.

This new Health Risk Score, can help dentists show with an easy to understand numerical value, what Dentists already know,  follow the soft tissue management protocol, don’t put off the perio procedures, and effectively reduce their health risks and to increase their life expectancy. Patients can also see the health benefits that affect their general health with regular dental checkups and cleaning every 6 months, at least, to prevent gum diseases and reduce the risk of developing cardiovascular disease.

We encourage dentists to use their patient’s Health Risk Score as a tool, an indicator of their patient’s general health and to help patients with a High Risk Score.  All of this is opt-in and available to the entire US dental community from Sikka Software with no charge. Thanks to our data scientist James Alikhani for working on this model and our AI Lab team for implementing the model. This Health Risk Score is available in your Practice Mobilizer which is a free, secure mobile app available on App store and Google Play, compatible with all practice management systems. You can also download it from www.practicemobilizer.com.

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