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Perio I Supplemental Cards > Prognosis > Flashcards

Prognosis Flashcards

1
Q

what are risk indicators?

A
  • probable or putative risk factors that have been identified in cross sectional studies but not confirmed by longitudinal studies
    • HIV/AIDS
    • osteoporosis
    • infrequent dental visits
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2
Q

what are risk factors?

A
  • environmental or biologic factors that increase the chance that an individual will get the disease
    • tobacco smoking
    • diabetes
    • pathogenic bacteria
    • microbial tooth deposits
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3
Q

what are risk determinants/background characteristics?

A
  • risk factors that are not typically modifiable
    • genetic factors
    • age
    • gender
    • socioeconomic status
    • stress
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4
Q

what are risk markers/predictors?

A
  • associated with risk for disease but don’t cause disease
    • previous history of periodontal disease
    • bleeding on probing
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5
Q

in relation to timing of the projection, describe long term vs. short term

A
  • long term has been described as 5 years or longer
    • prediction accuracy is reduced beyond 5 years
      • reassessment is often needed
  • short terms is less than 5 years
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6
Q

T or F:

periodontal disease progresses uniformly throughout the dentition

A

false

  • it does NOT progress uniformly throughout the dentition
  • the presence of local factors only affect individual teeth
  • general/systemic factors can affect the whole dentition
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7
Q

describe the 4 main systemic diseases and conditions related to periodontal disease

A
  • diabetes meelitus
    • poorly controlled
  • osteoporosis
  • immunosuppressant diseases
    • HIV
    • neutrophil defects
    • stress
  • nutrition
    • low intake of vit C and/or calclium
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8
Q

name 7 local risk factors related to periodontal disease

A
  • gingival inflammation
  • suppuration
  • plaque and calculus
  • persistent deep pockets
  • amount of remaining attachment
  • mobility
  • miscellaneous factors (LCF)
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9
Q

describe gingival inflammation related to periodontal disease

A
  • findings:
    • bleeding on gentle probing
    • gingival redness or erythema
  • smoking interferes with inflammation
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10
Q

there is ___ correlation between bleeding on probing (BOP) and subsequent attachment loss. BOP has a ___ positive predictive value. absence of BOP is an ___ predictor of health.

A
  • minimal
  • low
  • excellent
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11
Q

describe suppuration relative to periodontal disease

A
  • most studies fail to demonstrate an increased risk for progressive destruction
  • used to determine overall level of inflammation
  • most suppuration found in diabetic patients
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12
Q

plaque is directly related to ___

A

gingivitis

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13
Q

most studies show ___ correlation with plaque and future attachment loss

A

no or weak correlation

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14
Q

describe sex relative to periodontal disease

A
  • males have greater perio diagnoses and it is usually more severe
  • men use dental services less
  • poorer home care
  • reason for the difference may be due to hormonal influence
    • bone sparing effects of estrogen
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15
Q

describe race relative to periodontal disease

A

current evidence does not provide a basis for assigning prognosis categories

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16
Q

describe age relative to periodontal disease

A
  • older individuals show greater periodontal destruction than younger ones
  • cumulative effect
  • no increase risk for progression based on age
17
Q

describe persistent deep pockets relative to periodontal disease

A
  • harder to maintain
    • pocket depth > 5mm are difficult to maintain as healthy and had more residual plaque and calculus
  • increased chance to harbor periodontal pathogens
  • greater exhibition of bleeding on probing
18
Q

what are the options if IL-1 is positive?

