Risk Assessment of the Periodontal Patient

Question 1

What is “risk assessment?”

Answer 1

A statistical evaluation to determine how much you would like to gamble

(Given the facts that you KNOW… what do you think the odds are for disease progression or treatment outcome)

Question 2

A risk assessment:

• contains ______ components
• is the _______ of contracting a disease
• ______ between individuals

Answer 2

numerous
probability of contracting disease/having unfav. outcome
VARIES

Question 3

What are the four levels of evidence-based assessment of risk?

Answer 3

1. Case Reports
2. Cross-Sectional Analysis
3. Longitudinal Studies
4. Intervention Studies

Question 4

Describe the process for risk assessment:

Answer 4

1. Identify risk factors
2. Develop a risk-assessment model (look at evidence)
3. Assess the population (specific, ethnicity, etc)
4. Target a prevention program or intervention

Question 5

A polymorphism in which gene has been associated with an increased risk for periodontitis in certain populations?

Answer 5

IL-2

Question 6

What did Perio Predict use as its basis for assessing risk of periodontitis? What is wrong with this?

Answer 6

based on 6 Snps that were highly associated with perio disease.
there are ethnic differences for which this technology (these 6 Snps) was irrelevant and completely wrong

Question 7

What are “risk FACTORS?”

Answer 7

environmental, behavioral, or biological factors that are part of the CAUSAL CHAIN toward disease occurrence.

Question 8

What kind of evidence is required in order to establish risk factors?

Answer 8

Longitudinal Evidence is required…must show exposure precedes disease onset

Question 9

How many risk factors exist for perio disease?

Answer 9

Two:

smoking and diabetes

Question 10

True or False: Smoking is a risk factor, tobacco is not a risk factor.

Answer 10

True

Question 11

The “odds ratio” is a way of comparing whether the probability of a certain event is _________.

Answer 11

the same for two groups

Question 12

The odds ratio for both “smoking” and “diabetes” is approximately _____.

Answer 12

4

Question 13

“Extreme” smoking puts patients at a ____ times greater risk for perio disease.

Answer 13

16

Question 14

What is a “risk DETERMINANT?”

Answer 14

considered to be a substitute term for a risk factor; however, DETERMINANTS are reserved for those factors that cannot be modified

Question 15

What are some examples of risk determinants?

Answer 15

age (older>younger)
gender (men>women)
ethnicity 
socioeconomic status (poor>rich)
genetic predisposition (IL-1beta for example)

Question 16

What are “risk INDICATORS?”

Answer 16

a probable or putative risk factor that is NOT confirmed by longitudinal studies (if it were it would be a “factor”)

Question 17

Risk indicators are identified via ______ studies; risk factors or determinants are identified via ______ studies

Answer 17

indicators = cross-sectional
factors/determinants = longitudinal

Question 18

What are some examples of risk determinants?

Answer 18

obesity
inflammation
stress
osteoporosis
HIV/AIDS
Microbiota

Question 19

Risk determinants are _____ but not _____ to cause disease.

Answer 19

necessary

sufficient

Question 20

What are “risk PREDICTORS?”

Answer 20

increases risk for disease but is NOT part of the causal chain

Question 21

Risk _______ could be a consequence of the disease that would then put you at risk for future problems or disease.

Answer 21

predictors

predicting the future?

Question 22

Risk predictors are useful for predicting who is _______ but not in identifying likely _______.

Answer 22

at risk

interventions

Question 23

Situation: Two patients of the same age present without either risk factor (smoking/diabetes), both also lack risk indicators (inflammation) and both have good oral hygiene. However, patient A has 6 mm pockets and patient B has 1 mm pockets. Which patient has a risk “predictor?”

Answer 23

Patient A…. predicting the future….you could say that he/she is at higher risk for severe bone loss or attachment loss

Question 24

What are some examples of risk predictors?

Answer 24

bleeding on probing
previous perio history
remaining teeth

Question 25

What is a “prognostic factor?”

Answer 25

an environmental, behavioral, or biologic factor that directly affects the probability of positive outcomes when therapy is rendered
(if treated, how sure are we that there will be success?)

Question 26

What are some examples of prognostic factors in the periodontium?

Answer 26

extent and severity of presenting disease
level of oral hygiene
frequency of dental visits
smoking

Question 27

What are the four clinical components of the risk assessment?

Answer 27

1. Demographic Data (male or female?)
2. Medical History
3. Dental History (show up for cleanings?)
4. Clinical Examination

Question 28

True or False: Once an at-risk patient is identified and a diagnosis is made, their treatment plan may be modified.

Answer 28

True….sometimes even by a third party (annoying)

Question 29

Steps in the risk assessment are:

1. Determine ______
2. Modification of ________
3. Modification of _______ plan
4. Patient _______

Answer 29

determine risk
modification of prognosis
modification of treatment plan
patient education

Question 30

What is an “etiological factor?”

Answer 30

a variable contributing to the cause of the disease (ex. bacteria)

Question 31

What is the difference between etiology and risk?

Answer 31

etiology is the CAUSE…without this factor, disease will not occur
risk influences the CHANCE of developing the disease

Question 32

_______ postulates differ between different diseases.

Answer 32

Koch’s

Question 33

True or False: Caries and LAP are both caused by single bacterial species and therefore should have similarity in Koch’s postulates.

Answer 33

False