Risk assesment/prognosis

Question 1

Define Prognosis, Risk, and Prognostic factors

Answer 1

• Prognosis is a prediction of course and outcome of disease
• Risk is likelihood that an individual will develop a disease in a given time
• Prognostic factors and risk factors can be the same: Diabetes, smoking etc.,

Question 2

Describe the McGuire and Nunn classification of prognosis:

Answer 2

Based on tooth mortality

Good-fair-poor-questionable-hopeless

Question 3

Describe each prognosis category for McGuire and Nunn:

Answer 3

• Good: Control of etio factors, adequate support, easily maintained
• Fair: 25% CAL/Grade I fur- maintenance possible w compliance
• Poor: 50% CAL/Grade II fur - maintenance possible but difficult
• Questionable >50% CAL; (poor crown/root ratio); C II or III fur; >2+ mobility; root proximity
• Hopeless: Inadequate attachment to maintain health, comfort, fxn

Question 4

Describe the Kwok and Caton prognosis classification system?

Answer 4

probability of obtaining stability

Question 5

Describe the 4 classes of Kwok and Caton:

Answer 5

1. Favorable: Tx and Maintenance will stabilize tooth, future loss is unlikely
2. Questionable: local/systemic factors may or may not be controllable
3. Unfavorable: factors cannot be controlled
4. Hopeless: tooth must be ext

Question 6

Which type of defect has a better prognosis?

Answer 6

Angular because it is graftable

Question 7

How is age a prognosis factor?

Answer 7

Younger patients have greater reparative capability BUT if the pt is young that means it is more aggressive.

Question 8

Is a combined perio-endo lesion a good or bad for prognosis?

Answer 8

If it is combined, both endo and perio will result in better prognosis.

Question 9

Which is better: a center of rotation more apically or coronally?

Answer 9

More coronal is best

Question 10

Name systemic/environmental factors related to perio dz:

Answer 10

smoking; DM; incapacitating conditions limiting OH; genetic factors: IL-1 genotype/serum IgG2 levels/etc.; stress, substance abuse

Question 11

How long does a person have to stop smoking for them to have the same response as a nonsmoking individual?

Answer 11

11 years

Question 12

What are the local factors that can effect perio dx prognosis?

Answer 12

cementoenamel projections; plaque, calculus, sub-G restorations, tooth mobility

Question 13

What are the issues of tooth mobility?

Answer 13

mobility lowers response to therapy; ability to restore stability is inversely proportional to mobility caused by loss of supporting bone; plaque control may result in equal healing for hyper mobile teeth

Question 14

List the anatomic feature of a tooth that hurt the prognosis:

Answer 14

1. cervical enamel projections
2. Root concavities
3. Developmental grooves
4. Access to furcations

Question 15

In aggressive periodontitis, does the patient have a lot of plaque?

Answer 15

No- limited plaque but high in P. gingivalis and A.A.

Question 16

What is the prognosis for pt with perio dz due to hematological disorders or genetic disorders?

Answer 16

fair to poor

Question 17

What is the prognosis for NUG/NUP?

Answer 17

NUG: controlled plaque= good but repeated episodes is fair. NUP: usually has systemic factors and variable prognosis depending on systemic factor control

Question 18

Systemic Risk factors for periodontitis? (3)

Answer 18

Smoking, Diabetes (7 or less), bacterial plaque

Question 19

Genetic risks for perio dz?

Answer 19

IL genotype, neutrophil deficiency

Question 20

Tools for perio prognosis:

Answer 20

PRC= periodontal risk calculator; function diagram program; Darcey and Ashley

Question 21

PRC records?

Answer 21

Age, smoke, dm, pockets, BOP, furcation, sub-g calculus or restorations, bone height, vertical lesions

Question 22

PRA with functional diagrams assess?

Answer 22

bop, pockets, loss of teerth, age/loss of support, systemic and genetic areas, environment (smoker).

Question 23

Study show which as being better predictor - periodontist or computer?

Answer 23

calculator