The Oral Health Information Suite™ Its Use in the Management of Periodontal Disease The Oral Health Information Suite™ What is OHIS™? When and How is it used? Why should OHIS™ be used? Benefits from OHIS™ use What is OHIS™? A patent protected Internet-accessed information system that is comprised of a suite of related tools for the major oral health conditions including: Caries Periodontal disease Oral cancer Each tool includes: A scientifically derived mathematic algorithm using objective quantitative measurements to determine risk level A list of recommended interventions, stack-ranked by three levels of effectiveness based on the published literature and current standards of care for the patient’s unique conditions What is OHIS™?, cont. OHIS was designed to be easily incorporated into the normal workflow utilizing information of a traditional examination and accommodating the unique characteristics and needs of the patient, clinician, and treatment procedures. Unique for clinical dentistry by virtue of quantifying the risk for future disease in addition to quantifying the current periodontal disease state. Provides the means to measure oral health care and determine its value Facilitates quality care and continuous improvement What is the Current Treatment Flow and How Would it Change with OHIS™? Current Treatment Flow Re- Examination Diagnosis Treatment Provided Treatment Plan Finalized OHIS™ Treatment Flow Re- Analysis Treatment Provided Report Returned to Clinician’s Computer OHIS™ Processing Examination Algorithm Refinements Diagnosis Treatment Plan Finalized OHIS™ is an intelligent self-correcting system, as outcomes information determined in “Analysis” is used to refine risk assessment and appropriate treatment including the rank order of effectiveness. OHIS™ and HIPAA Compliance Compliance with HIPAA is accomplished by deidentifying the examination and treatment information sent to OHIS™. The clinician’s computer is the only site where information that identifies the patient resides. OHIS™ assigns a unique 32-character identification number to locate the records of a patient. This creates a secure means to transfer a patient’s entire collection of records, as only the patient and clinician have access to both the identification number and identity of the patient. Who Developed OHIS? How is it Obtained? www.previser.com How Does OHIS™ Technology Enhance Current Practice Methods? Diagnosis Risk Assessment Disease and Risk Treatment Plans Incorporating risk concepts Current Diagnostic Method Clinical Condition Pocket depth Tooth mobility Recession Furcations Attached gingiva Data Points 28 X 6 = 28 X 1 = 28 X 2 = 4X3+6X2 = 28 + 14 = Plaque score 28 X 4 = 112 Bleeding points Radiographic bone loss TOTAL 28 X 4 28 X 2 = = 112 56 598 168 28 56 24 42 The Basis for Text-Linguistic Diagnoses 5 Severity States 2 Extent States Health Gingivitis Beginning Periodontitis Moderate Periodontitis Severe Periodontitis Localized Generalized Text-Linguistic Connections And To Yields 17 Text-Linguistic Diagnoses Severity Text Nomenclature Health Health Gingivitis Gingivitis Beginning Periodontitis Localized Beginning Periodontitis Generalized Beginning Periodontitis Moderate Periodontitis Localized Beginning and Moderate Periodontitis Localized Moderate Periodontitis Generalized Beginning to Moderate Periodontitis Generalized Beginning and Localized Moderate Periodontitis Generalized Moderate Periodontitis Severe Periodontitis Localized Beginning and Severe Periodontitis Localized Moderate and Severe Periodontitis Localized Severe Periodontitis Generalized Beginning to Severe Periodontitis Generalized Beginning and Localized Severe Periodontitis Generalized Moderate to Severe Periodontitis Generalized Moderate and Localized Severe Periodontitis Generalized Severe Periodontitis Can Clinicians Determine a Periodontal Diagnosis Quickly and With a High Level of Agreement? Please determine a periodontal diagnosis from the periodontal charting and full mouth radiographs on the following slides. Thank you. What is Your Diagnosis? OHIS™ Disease Score = 21 Text-Linguistic Diagnosis = Localized Moderate Periodontitis 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facial Lingual 424 433 425 436 313 423 313 323 313 322 312 222 212 222 212 222 212 222 213 222 313 223 313 323 624 523 424 333 Lingual Facial 333 424 333 424 333 423 323 313 312 313 312 312 212 212 212 212 212 212 212 213 322 313 324 313 324 414 433 414 31 30 29 28 27 26 25 24 23 22 21 20 19 18 Tooth# Tooth# 1 32 16 17 170 What is Your Diagnosis? OHIS™ Disease Score = 36 Text-Linguistic Diagnosis = Generalized Moderate Periodontitis 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facial Lingual 315 335 525 535 525 535 415 535 513 524 313 333 315 334 514 534 414 434 414 434 414 435 415 535 525 535 524 544 Lingual Facial 456 415 655 525 545 514 545 414 425 415 515 515 515 515 515 525 525 535 515 515 535 514 535 425 555 525 555 514 31 30 29 28 27 26 25 24 23 22 21 20 19 18 Tooth# Tooth# 1 32 16 17 207 What is Your Diagnosis? OHIS™ Disease Score = 92 Text-Linguistic Diagnosis = Generalized Moderate to Severe Periodontitis 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facial Lingual 538 558 735 845 535 545 535 535 536 525 625 535 526 525 425 424 636 626 435 435 434 434 333 444 436 446 635 645 Lingual Facial 545 535 545 535 545 535 444 434 434 424 333 424 333 424 333 424 333 424 333 424 333 424 333 424 335 426 635 635 31 30 29 28 27 26 25 24 23 22 21 20 19 18 Tooth# Tooth# 1 32 16 17 111A What is Your Diagnosis? OHIS™ Disease Score = 97 Text-Linguistic Diagnosis = Generalized Severe Periodontitis 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Facial Lingual 537 537 735 635 535 534 535 435 536 535 625 535 526 535 425 435 636 635 435 434 434 434 333 333 437 337 735 735 Lingual Facial 545 535 545 535 535 535 535 535 525 525 525 525 525 525 525 525 525 525 525 525 535 525 535 525 545 526 645 635 31 30 29 28 27 26 25 24 23 22 21 20 19 18 Tooth# Tooth# 1 32 16 17 111B Current Diagnostic Method Summary Time-consuming process to document clinical findings, which at a minimum consists of 168 pocket depth measurements No standard and simple method exists to describe one set of nearly 600 data points Wide variation exists in the determination of a diagnosis Current Diagnostic Method Summary Text nomenclature for diagnosis is complicated and not very descriptive Text-based diagnoses are insufficiently precise to compare a single patient over time or multiple patients, as similar conditions may be described by the same diagnosis OHIS™ Diagnostic Method OHIS™ presents a standardized, objective, and simplified method for summarizing results of the standard periodontal examination into a clear, 1 – 100 scale describing the disease state No special tests are required, and only 13 data points are needed to quantify a periodontal diagnosis A numeric and text periodontal diagnosis can be obtained in seconds after the data is recorded Martin JA et al. A numeric method to describe a periodontal disease state. In preparation OHIS™ Diagnostic Method, cont. The method uses the combination of sextant severity diagnoses, which includes: Health, Gingivitis, and Beginning, Moderate, and Severe Periodontitis, and where Sextant severity diagnosis is based on: Deepest pocket Greatest radiographic bone height distance from the cemento-enamel junction Bleeding on probing 3 level scale 3 level scale Bitewings are minimally required although some loss of accuracy will occur Assignment of a Sextant Severity Diagnosis Bone Height Distance from CEJ Pocket Depth <2mm 2-4mm >4mm <5mm Gingivitis* Beginning Periodontitis Moderate Periodontitis 5-7mm Beginning Periodontitis Moderate Periodontitis Severe Periodontitis >7mm Moderate Periodontitis Severe Periodontitis Severe Periodontitis * Bleeding on probing exists Assignment of a Sextant Severity Diagnosis Bone Height Distance from CEJ Pocket Depth <2mm 2-4mm >4mm <5mm Health* Beginning Periodontitis Moderate Periodontitis 5-7mm Beginning Periodontitis Moderate Periodontitis Severe Periodontitis >7mm Moderate Periodontitis Severe Periodontitis Severe Periodontitis * Bleeding on probing does not exist Why Sextant Diagnosis is Used 28 teeth listed in order of their diagnosis is 528=3.7x1019 permutations 28 teeth grouped and counted by diagnosis is 35,960 combinations Sextants listed in order of their diagnosis is 56=15,625 permutations Sextants grouped and counted by diagnosis is 210 combinations Approximately 2 combinations of sextant diagnosis correspond to 1 disease score in the 1-100 scale The non-uniformity of the scale occurs as a condition of combinations OHIS™ Disease Score 1 Severity Text Nomenclature Health Health Gingivitis Gingivitis 4-10 Beginning Periodontitis Localized Beginning Periodontitis Generalized Beginning Periodontitis 11-36 Moderate Periodontitis Localized Beginning and Moderate Periodontitis Localized Moderate Periodontitis Generalized Beginning to Moderate Periodontitis Generalized Beginning and Localized Moderate Periodontitis Generalized Moderate Periodontitis 37-100 Severe Periodontitis Localized Beginning and Severe Periodontitis Localized Moderate and Severe Periodontitis Localized Severe Periodontitis Generalized Beginning to Severe Periodontitis Generalized Beginning and Localized Severe Periodontitis Generalized Moderate to Severe Periodontitis Generalized Moderate and Localized Severe Periodontitis Generalized Severe Periodontitis 2-3 What Diagnosis Would You Assign? 