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
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
3
Q
what are risk determinants/background characteristics?
A
- risk factors that are not typically modifiable
- genetic factors
- age
- gender
- socioeconomic status
- stress
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
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
- prediction accuracy is reduced beyond 5 years
- short terms is less than 5 years
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
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
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)
9
Q
describe gingival inflammation related to periodontal disease
A
- findings:
- bleeding on gentle probing
- gingival redness or erythema
- smoking interferes with inflammation
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
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
12
Q
plaque is directly related to ___
A
gingivitis
13
Q
most studies show ___ correlation with plaque and future attachment loss
A
no or weak correlation
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
15
Q
describe race relative to periodontal disease
A
current evidence does not provide a basis for assigning prognosis categories
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
what are 4 main individual risk factors of perio prognosis?
* genetic predisposition
* age
* race
* sex
26
what are 4 general factors that may affect perio prognosis?
* patient compliance
* cigarette smoking
* diabetes mellitus
* other systemic factors (neutrophil dysfunction, down's syndrome, etc.)
27
briefly describe the Kwok and Caton 2007 perio prognostatication system
* 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
describe Kwok and Caton's favorable prognosis
* 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
describe Kwok and Caton's questionable prognosis
* 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
describe Kwok and Caton's unfavorable prognosis
* 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
describe Kwok and Caton's hopeless prognosis
extraction is indicated
32
briefly describe the hirschfield and wasserman previous prognosis classification scheme
* 1978
* favorable and questionable
* furcation involvement, deep pockets, bone loss, and mobility
* did not consider systemic factors
33
briefly describe the becker et al previous prognosis classification scheme
* 1984
* good, questionable, hopeless
* included other criteria such as grooves, caries, abscesses
* did not consider systemic factors
34
briefly describe the mcguire and nunn previous prognosis classification scheme
* 1996
* excellent, good, fair, poor, questionable, and hopeless prognoses
* multiple stratifications may be reduntant
* based on tooth loos
* unreliable over the long term
35
what are some common anatomic features related to periodontal disease prognosis?
* enamel pearl
* bifurcation ridges
* root concavities
* developmental grooves
* root proximity
* furcation involvement
36
what are some tooth level prognostic factors of perio?
* mobility
* amount of remaining attachment
* probing depth
* bone loss
* presence/absence/severity of furcation lesions
* crown-to-root ratio
* endodontic status
* caries
37
what are some subject (patient) level prognostic factors of perio?
* 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
