Preventive Exam 3 [Periodontal Risk Assessment and Prognosis: Garaicoa]

Prognosis definition

A prediction as to the progress, course and outcome of an "even"

Prognosis (In dentistry)

A prediction as to the progress, course and outcome of a "disease/event"

Prognosis systems (Periodontal aspect)

Tooth Loss:

Good

Fair

Poor

Questionable

Hopeless

Periodontal Stability:

Favorable

Questionable

Unfavorable

Hopeless

Favorable

very likely after I treat this patient back to health

Questionable

I may or may not be able to bring this patient back to health

Unfavorable

Unlikely I am going to be able to bring this patient back to health

- Smoker patients

Hopeless

Unreasonable to treat (most likely extraction)

Systemic factors that may lead to unable to control perio outcomes

- Diabetes

- Smoking (hardest to control)

- Etc

Normal distance from the CEJ to the bone crest in normal conditions

1.5-2 mm

Example Hopeless prognosis (radiograph)

Nothing from a periodontal standpoint can bring that tooth back to stability

Main etiology of periodontal disease

Poor oral hygiene

Factors influencing prognosis: Individual Tooth prognosis

Factors influencing prognosis: Overall prognosis

Patient specific factors

Age

Disease severity

Plaque control

Compliance

Systemic/environmental factors

Systemic diseases/ conditions

Genetic factors

Stress

Smoking

Others

Anatomical-related factors

Root form

Cervical enamel projections

Enamel pearls

Bifurcation ridges

Root grooves/concavities

Root proximity

Furcation involvement

Tooth mobility

Local-contributing factors

Biofilm/calculus

Prothetic/restorative factors

Abutment selection

Caries

Non-viral teeth

Root resporption

Subgingival margins

Risk factor definition

The probability that an event will occur

Risk factor in health sciences

An aspect of personal behavior/lifestyle, an environmental exposure, and or an inborn/inherited characteristic which, on the basis of epidemiological evidence, is known to be associated with health-related conditions(s) considered important to prevent

Risk Assessment (Health sciences)

A systemic process of evaluating the potential risks that may be involved in a projected disease/event

Takeaway:

- Step by step process to predict event

Risk factors associated with periodontal disease

Scientific evidence:

- True risk factors

- Risk indicators

- Risk Determinants

- Risk Marker

Therapeutically-driven

- Modifiable factors

- Non-modifiable factors

True Risk factors defintion

An environmental, behavior, or biological factors confirmed by temporal sequence usually in longitudinal studies, which if present directly increase the probability of a disease occuring and if absent or removed reduces the probability. Once the disease occurs, removal of a risk factor may not result in a "cure"

True risk factors for periodontal disease

Smoking

"Keystone" pathogens

Diabetes

Risk indicators definition

Probable or putative environmental behavior or biological factors that have been identified in cross-sectional studies, but not confirmed through longitudinal studies.

Correlation between risk factor with condition can be deceptive

Risk Indicators for Periodontal Disease

Osteoporosis

HIV/AIDS

Obesity

Stress

Alcohol

Pregnancy

Risk Predictors/Markers definition

An attribute or exposure that is associated with increased probability of disease, but it is NOT necessarily a causal factor

Risk Predictors/markers for periodontal disease

Bleeding on Probing

Mobility

Gingival Recession

Previous periodontal disease

Rx bone loss

Risk determinant (demographic) definition

An attribute or exposure that cannot be modified

Risk Determinants for Periodontal disease

Age

Race/Ethnicity

Genetics

Risk Modifiers Definition

Factors that can change a person's risk level and/or progression of a disease

NOTE:

Any risk factor that can increase progression of a disease

- Smoking

- Diabetes

Treatment success depends on treating the ____ not the ____

person, disease

SUMMARY: Prognosis and risk assessment methods are not

sufficiently precise

SUMMARY: A myriad of risk factors (local contributing/ anatomical, patient-related, etc) can affect

the prognosis and used for risk assessment

SUMMARY: Types of risk factors

level of scientific evidence vs Modifiable/ non-modifiable

SUMMARY: Endpoints of prognosis systems

tooth loss vs periodontal stability