4 sextants have severe periodontitis and 2 have gingivitis 3 sextants have severe periodontitis and 3 have gingivitis 94 disease score and Generalized severe periodontitis 84 disease score and Generalized severe periodontitis 2 sextants have severe periodontitis, 2 have beginning periodontitis, and 2 have gingivitis 71 disease score and Generalized beginning to severe periodontitis Disease Score and its History OHIS™ Diagnostic Method Summary Streamlines the diagnostic process into a more efficient and effective clinical practice The disease score and its history are more readily comprehended than the typical periodontal charting, radiographs, and text nomenclature Establishes a standard and objective means that can be applied to all patients A change in the disease score reflects an improving, stable or worsening health condition Is an Accurate Diagnosis All that is Required to Determine Treatment? The Health-Disease Continuum Health-Disease Continuum Diagnosis Disease Health Loss Progression Limited or No Signs Invisible Signs and Symptoms Visible Stages Initiation Beginning Disease Severity Moderate Severe Diagnosis is the determination of the existence of disease Disease does not exist until tissue destruction occurs Lesions must exceed the threshold of measurement for a diagnosis to be made The Health-Disease Continuum Health-Disease Continuum Diagnosis Disease Health Loss Progression Limited or No Signs Signs and Symptoms Invisible Visible Stages Initiation Beginning Disease Severity Moderate Severe Diagnosis identifies severity; drives reparative treatment A diagnosis describes the current, static, disease state However,…….. The Health-Disease Continuum Health-Disease Continuum Diagnosis Disease Health Loss Progression Limited or No Signs Invisible Signs and Symptoms Visible Stages Initiation Beginning Disease Severity Moderate Severe Disease is a dynamic non-linear process that can cycle between breakdown and healing During the earliest stages of the disease process, reversibility or healing may be possible • • • • Tooth demineralization ----------------------> Sub-clinical inflammatory lesion ---------------> Abnormal cell division ---------------------------> Coronary artery plaque and inflammation ---> Caries Gingivitis Cancer Myocardial Infarction The Health-Disease Continuum Health-Disease Continuum Diagnosis Disease Health Loss Progression Limited or No Signs Invisible Signs and Symptoms Visible Stages Initiation Beginning Disease Severity Moderate Severe Diagnosis of a lesion at its earliest stage will be after the initiation of the disease process Risk predicts the future disease state; drives preventative treatment A healthy patient at-risk for disease would be denied the opportunity to prevent disease if interventions are withheld until a diagnosis is obtained What is Required to Determine Treatment Needs? Accurate diagnosis Accurate risk determination Understanding patient desires Knowledge of the likelihood that treatment interventions will result in the desired outcome Is the OHIS™ Risk Assessment Method Valid and Accurate? Validity and Accuracy of OHIS™ Determined Risk 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study who had only routine care Periodontal pocket depth measurements Digitized full-mouth radiographs with bitewings Medical and dental histories Risk was assessed at baseline using OHIS™ Page et al. Validity and accuracy of a risk calculator in predicting periodontal disease. J Am Dent Assoc 2002 Page et al. Longitudinal validation of a risk calculator for periodontal disease. J Clin Periodontol 2003 Validity and Accuracy of OHIS™ Determined Risk, cont. Changes in periodontal status determined by comparing baseline data to data at 3, 9, and 15 years Alveolar bone loss (mean bone loss, percentage of sites with bone loss per subject) Tooth loss (mean percent tooth loss, percentage of subjects with tooth loss in each risk group) Mean Bone Loss Mean Percent (±SE) Alveolar Bone Loss 8.0% 7.0% A measure of disease severity Risk 5 6.0% Risk 4 5.0% Risk 3 4.0% Risk 2 3.0% 2.0% 1.0% 0.0% Year 3 Year 9 Year 15 Percentage of Sites with Bone Loss 70% 65% A measure of disease extent Risk 5 Risk 4 % Sites with Bone Loss 60% Risk 3 55% Risk 2 50% 45% 40% 35% 30% 25% 20% 15% Year 3 Year 9 Year 15 Mean Tooth Loss 30.0% Mean % (±SE) Tooth Loss 25.0% Risk 5 20.0% 15.0% Risk 4 10.0% Risk 3 5.0% Risk 2 0.0% Year 3 Year 9 Year 15 Percentage of Subjects with Tooth Loss 100% 90% Risk 5 80% Risk 4 % of subjects 70% Risk 3 60% 50% 40% Risk 2 30% 20% 10% 0% Year 3 Year 9 Year 15 Mean Number of Teeth Lost 7 6 Risk 5 Number of teeth lost 5 Risk 4 4 Risk 3 3 Risk 2 Only 26% did not have periodontal disease at baseline 2 1 0 Total teeth Periodontally affected Periodontally unaffected How is Risk Distinguished from Diagnosis? Diagnosis vs. Risk Diagnosis describes Risk predicts Disease State Severe Periodontitis Worse Moderate Periodontitis Same Beginning Periodontitis Better Gingivitis Based on: Signs and Symptoms Risk Factors Current Future Time Health Signs and Symptoms vs. Risk Factors Signs and Symptoms Bleeding on probing Pockets Bone loss Pain Swelling Risk Factors Smoking Diabetes Pathogenic bacteria Pockets What is a Risk Factor? Risk factor is often used as a general term meaning those characteristics that strongly associate with groups of individuals who have disease compared to those who do not. Risk terminology includes: Risk Factor Background Characteristic Risk Indicator Risk Markers or Risk Predictors Risk Factor Definition An environmental, behavioral, or biologic factor confirmed by temporal sequence, usually in longitudinal studies, which if present directly increases the probability of a disease occurring, and if absent or removed reduces the probability. Risk factors are part of the causal chain, or expose the host to the causal chain. Once disease occurs, removal of a risk factor may not result in a cure. Beck JD. Community Dent Oral Epidemiol 1998 Background Characteristics Definition Associated with a higher probability of disease, but cannot be modified. Also referred to as a determinant. Age Gender Socioeconomic Status Familial history and genetic factors Risk Indicator Definition A possible risk factor not yet confirmed in published studies. A plausible correlate of disease identified in cross-sectional studies. Osteoporosis HIV and AIDS Frequency of visits to the dentist Risk Markers and Predictors Definition A characteristic strongly correlated with an increased probability of future disease but is not part of the causal chain. Bleeding on probing Clinical attachment loss Risk Assessment Risk cannot be determined from disease severity Every patient who has disease was, at a prior time, healthy, hence It is possible to be high risk AND low disease severity Risk assessment is used to develop a preventive intervention program to prevent disease before it occurs Risk Level modulates the aggressiveness and frequency of treatment OHIS™ Risk Assessment A future disease state is effected when treatment is applied or withheld OHIS™ risk assessment predicts the on-set and progression of periodontal disease for patients who have no more than routine dental care Predicting treatment effectiveness is a different type of risk assessment not currently determined by OHIS™ The OHIS™ risk score ranges from 1 for very low risk to 5 for very high risk Current Risk Assessment Method By subjective judgment Based primarily on disease severity and extent This is understandable, as the literature only provides a laundry list of risk factors with no guidance how to determine risk It is not surprising that the current method of risk assessment is generally an unreliable predictor of the future disease state OHIS™ Risk Assessment Criteria Accurate and valid predictor of a future disease state when no more than routine dental care is provided Time required for data collection and input must add no more than 5 minutes to a traditional periodontal examination and the procedure must be easily incorporated into the normal pattern of work flow Risk assessment information must be useful to create treatment recommendations that reduce risk and prevent disease incidence and progression Martin et al. The development and utility of an assessment tool for risk of periodontal disease. In preparation. OHIS™ Criteria for Use of Factors Scientific basis supported by publication in refereed scientific journal Information obtainable during traditional periodontal examination without use of special or laboratory testing Sufficiently high weight to impact risk score Useful to create treatment recommendations that reduce risk and prevent disease incidence and progression Factors Used by OHIS™ to Determine Risk and Recommend Treatment Smoking Diabetes Subgingival calculus Subgingival restorations Pockets Furcation involvements Vertical bone lesions Age Radiographic bone height History of