Periodontal Prognosis and Maintenance Flashcards
List and describe the 8 systemic periodontal risk factors
Uncontrolled diabetes (Type I or II): • Poor wound healing due to impaired immune response • Increased glucose in GCF changes composition of bacteria leading to more pathogenic bacteria
Genetics (which predispose to perio destruction):
• IL-1 phenotype- host response is altered
• Inadequate numbers or reduced function of circulating neutrophils
• Disorders such as neutropenia, agranulocytosis, lazy leukocyte syndrome, Down syndrome
Psychological Stress:
• Leads to a depressed immune response
• Lowered host resistance
• Release of pro-inflammatory cytokines (such as IL-6)
• Stress also leads to other behaviours like smoking, nutritional deficiencies
Hormonal changes:
• exaggerated immune response to biofilm
Smoking:
• Prevalence of perio pathogens is greater
• Neutrophil (PMN), B-cell & T-cell functions are impaired
• Altered fibroblast function
• Reduced gingival vascularity= poor healing, migration of PMNS, waste removal
Medications:
• gingival hyperplasia caused by epileptic medications
Osteoporosis
Cardiovascular disease
List and describe the 7 local periodontal risk factors
· Gingival overhang/ Deficient restorations
· Overcrowding and tooth morphology (talons cusps, deep fissures)
· Open contacts
· Calculus
· Tooth embrasures
· Occlusal forces
· Oral hygiene
List the modifiable periodontal risk factors
- Smoking
- Diabetes
- Oral hygiene
- Crowded teeth
- Gingival overhangs
List the non- modifiable periodontal risk factors
- Genetics
- Cardiovascular tooth loss
- Osteoporosis/ hormonal changes
List the 6 components of the Lang & Tonetti’s Risk Assessment Tool
At the three month review, look at:
• Percentage bleeding on probing
- Residual pockets > 5mm
- Loss of teeth from a total 28
- Loss of periodontal support in relation to patient’s age
- Systemic and genetic conditions
- Environmental factors
Describe the 6 components of the Lang & Tonetti’s Risk Assessment Tool
At the three month review, look at:
• Percentage bleeding on probing: reflects ability to perform proper plaque control, the host response to bacteria and the patients compliance
- Prevalence of residual pockets > 5mm: Shows, to an extent, the success of periodontal treatment
- Loss of teeth from a total 28: Teeth are important for the functionality of the dentition.
- Loss of periodontal support in relation to patient’s age: Evaluates the height of the alveolar bone and considers the patients age. This is recorded for posterior regions
- Systemic and genetic conditions: Having type 1 and 2 diabetes. In addition, possessing IL-1 genotype (found in advanced periodontitis). If unknown, this is not considered
- Environmental factors such as cigarette smoking: Heavy smokers are at high risk, moderate - low smokers are considered at moderate risk
Explain how the Lang and Tonetti’s risk assessment is recorded
Recorded as a web- diagram:
• Low Risk: area closest to the centre and within boundary of first bold ring
- Moderate Risk: area located between the first and second bold ring
- High Risk: area furthest from centre and outside second bold ring
Describe the benefits of using a Risk Assessment Tool
- Helps motivate patients as it is a visual representation
- Helps assess patient compliance
- Provides an insight into prognosis and the need for referrals where appropriate
Describe the disadvantages of using a Risk Assessment Tool
- Does not account for clinical attachment loss. It does not give a true and accurate picture of loss of periodontal support
- Does not factor into account reasons for tooth loss (may not be due to periodontal issues). Can result in a poor diagnosis
Discuss prognosis as it relates to periodontal disease and its usefulness
In terms of prognosis in periodontics, there is an overall prognosis and prognosis for individual teeth.
Establishing prognosis helps helps determine whether it makes more sense to attempt certain treatments or to withhold them.
Describe the assessment of overall prognosis
It involves evaluating the patient’s medical and social history and performing a periodontal examination/assessment. The results of the examination leads to the prognosis.
The following variables are established:
• Extent of disease (localised or generalised)
• Severity of disease (attachment loss)
• Patient’s ability and consistency in effective plaque removal
Describe the assessment of tooth prognosis
Following factors are considered: • Furcation involvement • Mobility • Root anatomy • Attachment loss (must consider tooth to root ratio) • < 4mm attachment loss = good prognosis • > 7mm attachment = poor prognosis
Define the 5 terms used to describe periodontal prognosis
- Good prognosis: Control of aetiologic factors and adequate periodontal support ensure the tooth will be easy to maintain by the patient and clinician
- Fair prognosis: Approximately 25% attachment loss and/or Class I furcation involvement (location and depth allow proper maintenance with good patient compliance)
- Poor prognosis: 50% attachment loss, Class II furcation involvement (location and depth make maintenance possible but difficult)
- Questionable prognosis: >50% attachment loss, poor crown-to-root ratio, poor root form, Class II furcations (location and depth make access difficult) or Class III furcation involvements; >2+ mobility; root proximity
- Hopeless prognosis: Inadequate attachment to maintain health, comfort, and function
List the 6 prognostic factors as described by the Miller-McEntire Scoring Index
- Smoking: Highest predictive indicator of tooth loss
- Probing depths
- Mobility
- Furcation
- Molar type
- Age: least predictive indicator of tooth loss
Explain the role of Supportive Periodontal Therapy (SPT) or Maintenance
Rationale:
• Residual plaque regrows in pockets
• Bacteria may recolonise- can return to pre-treatment levels in days to months
• New connective tissue reattachment (long junctional epithelial) results in weaker dentogingival unit and inflammation. It may rapidly separate from tooth
Thus, it is important to call the patient for a review to address these issues
