German Dental FHIR Profiles (R4) - Local Development build (v0.41.6) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

PAR and Prophylaxis Exchange

PAR and Prophylaxis Exchange

PSI

ProphylaxisObservationDE is the canonical PSI carrier. Every PSI component contains a base score from 0 through 4 and a required psi-sextant extension. Component order has no meaning.

The psi-additional-finding extension represents the KZBV star modifier separately from the base score. A sextant that cannot be assessed uses dataAbsentReason; it is not assigned an invented clinical score.

Whole-mouth index methods

API, QHI, PI, SBI, PBI, and GI are distinct machine-readable component codes. Their values are not interchangeable. API and SBI use percent in the published examples. Producers must retain the source scale for other methods and must not convert between methods without an explicit, externally governed rule.

Caries risk

The cariesRisk component exchanges one qualitative risk level. It is not a caries lesion, diagnosis, recall rule, or treatment recommendation. The IG defines no thresholds for deriving the level.

Clinical deposits

DentalDepositObservationDE represents one deposit finding with:

• a clinical deposit type,
• a vertical location relative to the gingival margin,
• an affected surface or prosthetic structure, and
• a body site.

The profile supports tooth, implant, and pontic findings without nested Observation components. Deposit terminology contains no fee codes or billing eligibility semantics.

Mobility and suppuration

PeriodontalObservationDE retains one mobility component bound to the authoritative PAR mobility ValueSet. Suppuration on probing is a separate, optional boolean component with the canonical periodontal measurement-site extension.

CarePlan linkage

A PAR CarePlan may reference baseline prophylaxis and periodontal observations through CarePlan.supportingInfo. A UPT activity may reference follow-up observations through CarePlan.activity.outcomeReference.

The current PAR-Richtlinie does not support a general hard invariant that PSI or MHU must have occurred within the previous six months. This IG therefore preserves source observations and dates without enforcing that rule.

Performer and delegation boundary

Periodontal and prophylaxis profiles mark Observation.performer as Must Support but do not make it mandatory when the source omitted it. The delegated assessment Bundle demonstrates a measurement performed through one PractitionerRole and a diagnosis asserted separately by a dentist.

The Observation records authorship; it does not prove authorization. A qualification audit requires resolved Practitioner or PractitionerRole references plus application or server policy. Measurement performer, diagnosis asserter, and billing provider are separate roles.

Radiographic bone loss and grading evidence

RadiographicBoneLossObservationDE records percentage bone loss at a reference tooth. When boneLossPerAge is present, it is the bone-loss percentage divided by the explicit age in completed years recorded in the same Observation.

The reviewed grading thresholds are below 0.25 for grade A, 0.25 through 1.0 for grade B, and above 1.0 for grade C. The ratio and related smoking or HbA1c Observations are evidence references; the IG does not calculate age, assign a grade, or override clinical judgment.

New Conditions reference those observations through Condition.evidence.detail. The retired ParGradingEvidenceExt remains resolvable only for compatibility with existing resources. HbA1c and smoking evidence reuse the HbA1cObservationDE and SmokingStatusDE profiles from the declared de.cognovis.fhir.praxis dependency. A smoking-status component in an oral screening is only a derived summary and does not replace the independent SmokingStatusDE evidence resource.

Historical resources may contain LOINC 32884-9, SNOMED CT 95570007, or the non-existent ICD-10-GM subdivision K05.31; importers should migrate them to LOINC 32910-2, SNOMED CT 109706009, and ICD-10-GM K05.3, respectively.

Adjunctive periodontal procedures

PeriodontalAdjunctiveProcedureDE distinguishes direct laser therapy, antimicrobial photodynamic therapy (aPDT), antimicrobial photothermal therapy (aPTT), and local subgingival antimicrobial application. usedReference points to the laser Device and any locally applied Medication or Substance. Device wavelength, lot, dose, and manufacturer details remain properties of the referenced resource or an appropriate procedure note.

The profile uses standard basedOn and reasonReference relationships. Systemic antibiotic prescribing remains in MedicationRequest or MedicationAdministration. The procedure profile contains no billing triggers, evidence grades, treatment recommendations, or proprietary product catalog.