Ch 18 perio Flashcards
What is the prediction or forecast of the extent and duration of disease and its response to tx
Prognosis
this is influenced by the pathogenesis of the disease and by individual pt factors, including overall health, risk factors and compliance
Prognosis
why is prognosis a major consideration in tx planning
all tx should be based on which intervention is expected to provide the best outcomes
is the expected outcome for the pt. It is determined on the basis of the specific risk factors that the individual pt presents
overall prognosis
why is healing and resolution of perio disease be altered for individuals with systemic diseases and conditions?
Because these pts respond differently to bacterial infection
individuals with this is less likely to follow the course of healing that one would expect- regeneration and repair of perio tissue over the days and weeks after tx
Systemic disease and conditions
overall prognosis is sometimes referred to as
global prognosis
once the overall prognosis is analyzed and determined, then what can be determined
individual tooth prognosis
To determine the overall case prognosis the following questions need to be addressed
- should tx be undertaken?
- Is tx likely to succeed (retain the teeth and provide good function)
- If prosthetic replacements will be made, can the periodontally treated teeth support the burden?
The dental hygienist must consider prognosis as either
short-term or long-term
This usually refers to survival of the teeth for 5 years or less
Short-term prognosis
The factors considered in making an overall prognosis for patients with periodontal disease include
- Age
- Systemic health
- Smoking
- Type of perio disease
- oral conditions (Including inflammation and bone levels)
- Attitude and perceptions of the pt
Usually involves assessing the likelihood of maintaining a tooth or teeth for a longer time frame (>5 years)
long-term prognosis
Many clinicians consider what the most critical factors in the lasting success of perio tx
The attitude, perceptions, and cooperation of the pt
What are some systemic diseases and conditions that influence the host ability to respond to perio disease
Diabetes, neutrophil defects, and factors associated with immunosuppression such as human immunodeficiency virus (HIV) infection or organ transplantation
What are the global prognosis
- Excellent
- Good
- Far
- Poor
- Questionable
- Hopeless
Which global prognosis has no bone loss, excellent condition, no systemic considerations, good pt cooperation
Excellent
Which global prognosis adequate remaining perio support and ease of maintenance, adequate patient cooperation
Good
Which global prognosis is attachment loss and furcation involvement (Class 1), pt cooperation likely, systemic factors controlled
Fair
Which global prognosis is attachment loss and furcation involvement that can only be maintained with difficulty (Class 2 or 3 ), tooth mobility, presence of systemic factors
Poor
Which global prognosis has poor-crown to root ratio, poor root form, root proximity, Class 2 or 3 furcation, mobility, presence of systemic factors
Questionable
Which global prognosis has advanced bone loss, inadequate attachment, uncontrolled environmental/systemic factors, tooth should be extracted
Hopeless
This does not only affect the severity of disease but also the healing potential of the oral tissues.
Smoking
Pt who ___ do not respond as well to perio therapy
Smoke
what type of periodontitis is generally good to tx
Chronic periodontitis
The prognosis of the individual teeth is evalvated first on the basis of what?
the overall prognosis and then the status of each tooth
What do you look at for each individual tooth prognosis
Pocket depths and attachment loss Mobility Amount and location of furcation involvement Tooth morphologic features Bone levels General condition of the tooth Ability to modify etiologic factors
what can harbor pathogenic plaque biofilms and are associated with increased inflammation
pockets depths, particularly persistent deep pockets
what generally reflect loss of attachment to the tooth, a further indication that the tooth is weakened and an indicator of a less favorable prognosis
Deep pockets
What is also associated with deep pockets and persistent inflammation
Bleeding
This is associated with less favorable periodontal outcomes but is not confirmed as a risk factor. It is caused by inflammation in the periodontal ligament and bone loss
Mobility
Can result from loss of support for the tooth (bone and clinical attachment loss) or trauma from occlusal
Mobility
If mobility is the direct result of loss of support for the tooth, than the prognosis is
Less favorable
This has a negative effect on the prognosis for an individual tooth
Furcation
Access for scaling and root planing and homecare is difficult to obtain; therefore these areas can continue to harbor pathogenic plaque biofilm.
