[BOOK] CHAPTER 32: RISK ASSESSMENT

risk

the probability of an individual to develop a specific disease in a given period which may vary from one individual to another

either predisposes to develop periodontal dx or influence the progression of an existing dx

risk elements are:

risk factors

risk determinants

risk indicators

risk predictors / markers

risk assessment

involves identifying elements that either predispose a patient to developing periodontal disease or influence progression of a disease that may already exist

risk factors

are environmental, behavioral or biologic factors

when present, increases the likelihood that an individual will develop the disease

identified through longitudinal studies of patients with the disease of interest

exposure to this factor may occur at a single point in time; over multiple, separate points in time; or continuously.

the exposure must occur before disease onset

examples of risk factors

tobacco smoking

diabetes mellitus

pathogenic bacteria & microbial tooth deposits

severe periodontal disease

has been found to be a significant risk factor for poor glycemic control

anatomic factors that at risk to periodontitis as they harbor bacterial plaque and present

furcations

root concavities

developmental grooves

cervical enamel projections

enamel pearls

bifurcation ridges

3 specific bacteria etiologic agents of periodontitis

Actinobacillus actinomycetemcomitans

• Actinobacillus actinomycetemcomitans - old term

Porphyromonas gingivalis

Tannerella forsythia

• Aacteroides forsythus - old term

are common sites with root proximity complications.

mx 1st & 2nd molars

biologic width

represents the anatomic dimensions of the epithelial attachment and the connective tissue attachment.

A restoration that does violate this would initiate a chronic inflammatory condition that results in bone and attachment loss to reestablish the dimensions

risk determinants

aka: background characteristic

these are risk factors that cannot be modified

examples of risk determinants

age

genetic factors

socioeconomic status

gender — males are more prone to periodontitis

stress — incidence of ANUG increases during stressful periods

risk indicators

aka: putative risk factors

are probable that have been identified in cross-sectional studies but not have been confirmed through longitudinal studies

factors associated with periodontal disease but not yet proven to be causative due to insufficient evidence

examples of risk indicators

osteoporosis

infrequent dental visits

HIV / acquired immune deficiency syndrome

risk markers / predictors

these are associated with increased risk for disease but do not cause the disease

examples of risk markers / predictors

previous history of periodontal disease

bleeding on probing — together with increased pocket depth may serve an excellent predictor for future attachment loss.

pregnancy

development of pyogenic granuloma

a reactive hyperplasia in response to local irritants, hormonal factors

gingiva on anterior teeth as most common site

scorbutic gingivitis

gingivitis due to vit C deficiency

a diabetic patient with a HbA1c of 9.5%

a patient would be expected to be at greatest risk for periodontal disease

smoking

a well-known risk factor for chronic periodontitis

The risk for periodontal disease after smoking cessation lowers continuously.

In the first few years after smoking cessation, the risk ranges between the risk for smokers and that for never-smokers.

Three years following smoking cessation, the risk for periodontal disease is three times higher in former smokers when compared to the risk of never smokers.

After eleven years, the risk for periodontal disease is similar between former smokers and never-smoker

grade I furcation involvement

incipient bone loss or early lesion

interradicular bone is intact

depression on furcal opening described as dimples

grade II furcation involvement

partial bone loss

moderate loss of interradicular bone

probe enters opening of furcation but not through & through

CUL-DE-SAC lesion

grade III furcation involvement

total bone loss

through & through furcation involvement that can only be seen radiographically

grade IV furcation involvement

total bone loss

through & through furcation involvement with gum recession that is clinically visible

plaque-induced gingival diseases

most common

result of interaction between plaque bacteria & inflammatory cells of host

modified by systemic factors, by medications, by malnutrition

non-plaque-induced gingival diseases

less common

in response to infections

in response to allergy

in response to trauma

gingival lesions of genetic origin

chronic periodontitis

older px (55 y.o)

any arch is affected

no familial aggregation

slow to moderate attachment loss

horizontal (suprabony) pattern of bone loss

consistent destruction in relation to microbial deposits

often commensurate with observed periodontal destruction

aggressive periodontitis

young px (<35 y.o)

rapid attachment loss

yes to familial aggregation

first molar & incisors are affected

often minimal presence of plaque

vertical / angluar (infrabony) pattern of bone loss

inconsistent destruction in relation to microbial deposits

causative agent of localized aggressive periodontitis (LAP)

aggregatibacter actinomycetemcomitans (Aa)

causative agent of generalized aggressive periodontitis (GAP)

porphyromonas gingivalis

causative agent of necrotizing ulcerative gingivitis (NUG)

spirochetes

causative agent of necrotizing ulcerative periodontitis (NUP)

fusiform bacteria

bacterias found in chronic periodontitis

P. gingivalis and T. forsythia

other etiologic factors in periodontitis

Campylobacter rectus

Eubacterium nodatum

Fusobacterium nucleatum

Prevotella intermedia/ nigrescens

Peptostreptococcus micros

Streptococcus intermedius

Treponema denticola

calculus

reservoir for bacterial plaque

has been suggested as a risk factor for periodontitis

Although the presence of some calculus in healthy individuals receiving routine dental care does not result in significant loss of attachment, the presence of calculus in other groups of patients, such as those not receiving regular care and patients with poorly controlled diabetes, can have a negative impact on periodontal health

associated with severe chronic periodontitis in nonsmoking subjectss

interleukin-1α (IL-1α)

interleukin-1β (IL-1β)

—Overall, it appears that changes in the IL-1 genes may be only one of several genetic changes involved in the risk for chronic periodontitis. Therefore, although the alteration in the IL-1 genes may be a valid marker for periodontitis in defined populations, its usefulness as a genetic marker in the general population may be limited

IgG2

the antibody response to A. actinomycetemcomi- tans in patients with aggressive periodontitis

age

as a risk determinants

Although periodontal disease is more common and severe in older individuals, this is mainly due to cumulative exposure to risk factors over time, not aging itself.

Studies show that people who maintain good preventive care throughout life have minimal attachment loss, indicating that periodontal disease is not an inevitable consequence of aging.

However, age-related changes (e.g., medications, reduced immunity, poor nutrition) may interact with other risk factors and increase susceptibility, but this is not yet fully established.