A
  • host modulation
  • increase maintenance therapy
19
Q

describe polymorphism of the IL-1 gene

A
  • IL-1 expressed as inflammatory cytokine
  • 1.7x more likely to lose teeth
  • 7.7 fold in heavy smokers
  • found in 30% in white population
  • lower in other races
  • currently: test used (PST-periodontal susceptibility test)
20
Q

describe amount of remaining attachment relative to periodontal disease prognosis

A
  • tooth or dentition with severe attachment loss less favorable
    • especially for younger individuals
21
Q

describe 3 causes of mobility relative to periodontal disease prognosis

A
  • loss of alveolar bone
  • inflammation of the PDL
  • occlusal trauma
  • *only inflammation and trauma can be corrected predictably
22
Q

describe mobility relative to periodontal disease prognosis

A
  • initial presence = increase in bone loss over time
  • fleszar showed better healing in non-mobile teeth after perio therapy
  • less favorable results after regenerative therapy
23
Q

describe genetic predisposition relative to periodontal disease prognosis

A
  • michalowicz via twin studies
    • showed 50% risk for chronic periodontitis
  • confounding factors were accounted for
24
Q

describe smoking relative to periodontal disease prognosis

A
  • # 1 modifiable risk factor
  • heavy smokers are 3x more likely to lose teeth (>/= 20 cigarettes a day)
  • likelihood of improved prognosis by 60% if smoking stops
25
Q

what are 4 main individual risk factors of perio prognosis?

A
  • genetic predisposition
  • age
  • race
  • sex
26
Q

what are 4 general factors that may affect perio prognosis?

A
  • patient compliance
  • cigarette smoking
  • diabetes mellitus
  • other systemic factors (neutrophil dysfunction, down’s syndrome, etc.)
27
Q

briefly describe the Kwok and Caton 2007 perio prognostatication system

A
  • based on probability of disease progression
  1. favorable - likely leads to periodontal stability
  2. questionable - may lead to periodontal stability
  3. unfavorable - unlikely leads to periodontal stability
  4. hopeless - extraction needed
28
Q

describe Kwok and Caton’s favorable prognosis

A
  • periodontal status of the tooth can be stabilized with comprehensive periodontal treatment and maintenance
  • future progression of disease is unlikely if treatment and maintenance are adequate
29
Q

describe Kwok and Caton’s questionable prognosis

A
  • periodontal status is influenced by local and systemic factors which may or may not be controlled
  • the periodontium may be stabilized with adequate treatment and therapy if these factors are controlled, otherwise, future periodontal breakdown may occur
30
Q

describe Kwok and Caton’s unfavorable prognosis

A
  • the periodontal status of the tooth is influenced by local and/or systemic factors which cannot be controlled
  • periodontal breakdown is likely to occur even with comprehensive periodontal treatment and maintenance
31
Q

describe Kwok and Caton’s hopeless prognosis

A

extraction is indicated

32
Q

briefly describe the hirschfield and wasserman previous prognosis classification scheme

A
  • 1978
  • favorable and questionable
  • furcation involvement, deep pockets, bone loss, and mobility
  • did not consider systemic factors
33
Q

briefly describe the becker et al previous prognosis classification scheme

A
  • 1984
  • good, questionable, hopeless
  • included other criteria such as grooves, caries, abscesses
  • did not consider systemic factors
34
Q

briefly describe the mcguire and nunn previous prognosis classification scheme

A
  • 1996
  • excellent, good, fair, poor, questionable, and hopeless prognoses
  • multiple stratifications may be reduntant
  • based on tooth loos
    • unreliable over the long term
35
Q

what are some common anatomic features related to periodontal disease prognosis?

A
  • enamel pearl
  • bifurcation ridges
  • root concavities
  • developmental grooves
  • root proximity
  • furcation involvement
36
Q

what are some tooth level prognostic factors of perio?

A
  • mobility
  • amount of remaining attachment
  • probing depth
  • bone loss
  • presence/absence/severity of furcation lesions
  • crown-to-root ratio
  • endodontic status
  • caries
37
Q

what are some subject (patient) level prognostic factors of perio?

A
  • age
  • smoking
  • diabetes or other systemic diseases
  • overall degree of bone loss, attachment loss
  • number of residual deep pockets after therapy
  • percentage or number of bleeding sites after therapy
  • genetic predisposition
  • compliance with home care and maintenance
  • number and position of remaining teeth
  • patient desires
  • ecomonic factors

Perio I Supplemental Cards (7 decks)

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