periodontal surgery for pockets Oral hygiene Dental care frequency Why Were Some Factors Not Used? Scientific Basis Not Supported by a Refereed Publication Race Gender Gingival crevicular components Bleeding points Oral hygiene indices Suppuration Gingival redness Lamina dura Information Not Typically Obtained Genetic testing (PST®) Polymorphoneuclear leucocyte disorders Gingival crevicular components Bleeding points Oral hygiene indices Clinical attachment loss Bacteria Culturing Low Prevalence, Which Would Not Affect Accuracy of the Risk Score for a Large Population Occlusion-related pathology HIV and AIDS Medications Pregnancy Osteoporosis Not Useful to Create Treatment Recommendations Race Socio-economic status Clinical attachment loss OHIS™ Risk Assessment Method Summary OHIS™ presents a standardized, valid, and accurate method to determine risk level Risk levels range from 1 for very low risk to 5 for very high risk The time required for data collection and input adds no more than 5 minutes to a traditional periodontal examination and is easily incorporated into the normal work flow Risk level and disease state are determined from only 23 data points What Data does OHIS™ Require and How is it Entered into the System? Data points 1 to 4 Data points 5 to 11 Data points 12 to 23 Incorporating Risk Concepts into Treatment Planning Risk is the fundamental principle that should justify treatment Low risk means that disease is unlikely to progress and justification for treatment is minimally supported High risk means that disease is likely to progress and justification for treatment is maximally supported Risk is used to determine preventive interventions Risk is also used to modulate the intensity and aggressiveness of reparative treatment Risk and Treatment Treating disease generally involves repair Repair may increase the risk of new disease Risk should drive preventive treatment Reduction in risk is accomplished by managing risk factors Risk reduction can intercept invisible disease processes Both Risk and Disease are Important The severity of disease is used to determine how much and what type of treatment is needed Risk is used to determine how conservative or aggressive treatment should be With or without disease, risk is used to determine the best treatment to prevent new disease from occurring Treatment Needs Increase with Advancing Risk and Disease State Disease State Treatment Intensity and Aggressiveness Severe Periodontitis Moderate Periodontitis Treatment Intensity and Aggressiveness Very Low Low Moderate Risk Level Beginning Periodontitis Gingivitis Health High Very High Current vs. OHIS™ Method of Identifying Treatment Need Current Method OHIS™ Method Severity and Extent of Disease Reparative Treatment Standard Preventative Treatment Severity and Extent of Disease Reparative Treatment Risk factors and risk level Preventative Treatment How Can a Clinician Correlate Diagnosis, Risk, and Treatment Needs Treatment Stratification Matrix Health Very high risk Gingivitis Cannot be currently measured Beginning Periodontitis Moderate Periodontitis Severe Periodontitis Risk = 5 Disease = 4-10 Risk = 5 Disease = 11-36 Risk = 5 Disease = 37-100 High risk Risk = 4 Disease = 1 Risk = 4 Disease = 2-3 Risk = 4 Disease = 4-10 Risk = 4 Disease = 11-36 Risk = 4 Disease = 37-100 Moderate risk Risk = 3 Disease = 1 Risk = 3 Disease = 2-3 Risk = 3 Disease = 4-10 Risk = 3 Disease = 11-36 Risk = 3 Disease = 37-100 Low risk Risk = 2 Disease = 1 Risk = 2 Disease = 2-3 Risk = 2 Disease = 4-10 Risk = 2 Disease = 11-36 Risk = 2 Disease = 37-100 Very low risk Risk = 1 Disease = 1 Risk = 1 Disease = 2-3 Risk = 1 Disease = 4-10 Risk = 1 Disease = 11-36 Cannot occur Patients in these categories have the most complex needs generally requiring advanced clinical skills and experience Patients in these categories are borderline for treatment complexity It is possible but unlikely to observe patients with these disease and risk profiles Patients in these categories have routine needs generally requiring basic clinical skills and experience How Can OHIS™ Assist in the Determination of Treatment? OHIS™ Assisted Treatment Planning A list of commonly used treatment procedures for the patient’s risk factors and conditions grouped by three levels of expected effectiveness is provided as an aid to the dentist in decision making Treatment should be targeted to the existing factors and conditions Risk is used to modify treatment intensity and aggressiveness Using the Scores in Treatment Planning Identifies the effectiveness of treatment Lower scores are indicative of