Final; Prognosis Flashcards
What is a prognosis
it is a prediction of the course, duration, and outcome of a disease based on the pathogenesis of the disease and the presence of risk factors for the disease
When is a prognosis established
after the diagnosis is made and before the treatment plan is established
What are the two types of prognosis
overall
individual tooth
What are the 7 factors that affect the overall prognosis?
patient age disease severity systemic factors smoking plaque control patient compliance prosthetic possibilites
What are four systemic/environmental factors
smoking
systemic disease/condition
genetic factors
stress
What are four prosthetic/restorative factors
abutment selection
caries
non-vital teeth
root resorption
Why do you determine the overall prognosis before the individual tooth
if the overall prognosis of the whole moth is hopeless, then don’t plan on keeping teeth regardless
What are some factors that can affect the individual tooth prognosis
affected by overall prognosis mobility probe depth bone loss furcation involvement local factors
What are the classifications of the Becker, Berg, and Becker
good
questionable
hopeless
What are the classifications of McGuire and Nunn
very good good fair poor hopeless
What classifies a good prognosis under the BBB classification system
2 or more factors
- < 50% bone loss
- No furcation involvement
- < 2 mobility
What classifies a questionable prognosis under the BBB classification system
2 or more factors
- ≥ 50% bone loss
- 6-8mm probing depth
- class 2 furcation
- anatomical variables
What classifies a hopeless prognosis under the BBB system
2 or more factors
- more than 75% bone loss
- more than 8mm probing depth
- class 3 furcation
- class 3 mobility
- poor crown/root ratio
- unfavorable root proximity
- repeated periodontal abscess formation
*What classifies a good prognosis under the McGuire and Nunn system
25% attachment loss / CLI furcation
adequate remaining bone support
adequate possibilites to control etiological factors
patient cooperation
no systemic environmental factors or well controlled
What classifies a fair prognosis under the McGuire and Nunn system
25-50% attachment loss
grade I or grade II furcation involvement
adequate maintenance possible
few systemic complications
What differs between BBB and M&N
M&N uses attachment loss, BBB uses bone loss
What classifies a poor prognosis with McGuire and Nunn
> 50% attachment loss
tooth mobility
grade I and II furcation involvements
difficult to maintain areas and/or doubtful patient cooperation
presence of systemic/environmental factors
What classifies a hopeless prognosis with McGuire and Nunn
>75% attachment loss tooth mobility 2+ grade II and III furcation involvements difficult-to-maintian areas and/or doubtful patient cooperation root proximity
Why would the prognosis for a patient that is older but with the same amount of bone loss as someone younger, be better
for the older person is took however long (60 years or whatever) to get that loss, while someone younger, took less, although the younger patient may have a better restorative capacity
What are two parameters of disease severity
level of clinical attachment
radiographic examination shows the amount of root surface still invested in the bone
Which has a better prognosis; a tooth with deep pockets and little attachment loss or one with shallow pockets and severe attachment and bone loss
deep pockets and little attachment loss
What differs in prognosis of bone loss defects
horizontal bone loss depends on the hight of existing bone
in regards to angular bone loss, the number of remaining walls
This is nearer to the crown which results in a more favorable distribution of forces to the periodontium and less tooth mobility
Crest
This is the primary etiological factor associated with periodontal disease
bacterial plaque
This is critical to the success of periodontal therapy and to prognosis
effective removal of plaque on a daily basis by the patient
The prognosis for patients with gingival and periodontal disease is dependent on what three things
the patients attitude
desire to retain natural teeth
willingness and ability to maintain good oral hygiene
What are two options the dentist can do with a patient who is not compliant
refuse to accept the patient for treatment
extract the teeth with hopeless/poor prognosis and preform SRP on remaining teeth
This affects the severity of periodontal destructions and healing potential of the periodontal tissues
smoking
In smokers, prognosis of slight-moderate periodontitis is generally what
fair to poor
In smokers with severe periodontitis, the prognosis may be what
poor to hopeless
A smoker can do this to affect prognosis
cessation of smoking
Patients with slight to moderate periodontitis, who stop smoking can be upgraded to what prognosis
good
Patients with severe periodontitis who stop smoking may be upgraded to what prognosis
fair
Well-controlled diabetics with slight to moderate periodontitis, who comply with their recommend periodontal treatment should have what prognosis
good
This may be helpful to a patient and improve prognosis especially in patients with Parkinson’s or other systemic diseases
electric toothbrushes
This is the most important local factor in periodontal disease
microbial challenge presented by bacterial plaque and calculus
What are outcomes of plaque retentive features that decrease prognosis?
greater gingival inflammation
more marginal bone loss
poorer compliance with home care
Prognosis is poor for teeth with what anatomical features
- short tapered roots and large crowns or disproportionate crown/root ratio
- reduced root surface available for periodontal support
- periodontium may be more susceptible to injury by occlusal trauma
These anatomical features can interfere with SRP and can prevent regeneration of cementum and PDL
cervical enamel projections CEPs
enamel pearls
bifurcation ridges
These cannot attach to enamel, so you may have to remove enamel to expose cementum
gingival fibers
This appears on the maxillary first premolars and the mesiobuccal root of the maxillary first molar which increases the attachment area and produces a shape more resistant to torquing
root concavities
What are the three principal causes of tooth mobility
loss of alveolar bone
inflammatory changes in the PDL
trauma from occlusion
This type of tooth mobility may be correctable
tooth mobility caused by inflammation and TFO
This type of tooth mobility is likely to NOT be corrected
mobility due to loss of alveolar bone
Long term prognosis for patients with plaque induced gingival diseases modified by systemic factors depends on what two things
control of bacterial plaque and control or correction of the systemic factors
In drug-induced gingival enlargement this is usually necessary to correct the alterations in gingival contour
surgical intervention
In slight/moderate chronic periodontits, the prognosis is generally good, provided what
inflammation can be controlled
What type of prognosis does aggressive periodontitis have
poor
Periodontits as a manifestation of systemic diseases can be divided into what two categories
those associated with hematologic disorders such a leukemia and acquired neutropenia
those associated with genetic disorders such as familial and cyclic neutropenia, down syndrome, Papillion-Lefevre, and hypophosphatasia
Patients with periodontits has a manifestation of a systemic disease have what prognosis
fair to poor
The prognosis of a patient with NUG is what
good
The prognosis of a patient with repeated episodes of NUG is what
fair
The prognosis of a patient with NUP depends on what
reducing local and secondary factors but also dealing with the systemic problem (like HIV)
Are old patients more susceptible to perio?
No
Is perio more severe in older individuals?
Yes
