Patient assessment in general dental practice - risk assessment or clinical monitoring?

Risk assessment in general dental practice is becoming increasingly common and has led to the development of care protocols, which aim to act as a framework for decision making to produce an optimum level of care. However, many models of risk have been informed by research undertaken in academia and are based upon summary statistics of populations. In practice, a significant proportion of patients attend on a non-symptomatic, continuous and regular basis, often over long periods of time. This provides general dental practitioners with a wealth of knowledge about their patients to inform clinical decision making on an individual basis. The purpose of this paper is to highlight the important differences between an academic assessment of risk and one that is relevant to practice, before introducing a simple tool to screen out patients who are considered to be 'low risk'. The relevance of this tool is discussed, along with its potential uses and limitations as a means to promote discussion during the development of the pilots for the new dental contract to be introduced by the coalition government.