improvement and the possibility that the current condition can be maintained or continue to improve with the current treatment plan Higher scores are indicative of a worse situation and the need for different treatment While a lower risk score is desirable, it is possible for a patient’s risk to remain high without the disease worsening Risk score change corresponds to an increase or decrease of more than 20% making it less sensitive than the 100-point disease score Guidelines for Referral to a Periodontist Most patients are referred when disease is severe resulting in more tooth loss and treatment that is complex and expensive When treatment is initiated during the early stages of disease, success is more likely, treatment is more conservative, and fewer teeth are lost Risk predicts the future severity of disease Referral to a periodontist should be based on Risk and Disease Guidelines for Referral to a Periodontist, cont. Establish protocol for your practice such as: A threshold for risk regardless of disease state score (e.g. risk ≥4) A threshold for an increase in risk (e.g. risk change ≥1) A threshold for the disease state score (e.g. disease state ≥11) A threshold for an increase in the disease state score (e.g. disease state score change ≥10) Is OHIS™ Needed? The need and value of OHIS™ is not intuitively apparent, as clinicians routinely diagnose, formulate treatment plans, and predict outcomes. Furthermore there is evidence that oral health has improved. However, wide variation and inaccuracy exists for diagnosis and risk assessment, suggestive that some patients receive un-needed care and others fail to receive needed care. Is OHIS™ Needed?, cont. An information system that determines outcomes is non-existent, which denies the clinician and patient from an accurate understanding of oral health changes, favorable and unfavorable, that are attributable to treatment and behavioral decisions. Dentistry has been practiced within this information void for decades resulting in the deterioration of the authority and profitability of dentists. Is OHIS™ Needed?, cont. Periodontal treatment can prevent tooth loss A standard uniform application of treatment procedures harms some patients A decision to determine treatment that does not include an accurate assessment of risk harms patients Risk assessment is distinctly different from diagnosis and is not determined with consistent accuracy by a clinician using subjective judgment Acceptance of the validity of these statements means you believe quality care requires use of OHIS™ OHIS™ Benefits OHIS™ creates an opportunity for clinicians to establish their method of determining oral health care excellence and the development of practice policies based on actual clinical outcomes, which might prevent organizations from imposing conflicting standards. Dentists who provide exceptional care measured by outcomes could justify higher fees and use the information to market their expertise. OHIS™ Benefits, cont. Numeric scores Simplify the clinician’s explanation of disease and risk Are more easily and readily understood by the patient compared to traditional text-linguistic descriptions The enhanced understanding would be expected to result in a higher commitment to treatment and greater participation by the patient in their own disease prevention and health improvement. OHIS™ Benefits, cont. A patient traditionally determines oral care excellence from their subjective interpretation of the clinical facility, service experience, resolution of symptoms or changes perceived with the senses, and the whiteness of their teeth. A patient could, for the first time, determine quality care by the change from pre-treatment to post-treatment scores. Summary OHIS™ is an efficient, effective, and accurate method to: Document a periodontal condition Diagnose periodontal disease Predict a future periodontal disease state Determine treatment dynamically Communicate with a patient Summary, cont. OHIS™ was designed for clinical utility by: Providing accurate and valid diagnostic, risk, and treatment information Utilization takes little time and fits within normal procedures and work flow. OHIS™ should be used routinely OHIS™ can improve oral health care quality and preserve the status of the private practice clinician www.previser.com Click to download Contact Information Web site URL www.previser.com Online support http://support.previser.com Support by phone 360.661.5763 Support by email support@previser.com Corporate address PreViser Corporation 20849 Cascade Ridge Drive Mount Vernon, WA 98274 Corporate phone 360.941.4715