11 - Diagnosis and Prognosis Flashcards
Reification definition
Naming something to give it a certain reality
General concept of a disease, disease as an abstract category
Ontology
Personal unique response to an etiologic agent, patient health, homecare, and diet
Physiologic
Diagnosis helps in determining treatment modality and course of the disease
Clinical utility
Helps clinician distinguish between 2 disease entities that have the same presentation but different etiologies
Biologic plausibility
Sensitivity identifies those who ______
Truly have the target disorder
Sensitivity formula
TP/(TP + FN)
Specificity formula
TN/(TN+FP)
PPV formula
TP/(TP + FP)
NPV formula
TN/(TN + FN)
Likelihood ratio definition
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
High threshold for disease (8mm CAL) does what to sensitivity/specific?
Highly sensitive
Poor specificity
Low threshold for disease (2mm CAL) does what to sensitivity/specificity?
Highly specific
Poor sensitivity
What test characteristics do you want for a 99% fatal disease if the treatment was mild (ABCs)?
Highly sensitive
Have more false positives but that’s OK
General dentists and periodontal exams/diagnoses? (2 sources)
McFall - 16% of charts had perio dx
Heins - 62% w/ perio charting + 60% w/ perio dx
The diagnosis given before treatment is administered which can be changed
Presumptive diagnosis
Bacteria are necessary but not sufficient to cause disease (2 sources)
Loe - Sri Lankans, 11% didn’t develop disease
Grossi - Smoking more important risk factor than periodontal pathogens
AAP guidelines for slight/moderate/severe
1-2mm CAL
3-4mm CAL
5+mm CAL
Elements required for determining causality (4 + source)
Austin Bradford Hill
Strength of association
Dose response relationship
Temporality (longitudinal)
Consistency (between studies)
Determining the overall risk of disease for a given individual or group based off of putting all the risk factors and indicators together
Risk assessment
All the possible results that could result from treatment
Outcome
True outcome definition
Example
Unequivocal evidence of tangible effect to patient
Tooth loss
Surrogate outcome
Example
Can predict true outcome, must be related to true outcome
Clinical attachment loss
BOP as risk indicator (source)
Lang
4/4 BOP at visits, breakdown occurred only 30% of time
BOP good indicator for whole mouth prognosis
Smoking as risk factor for periodontal disease (source)
McGuire & Nunn
- Heavy smokers 3X more likely to lose teeth after periodontal therapy
- Decreased likelihood of improved prognosis after treatment by 60%
Twin studies & periodontal disease (source)
Michalowicz
Genetics make up as much as 50% of risk for ChP
IL-1 & ChP (3 sources)
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
IL-1 longitudinal studies
There aren’t any showing an increased incidence of CAL over time
Age + CAL (Erie County)
Grossi
Older the age the greater the periodontal destruction
No effect of age + CAL (2 sources)
Axellson - age does not affect progression of disease
Lindhe - no difference in response to therapy w/ age
Age w/ Japanese subjects (source)
Haffajee
More disease progression w/ age
Race + diabetes (source)
Emrich w/ PIMA Indians
3X risk for DM2
2X CAL in 15-24 year olds
Sex + periodontal disease
M > F
Exists even when correcting for dental care/hygiene
Absence of BOP as indicator of health (source)
Lang
98% of non-bleeding sites are stable
Full mouth BOP and predicting CAL (2 sources)
Joss - 60% of sites lost at least 2mm when BOP >30%
Claffey - no relation between full mouth BOP and future CAL
Persistent deep pockets + periodontal prognosis (2 sources)
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
Mobility and negative effect on prognosis (3 sources)
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
Mobility and no effect on prognosis (source)
Rosling
Severe disease w/ innocuous treatment. What type of test do you want?
Highly sensitive, you are okay with overtreatment
Mild disease w/ dangerous treatment. What type of test do you want?
Highly specific test, you want to undertreat
PPV is the ____ rate
False positive
NPV is the _____ rate
False negative
BOP specificity/sensitivity/PPV/NPV
High specificity, NPV
Low sensitivity, PPV
BW for caries specificity/sensitivity/PPV/NPV
High sensitivity
Low specificity
