Perio Risk assessment

Risk factor vs risk

risk: probability that an individual will get specific disease

factor: increases probability that disease will occur

• Overall, __% of adults 30 years or older had total periodontitis

• Prevalence of nonsevere and of total, but not __, increases with?

• Prevalence of total is greatest among ___, __ americans, adults below _, current ?, and those with self reported ?

  • the prevalence increased with increasing number of ___, but not with ?

• Among dental health related subgroups, prevalence of total periodontitis was highest among adults who ___, and increased with increasing duration of ?

• 42%

• severe, age

• men, mexican, FPL, smokers, diabetes,

  • Number of teeth missing, BMI

• do not use floss, since last dental visit/no visit in past year

What factors contribute?

Etiological/Predisposing/Contributing

• Local: subject, tooth, site

• Systemic

• Modifiable

• Nonmodifiable

How can we consistently and object evaluate periodontal risk in clinic?

• Periodontal risk calculator

  • Web based tooth that uses known risk factors to predict risk, high level of accuracy

• Periodontal Risk Assessment

  • Internet based tool used to predict progression

Modifiable Factors (8)

• Tobacco

• Diabetes

• Metabolic syndrome

• Obesity

• Alcohol

• Diet

• Psychosocial Factors

• Medications

Tobacco Cessation form

D1320

Diabetes Mellitus: how does it affect? What measures and what is the goal? Readings give you an indication of?

• Increases risk and achieves poor results to treatment

• HbA1C measures overall glycemic control over past 3 months

  • Hemoglobin with attached glucose, try to near 7

• current glycemic control

Metabolic syndrome

Chronic with 3 of following factors:

• Hypertension

• Hyperglycemia

• Abdominal Obesity

• Decreased levels of LDL cholesterol

• High triglycerides

Obesity

doubles risk of perio, 40% of US is obese, emerging risk factor

Alcohol Consumption, what is heavy?

Heavy: > 2 drinks a day

Risk doubles for women, 25% for men

Diet

Macronutirent: high carbs (sugar) impacts glycemic control

Micronutirent: vitamin deficiencies impacts onset, progression, healing

Psychosocial

high levels of stress: behavior changes, immune response

Medications

Gingival Enlargement: increases plaque retention while complicating complete removal

4 specific medications

• Phenytoin: seizure medication

• Cyclosporine: anti rejection medication

• Nifedipine: calcium channel blocker, used for angina or arrythmias

• Oral contraceptives: Estrogen/Progesterone hormones cause inflammation

Nonmodifable factors

Genetic predisposition, host response, osteoporosis, age

Genetic predisposition

33-39% risk is genetic

Host response

Biofilm is most well documented of all risk factors, control of biofilm is modifable but the way our body responds is nonmodifiable

Osteoporosis

• osteoporosis: 3x greater risk for > 4 mm CAL

  • Osteopenia: 2x greater risk for > 4 mm CAL

Local Factors

• tooth related: appliances, contour, etc

• Gingival related: position, mouth breathing, etc

• Self: neglect, diet, dental IQ

Surface Irregularities

Calculus, pits and fissures, demineralization and cavitations, exposed root surfaces, latrogenic effects

Tooth anatomy: poor oral hygiene impacted by ?

• Furcation: entrance can be 3-5 mm from CEJ in molars

• Grooves: 5% max incisors

• cervical Enamel Projections (CEP)

  • common anomaly that acts as contribute factor in perio disease

  • Prevention of CT attachment, results in weaker epithelial attachment less resistant to bacteria

What are all of these related to?

• Congenital Abnormalities

• Erosion

• Attrition

• Open contacts

• Carious lesions

• Heavy calc

• Overhanging restorative margins

Contour

What are these related to?

• malocclusion

• Migration

• Hyper or hypo eruption

• Exposed root surface

• Lack of function

• Food impaction

Tooth positioning

What are these related to?

• Defective contacts

• Faulty restorations

• Deficient margins

• Ortho appliances

• Partial denture clasps

Restorative, Applicances, Prostheses

MUSOD use/requirement

• PRC-preViser

• All comprehensive and transfer exams

• Annually for Perio maint with updated radiographs and POE

• Requirement for:

  • Patient treatment plan consultation (M9050)

  • Surgical Sciences Perio case completion

  • General Dental Science Completion

What to expect at MUSOD

more residual disease in compromised patients, PreViser numbers will never go back to total health in perio involved patients due to horizontal bone loss (irreversible, parameter for risk calculator)

Clinical Assessment Gathering: where is the data collected from?

• medical history

• Dental history

• Perio chart

• Dental chart

  • Current Radiographs

Info Necessary to complete PRC

• ____: in last year

• ___: former, current, never

• __ status

• Oral hygiene measured by __: excellent: %?, acceptable? Unacceptable?

• __ __ history

• __ on probing

• __ involvement: what is considered?

• __ restorations: detectable by _ or ?

• __ calculus: detectable same as above

• __ assessment: ? ? lesions and ?

• ?

• dental care frequency

• Smoking history

• Diabetic

• Plaque: 0-10%, 11-30%, 30%+

• Periodontal surgery

• Bleeding

• Bifurcation: Glickman Grade 2 or higher

• Subgingival: radiographs or explorer

• Subgingival Calc

• Radiographic: vertical bone loss lesions and horizontal bone loss

• Age

Radiographic Assessment:

• Use radiographs taken within __ months

• Choose most ideal radiograph of __ site to make your bone loss measurement in each sextant

• minimal distortation and clear bone crest and PDL

• What kind is best?

• What kind is acceptable, if you check geometry?

• What should not be?

6 months, deepest, vertical bitewings (not horizontal), PA

NOT non-diagnostic radiographs