perio disease: epidemiology and risk factors Flashcards
epidemiology
the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control health problems
3 main purposes of epidemiology
- determine amount/distribution of disease in a population
- investigate disease casualty
- control the disease
whats the difference between public health and clinical practice in terms of perio disease?
health of group vs health in individuals
-determinants of disease: dental plaque in individuals vs low SES or access to preventative dentistry
what is the underlying assumption in epidemiology?
distribution of disease among members of a population is not random
prevalence
proportion of cases within a population at a given point in time
**proportion not rate
=# of cases present in population/persons at risk for dises
*estimates burden of disease in a given population
why is prevalence useful?
for estimating health care resource needs
what is prevalence influenced by?
population dynamics and additive/cumulative effect of aging
what results in higher prevalences?
more sensitive diagnostic tests and new treatment modalities that enhance survival
incidence
average percentage of unaffected persons who will develop the disease of interest during a given period of time
*(risk or probability that a person will become a case…it IS rate
=# of NEW cases in population/persons in pop at risk
observation studies
cross sectional
cohort
case/control
(retrospective mostly)
manipulation studies
community intervention trials
randomized clinical trials
what leads to causality exploration?
case/control cohort
what leads to causality determination?
clinical trial
retrospective cohort
exposure–> outcome
case control
exposure
RCT and prospective cohorts
exposure–>outcome
retrospective measures at —
end
prospective measures at —
beginning
experimental study
preventions and treatments for diseases, active manipulation
observational study
causes, preventions, and treatments for diseases, passively
what increases the probability of making the correct diagnosis?
diagnostic tests
sensitivity
probability of a positive test among persons with disease
specificity
probability of a negative test among persons without the disease
positive predictive value
probability that a person has the disease given that a positive test has been obtained
negative predictive value
probability that a person does not have disease given that a negative test has been obtained
sens/spec is the probability of what?
a test result
predictive values are probability of what?
disease status
risk
predicts the ‘‘who will get the disease” in a specific period of time
risk factors
characteristics of individuals that place them at increased risk for getting disease
risk assessment
predicting an individual’s probability of disease
-helps clinicians to modify risk factors as part of therapy
prognosis
prediction of the course or outcome of disease
outcomes of periodontitis
tooth loss, recurrent disease, and loss of function
prognostic factors of periodontitis
tooth type, furcation involvement, bone loss, pocketing, mobility, occlusal force, home care, smoking, and systemic disease
periodontal index systems
numerical rating scale for perio status of a person or population that considers prevalence and severity
-measurement of perio pockets and gingival tissue status
a good index is…
reproducible easy to use rapid valid reliable adequate specificity adequate sensitivity
periodontal disease indicators
plaque index ging inflamm probing depths (most objective index) bleeding upon probing clinical attachment levels radiographic assessment of bone loss
gingival indices
measure one or more of: color contour bleeding extent of ging involvement ging crevicular fluid flow
gingival health and periodontal health
- no perio loss
- no inflamm
- no PD (<3 mm)
- no rec
- no CAL loss (> 1 mm)
- no BOP
gingivitis
no perio loss, inflammation present
- no PD
- no rec
- no CAL loss
- BOP
gingival health on reduced perio
perio loss but no inflamm
- no PD
- recession
- CAL loss
- No BOP
T/F gingival plaque isn’t the only cause of periodontitis
true
_____% of non-institutionalized US pop 13 years and older had gingival bleeding in at least one gingival site
54%
on average per person, ____% of site had gingival bleeding
10
among persons with gingival bleeding, an average of ____ %sites had gingival bleeding
18
gingivitis is more prevalent among—
adolescents
are males or females in all age groups more likely to get gingivitis?
males
the prevalence of gingivitis is esp high for males aged ___ to ___
13-17
it is clear from experimental and epidemiologic studies that ______ is the direct cause of gingivitis
microbial plaque
smoking as a risk factor for perio disease
smoking is one of the most important risk factors for adult periodontitis, but its role in gingivitis is unclear
define periodontitis
inflammation of periodontium that extends beyond the gingiva and produces bone loss and destruction of connective tissue attachment of teeth
3 primary forms of periodontitis
- necrotizing
- periodontitis
- systemic disease
current classification of periodontitis is based on ___-
CAL which is more indicative of disease accumulation throughout time
staging is based on
severity
complexity
grading is based on
progression
risk
stage I
- CAL: 1-2 mm
- RBL: coronal third
- tooth loss: none
- local complexity: max probing depth < 4 mm; horizontal bone loss
stage II
-CAL: 3-4 mm
-RBL: coronal third
-tooth loss: none
-local complexity: max probing depth <5 mm
mostly horizontal bone loss
stage III
CAL: > 5 mm
RBL: extending to middle third of root and beyond
tooth loss: less than or equal to 4 teeth
local complexity: state II complexity plus probing depths of >6 mm, vertical bone loss > 3 mm, furcation involvement class II or II, moderate ridge defects
stage IV
CAL: > 5 mm
RBL: extending to middle third of root and beyond
tooth loss: more than 5 teeth
stage III complexity plus need for rehab due to masticatory dysfunction, occlusal trauma, severe ridge defects, bite collapse, less than 20 teeth
for each stage add
- localized
- generalized
- molar/incisor pattern
grade A
slow no bone loss over 5 years % bone loss/age: <0.25 heavy biofilm with low levels of destruction non smoker non diabetes
grade B
moderate bone loss: <2 mm over 5 years % bone loss/age: 0.25 to 1.0 destruction commensurate with biofilm deposits <10 cigs/day HbA1c: <7% in diabetics
grade C
rapid bone loss: > 2 mm over 5 years % bone loss/age: > 1.0 destruction exceeds expectations given biofilm deposits; periods of rapid progression or early onset > 10 cigs/day HbA1c>7%
what is the prevalence of periodontal pockets ?
> 4 mm —-23%
the increase in prevalence of attachment loss with increasing age is not seen with–
pocket depth
PSR may lead to—
underestimation of periodontitis
estimated that approximately —– of USA population >30 years has perio disease
half
what’s the typical profile of periodontitis?
- becomes clinically significant after 30 years old
- slow progression of attachment loss over time
- males more than females to have attachment loss and more teeth with pockets
- increased prevalence with age is more likely a reflection of cumulative effect of CAL over time
3 main microorganisms for perio
A actinomycetemecomitans
porphyromonas gingivalis
t. forsythia
*the presence of these pathogens is not sufficient to cause disease
what are other local factors that may cause perio?
diabetes, smoking, nutrition, SES, genetics, systemic diseases
non-modifiable risk factors
age
gender
race
gene polymorphisms
modifiable risk factors
biofilm formation control
cigarette smoking
psychosocial factors
systemic disease