Furcation
% of mandibular molars may have cervical enamel projections
25%
% of maxillary molars may have cervical enamel projections
20%
% of maxillary lateral incisors have lingual grooves
6%
% of maxillary central incisors have lingual grooves
3%
Bone level is important for individual teeth because
it defines the amount of support remaining for the tooth. Greater bone loss will result in more mobility
Most often prognosis is what
determined and the ideal tx plan is formulated in the nest interest of the pt with the intent to preserve all teeth for as long as possible
All pts deserve to know what
the tx options and how decisions may alter their oral health in the future
In the end, who is the one who accepts the treatment or chooses to modify it.
The pt
what is categorized into groups of diseases are generally similar signs, symptoms, and outcomes
periodontal disease
Is a reversible disease caused by bacterial plaque biofilm. It can occur around teeth with or without attachment loss
Gingivitis associated with dental plaque only
The prognosis is considered ____, provided that all contributing factors can be eliminated and the tissue can be returned to a state of health.
Good `
An _____ prognosis is reserved for gingival disease in which no attachment loss has occurred; consequently, healing the gingival inflammation completely restores the oral condition.
excellent
Plaque-Induced gingival disease modified by medication, what are the meds
phenytoin, nifedipine, and oral contraceptives
what is the prognosis of plaque-induced gingival disease modified by medications
fair to good
The prognosis of gingival disease modified by malnutrition depends on what
the severity and duration of the deficiency
What is the prognosis of gingival disease modified by malnutrition
range from hopeless to good
the prognosis for chronic periodontitis is generally ___ if the inflammation is controlled
good
occurs as localized or generalized forms and is related to loss of attachment and bone destruction in otherwise healthy patients
Aggressive periodontitis
It is found as a family trait
Aggressive periodontitis
which form of aggressive perio usually appears around the age of puberty and is amenable to periodontal tx and systemic antibiotic therapy, With proper tx it has a good to excellent prognosis
localized
which form of aggressive perio is usually seen in young adults and often has other associated risk factors, such as smoking, and possibly systemic alteration in host defenses. The prognosis has a fair to poor or even questionable
generalized
is primarily caused by bacterial plaque biofilm with secondary factors such as stress or poor nutrition.
Necrotizing ulcerative gingivitis (NUG)
is amenable to periodontal treatment with the prognosis dependent on managing both the systemic condition and the manifestations of the local periodontal disease.
In general, the prognosis for this disease is good.
NUG
one straightforward way to assess the results of tx is to wht
monitor tooth loss in pts with treated perio disease
The prognosis for aggressive forms of periodontal disease is:
A. unable to be determined
B. better than that for chronic perio
C. less favorable than that for chronic perio
D. exactly the same as the individual tooth
less favorable than that for chronic perio
Global prognosis is the same as the individual tooth prognosis for all pts. The individual tooth prognosis can differ from the overall prognosis
The first statement is false, and the second statement is true
When pts successful complete periodontal therapy and are compliant with maintenance care, what is the expected rate of tooth loss over 10 years? A. one per year B. five to six per year C. one per 10 years D. five to sic per 10 years
one per 10 years
In general, the most critical element is determining prognosis is A. the attitude of the pt B. dental hygiene care history C. the type of perio disease D. the pathogenesis of the disease
the attitude of the pt
Age is a significant factor in determining the overall prognosis because
A. older ppl are less likely to cooperate with tx
B. younger ppl are less likely to cooperate with tx
C. an older individual with significant perio destruction Is likely to be more significant to disease
D. a younger individual with significant perio destruction is likely to be more susceptible to disease
an older individual with significant perio destruction Is likely to be more significant to disease
what are some oral conditions that should be analysis
heavy deposits of plaque biofilm and calculus and severity of inflammation
what indicates how much support for the tooth has been lost
clinical attachment loss
what is caused by inflammation in the perio ligment and bone loss
mobility
