Prognosis Flashcards
Prognosis definition
Prediction of course, duration, outcome of a disease
What is prognosis based on?
The pathogenesis of the disease and presence/absence of risk factors (specific to that disease)
When is prognosis established?
After diagnosis, but before the treatment plan
What are the 2 types of of prognosis
Overal prognosis
Individual tooth prognosis
If a patient has a hopeless overall prognosis, what should you do or not do?
Do not have to do the prognosis of individual teeth
What effect the overall prognosis?
Patient age (older is better) Current severity of disease, systemic factors, smoking Local factors (calculus, plaque, etc) Patient compliance Prosthetic possibilities
When is individual tooth prognosis made?
After overall prognosis (don’t do if overall is hopeless)
T/F - individual prognosis is effected by the overall prognosis
True
What is taken into account for individual tooth prognosis?
Mobility Pocket depths Bone loss Furcations Local factors
What are the two types of Prognosis Classification systems?
Becker, Berg, and Becker
McGuire and Nunn
Becker, Berg, and Becker Prognosis classification system
Good –> Questionable –> Hopeless
Cannot use this system without radiographs -need to assess bone levels
Use bone levels/probe depths as primary basis
McGuire and Nunn Prognosis classification system
Good –> Fair –> Poor –> Hopeless
Used at OSU
CAL is used as the primary basis
BB+B’s Good Classification
Need 2 of the following:
Where does the bone loss percentage come from for the BB+B Classification
Bone loss levels are the average around the entire tooth
BB+B’s Questionable Classification
Need 2 of the following:
50% bone loss
6-8 mm probe depths
Class 2 furcation
Anatomical variables (any anatomy that can promote perio problems - deep palatal groove on max incisors, furcation of max 1st PMs)
BB+B’s Hopeless Classification
>75% bone loss > 8mm probe depth Class III Furcation Poor crown:root ratio (1:1 is minimally acceptable) Unfavorable root proximity Repeated perio abscess formation
Which teeth are most likely to have unfavorable root proximity?
Maxillary 1st and 2nd molars
McGuire and Nunn Good Prognosis
“Adequeate” Remaining bone support
“Adequate” possibilities to control etiologic factors/create a maintainable dentition
“Adequate” patient cooperation
NO systemic factors or well-controlled systemic factors (diabetes)
McGuire and Nunn Fair Prognosis
25-50% CAL
Class I or “easily accessible” Class II furcations
“Adequate” possible maintenance present
Few systemic factors
McGuire and Nunn Poor Prognosis
> 50% CAL
Class I or Class II furcations
Difficult areas to maintain and/or poor patient compliance
Presence of systemic (environmental factors)
McGuire and Nunn Hopeless Prognosis
>75% CAL Mobility (2+) Class II or Class III furcations Difficult areas to maintain and/or poor patient compliance Unfavorable Root Proximity
How does patient age effect prognosis?
If two patients (one older, one younger) have the same levels, the older patient has a better prognosis
- longer time frame for destruction
- this is because if it’s a younger patient, it’s a more aggressive disease
What helps us determine Disease severity?
CAL - for approximate extent of root surface w/o PDL
Radiographic exam - for amount of root surface still enveloped by bone
Why is CAL better to use than PD?
PD is subject to hyperplasia
How do you measure CAL?
CAL = PD + gingival recession
What has a worse prognosis…vertical or horizontal bone loss?
Horizontal
What is the prognosis of horizontal bone loss based on?
It depends on the height of existing bone
What is the prognosis of vertical bone loss based on?
of remaining walls
What is the relation of prognosis and Crot?
The closer the center of rotation is to the crown, the better the prognosis
- better distribution of force to the periodontiium
- less mobility
What is the primary etiologic factor for perio disease?
Plaque
-effective daily removal of plaque by patient is critical to success and prognosis
How is patient compliance related to prognosis?
Prognosis is dependent on pt’s attitude/desire and ability to maintain good hygiene
-without this, treatment will not succeed
What does the dentist have the option to do?
Refuse to accept the patient for treatment (fear of litigation) Extract teeth (helpless or poor) and perform SRP on remaining dentition
What is the prognosis (McGuire and Nunn) of a patient who is a smoker with slight to moderate perio issues?
Fair-poor prognosis
What is the prognosis (McGuire and Nunn) of a patient who is a smoker with severe perio issues?
Poor-hopeless
How would the prognosis change for a patient who was a smoker but stopped?
Can go up an entire class
fair-poor –> good ; with slight to moderate perio
poor-hopeless –> fair ; with severe peio
How does well-controlled diabetes effect a patient with slight to moderate perio?
Should still have a good prognosis if it’s well-controlled
How does Parkinson’s effect prognosis?
It limit patient’s performance of oral procedures due to limited dexterity
Worsens the prognosis - electric toothbrushes may help
How can plaque/calculus effect prognosis
Microbial challenge of plaque/calculus is the most important local factor for perio disease
More plaque retentive factors decreases prognosis
What anatomic factors effect prognosis?
Short tapered roots / large rowns (unfavorable crown:root ratio)
Cervical enamel projections/enamel pearls/ bifurcation ridges
Root concavities
Poor crown:root ratio effect on prognosis
If unfavorable is leads to a poor prognosis
- decreased amount of root surface for perio support
- periodontium is more susceptible to trauma form occlusion
How do Cervical enamel projections, enamel pearls, and bifurcation ridges effect prognosis?
Interfere with SRP
Prevent regeneration of cementum and PDL
How common are CEPs?
found on 73% of molars
How do root concavities effect prognosis?
Increase attachment area and create a root shape that is more resistant to torquing forces
- covered in alveolar bone so there is more “staying power”
- especially max 1st PM and MB root of max 1st molar
For plaque-induced gingival diseases, what does prognosis depend on?
It depends on plaque control and control of systemic disease
What is the prognosis for aggresive periodontitis
Always poor
What is the prognosis of perio disease due to systemic disease
Fair-poor
What is the primary factor of NUG?
Bacterial plaque
What is the secondary factor of NUG?
Acute stress, smoking, poor nutrition - leading to immunosuppression
What is the prognosis of NUG?
Good
Repeated episodes = fair
