determination of prognosis Flashcards
what is a prognosis?
prediction of the probable course, duration, and outcome of a disease
T/F a prognosis is dynamic
True
T/F prognosis is also called risk
False. prognosis is often confused with risk
what is risk?
the likelihood that an individual will develop a disease
what are risk factors?
environmental, behavior, or biologic factors that put an individual at increased risk for developing a disease
what are risk factors for periodontitis?
smoking
diabetes
pathogenic bacteria
what are examples of non-modifiable risk factors
genetic factors
age
what are risk indicators?
probable or putative risk factors (not confirmed through longitudinal studies; e.g. HIV/AIDS, osteoporosis, infrequent dental visits)
what are risk predictors?
assoc with inccreased risk for disease, but do not cause disease (e.g. bleeding on probing, previous history of periodontal disease)
what is a prognosis?
a rdiction of probable course of disease
what are prognostic factors?
characteristics that predict the outcome of disease once disease is present (e.g. furcation involvement)
sometimes something may be both a __________ and a __________
Risk factor, prognostic factor
e.g. smoking, diabetes (increased risk for aquiring periodontitis and worse prognosis once they have periodontitis)
what are the types of perio prognosis?
good
fair
poor
questionable
hopeless
what kind of attachment and bone loss is present is good prognosis?
no or slight attachement and bone loss
T/F with good prognosis there are no systemic or environmental factors
true
with good prognosis can you use the tooth as an abutment tooth?
yes
what kind of bone loss is present with a fair prognosis?
moderate (25%) attachment and bone loss
with a fair prognosis what kind of mobility is there?
CL I mobility
what kind of furcation involvement is assoc. with fair prognosis?
Degree I furcation involvement
T/F with a fair prognosis there is no systemic or environmental factors
False, (limited systemic or environmental factors)
with a fair prognosis can you use the tooth as an abutement tooth?
yes, but with caution
what type of attachment and bone loss is present with poor prognosis?
severe (50%)
what kind of crown root ratio would be present in poor prognosis?
poor (greater than 1:1)
what kind of mobility is present with a poor prognosis
CL II mobility
what kind of furcation involvement is assoc with poor prognosis?
Degree II
T/F with a poor prognosis, systemic and environmental factors are not controlled
True
with a poor prognosis can you use the tooth as an abutment tooth?
NO
with questionable prognosis there is ________ attachment and bone loss
severe (>50%)
what kind of furcation involvement is present in questionable prognosis?
CL II or III
what kind of mobility is present in questionable prognosis?
CL II or III
what kind of mobility is present in hopeless prognosis?
CL III
what kind of bone loss is present in hopeless prognosis?
severe
T/F with a hopeless prognosis it may jeopardize the adjacent tooth
true
whta kind attachment is present in hopeless prognosis?
inadequate attachment to maintain health, comfort, function
T/F you can save a tooth with a hopeless prognosis with extreme tx measures
False. non-restorable, ext indicated
what 3 prognosises were est with reasonable degree of accuracy
good, fair, hopeless
what prognosises were likely to change and were more unpredictable?
poor, questionable
what are the big factors assoc with the overall prognosis?
disease severity (PD, furcation involvement, mobility, % bone loss)
smoking
with individual tooth prognosis what are the influences?
same factors as overall prog. plus
local factors
tooth anatomical factors
prosthetic and restorative factors
T/f you should determine the individual tooth prognosis first
false. overal prognosis first
what grades generally lead a good perio prognosises? what are the exceptions?
grades A/B
except:
severe perio
non-compliant
pt with systemic disease
these will downgrade to fair/poor
molar-incisor pattern perio has a __________ prognosis if treated early with systemic antibiotics and regenerative therapy
good
generalized Grade C perio has _________ or _________ prognosis
poor, questionable
do not respond well to conventional periodontal therapy
the _______ the stage and/or grade the ________ the individual and overall prog.
higher, poorer
with perio as a manifestation of systemic disease it has a ______ or _______ prog
poor, questionable
w/ necrotizing gingivitis there is a _________ prog
good
with recurrent it downgrades prog.
what are clinical factors that determine prog?
pt age
disease severity
plaque control
pt compliance
which has better prog.
tooth A: 8 mm pocket, heavy calc in a 50 yr old pt
tooth B: 8 mm pocket, no calc in a 30 yr old pt
A
tooth has a slower rate of progression
tooth b has grade C perio
removal of local factors (calc) can improve the prog of tooth A
older pt vs young pt with the same amount of attachment loss. which pt has a better prog?
older pt
b/c rate of progression is slower
grade a perio has a better prog than grade c perio
what are the big local (tooth related) factors that determine prognosis?
probing depth
mobility
furcation involvement
bone loss severity
__________% of molars have cervical enamel projections at the furcation
17-28%
what’s the issue with cervical enamel projections?
ct fibers will not attach to enamel
increases susceptibility to pocket formation
increases susceptibility to furcation involvement
what’s the issue with the mesial root concavity?
difficult access for scaling
which tooth is common for mesial root concavity?
max 1st premolars
what is the percentage of time that the M root of the mand 1st molar has a concavity? for the distal?
100%, 99%
on the max 1st molar which root is the most likely to have a concavity?
the MB root (94%)
the furcation entrance is smaller than the curette ________% of the time
58%
what tooth is most common to have palatogingival groove?
max incisors
lateral most common (5%)
what prosthetic and restorative factors will determine prog?
abutment selection
caries
non-vital teeth
root resorption
what’s the key pt factor that affect prog.?
smoking
-has the most negative impact on tooth survival
-246% greater chance of tooth loss (compared to non-smoker)
what are the key local factors that affect prog.?
probing depth
mobility
furcation involvement
% bone loss
what’s the prog.?
-56 yr old female
-non-smoker
-hypothyroid well-controlled synthroid
-CL III mobility
-11 mm pd’s with suppuration
-#25: non-vital
hopeless
what’s the prog.?
34 yr old female
non-smoker
healthy
-3 mm recession facial #25 with MGD
good b/c you can do a graft
what’s the prog.?
58 yr old female
depression controlled with paxil
4mm CAL on lingual
deg I furcation involvement buccal and lingual
CL I mobility
fair
what’s the prog.?
58 year old female
type 2 diabetes
HbA1c = 8.6%
smoker, 1pack/day
4mm CAL on lingual
deg I furcation involvement buccal and lingual
CL II mobility
poor (systemic diseases not well controlled)
