11 - Diagnosis and Prognosis

Question 1

Reification definition

Answer 1

Naming something to give it a certain reality

Question 2

General concept of a disease, disease as an abstract category

Answer 2

Ontology

Question 3

Personal unique response to an etiologic agent, patient health, homecare, and diet

Answer 3

Physiologic

Question 4

Diagnosis helps in determining treatment modality and course of the disease

Answer 4

Clinical utility

Question 5

Helps clinician distinguish between 2 disease entities that have the same presentation but different etiologies

Answer 5

Biologic plausibility

Question 6

Sensitivity identifies those who ______

Answer 6

Truly have the target disorder

Question 7

Sensitivity formula

Answer 7

TP/(TP + FN)

Question 8

Specificity formula

Answer 8

TN/(TN+FP)

Question 9

PPV formula

Answer 9

TP/(TP + FP)

Question 10

NPV formula

Answer 10

TN/(TN + FN)

Question 11

Likelihood ratio definition

Answer 11

Ratio between the likelihood of a positive test if one has the target disorder / likelihood of a positive test if one does not have the disorder

Question 12

High threshold for disease (8mm CAL) does what to sensitivity/specific?

Answer 12

Highly sensitive

Poor specificity

Question 13

Low threshold for disease (2mm CAL) does what to sensitivity/specificity?

Answer 13

Highly specific

Poor sensitivity

Question 14

What test characteristics do you want for a 99% fatal disease if the treatment was mild (ABCs)?

Answer 14

Highly sensitive

Have more false positives but that’s OK

Question 15

General dentists and periodontal exams/diagnoses? (2 sources)

Answer 15

McFall - 16% of charts had perio dx

Heins - 62% w/ perio charting + 60% w/ perio dx

Question 16

The diagnosis given before treatment is administered which can be changed

Answer 16

Presumptive diagnosis

Question 17

Bacteria are necessary but not sufficient to cause disease (2 sources)

Answer 17

Loe - Sri Lankans, 11% didn’t develop disease

Grossi - Smoking more important risk factor than periodontal pathogens

Question 18

AAP guidelines for slight/moderate/severe

Answer 18

1-2mm CAL
3-4mm CAL
5+mm CAL

Question 19

Elements required for determining causality (4 + source)

Answer 19

Austin Bradford Hill

Strength of association
Dose response relationship
Temporality (longitudinal)
Consistency (between studies)

Question 20

Determining the overall risk of disease for a given individual or group based off of putting all the risk factors and indicators together

Answer 20

Risk assessment

Question 21

All the possible results that could result from treatment

Answer 21

Outcome

Question 22

True outcome definition

Example

Answer 22

Unequivocal evidence of tangible effect to patient

Tooth loss

Question 23

Surrogate outcome

Example

Answer 23

Can predict true outcome, must be related to true outcome

Clinical attachment loss

Question 24

BOP as risk indicator (source)

Answer 24

Lang

4/4 BOP at visits, breakdown occurred only 30% of time

BOP good indicator for whole mouth prognosis

Question 25

Smoking as risk factor for periodontal disease (source)

Answer 25

McGuire & Nunn

• Heavy smokers 3X more likely to lose teeth after periodontal therapy
• Decreased likelihood of improved prognosis after treatment by 60%

Question 26

Twin studies & periodontal disease (source)

Answer 26

Michalowicz

Genetics make up as much as 50% of risk for ChP

Question 27

IL-1 & ChP (3 sources)

Answer 27

Kornman - genetic polymorphism that upregulates adhesion factors on endothelial cells

Armitage - IL-1 30% in Caucasians, 3% Asians

McGuire & Nunn - Those w/ IL-1 2.7X likelihood of losing teeth. 7.7X when a smoker

Question 28

IL-1 longitudinal studies

Answer 28

There aren’t any showing an increased incidence of CAL over time

Question 29

Age + CAL (Erie County)

Answer 29

Grossi

Older the age the greater the periodontal destruction

Question 30

No effect of age + CAL (2 sources)

Answer 30

Axellson - age does not affect progression of disease

Lindhe - no difference in response to therapy w/ age

Question 31

Age w/ Japanese subjects (source)

Answer 31

Haffajee

More disease progression w/ age

Question 32

Race + diabetes (source)

Answer 32

Emrich w/ PIMA Indians

3X risk for DM2
2X CAL in 15-24 year olds

Question 33

Sex + periodontal disease

Answer 33

M > F

Exists even when correcting for dental care/hygiene

Question 34

Absence of BOP as indicator of health (source)

Answer 34

Lang

98% of non-bleeding sites are stable

Question 35

Full mouth BOP and predicting CAL (2 sources)

Answer 35

Joss - 60% of sites lost at least 2mm when BOP >30%

Claffey - no relation between full mouth BOP and future CAL

Question 36

Persistent deep pockets + periodontal prognosis (2 sources)

Answer 36

Greenstein - Deep pockets harbor periodontal pathogens and exhibit more BOP

Haffajee/Socranksy/Lindhe - Japanese population, mean probing depth and prior CAL were strong predictors of future attachment loss

Question 37

Mobility and negative effect on prognosis (3 sources)

Answer 37

Nieri - mobility at baseline associated w/ increased bone loss over time
Fleszar - better healing response in firm teeth
Cortellini - better regenerative outcomes in firm teeth

Question 38

Mobility and no effect on prognosis (source)

Answer 38

Rosling

Question 39

Severe disease w/ innocuous treatment. What type of test do you want?

Answer 39

Highly sensitive, you are okay with overtreatment

Question 40

Mild disease w/ dangerous treatment. What type of test do you want?

Answer 40

Highly specific test, you want to undertreat

Question 41

PPV is the ____ rate

Answer 41

False positive

Question 42

NPV is the _____ rate

Answer 42

False negative

Question 43

BOP specificity/sensitivity/PPV/NPV

Answer 43

High specificity, NPV

Low sensitivity, PPV

Question 44

BW for caries specificity/sensitivity/PPV/NPV

Answer 44

High sensitivity

Low specificity