Integrating the P4 model in prevention- iTOP revisited

Dentistry has traditionally been built on the surgical model of disease management. However, that model is rapidly changing too. With the overdue recognition that the mouth is connected to the rest of the body, healthcare is starting to recognize that oral diseases have an impact on systemic health. Long gone are the days of only scraping roots to treat periodontal disease, or just drilling holes in teeth to treat dental caries. P4 is relevant at each stage of caries management. It refers to all preventive, non-invasive and ultra-conservative treatments that are not properly indicated according to individual caries risk level (e.g. preventive sealants for low caries risk patients). P4 also refers to unnecessary invasive/surgical interventions when non-invasive (fluoride and therapeutic sealants) and micro-invasive techniques (resin infiltrations) can be indicated. iTOP is the main pillar of maintenance of oral health and has been implemented in dental practices worldwide. Effective regular mechanical plaque control, as the principal component of iTOP concept, is a gold standard that can be achieved only in well informed and trained individuals. It is of a paramount importance for prevention and successful treatment as well as maintenance of results achieved following the therapy. As one size does not fit us all, iTOP advocates individual approach that is tailored to individual needs of our patients. As such, it is highly effective in promoting positive behaviour and habits towards prevention of the most common oral diseases such as dental caries and periodontitis. iTOP – individually trained oral prophylaxis – is a method to learn the optimal oral health management through hands-on training (T2T) on the use of selected tools and techniques. Considering the impact of dental caries and periodontal disease on systemic health and benefits of good oral health practices to minimise their risk, it is important to ensure that people are motivated to engage in good oral hygiene behaviours and are provided risk assessment as a part of routine care.  This presentation will highlight the P4 model approach, and also throw some light on iTOP strategies for prevention.