Unit 2 Flashcards
What should diagnostic (assessment) procedures be?
- systematic & organized for specific purpose
- merely assembling facts is insufficient
- findings must be correlated to provide a meaningful explanation for the clients periodontal condition
What is the rationale behind assessing the overall appraisal of the client
assess physical appearance
- color
- talking
- anxiety
- walking
What is the rational behind assessing the medical history of a client?
-some hygiene procedures can exacerbate some conditions
What is the rational behind assessing the dental history of a client?
- do they attend regularly
- can they afford it
- experiences
- LA reactions
- what’s their chief complaint - what is their priority which is our responsibility to respect
What are some limitations of conventional periodontal diagnostic techniques?
- date respresents a disease/health evaluation at one point in time
- clinicians need to attempt to identify, quantify and determine the extent, severity and relevance of both current clinical signs of inflammation as well as historical evidence of damage
- sites of active disease can not be reliably identified or progression accurately predicted
What do the ideal perio diagnostic tools provide?
- all causes of the condition or differences in client susceptibility to disease
- clear information on whether the infection is progressing or in remission
- whether response to treatment will be positive or negative
Keep in mind that the current view of the natural history of disease susceptibility is related to the entire person vs just the local site (host response is largely generalized)
What do the ideal perio diagnostic tools provide?
- all causes of the condition or differences in client susceptibility to disease
- clear information on whether the infection is progressing or in remission
- whether response to treatment will be positive or negative
Keep in mind that the current view of the natural history of disease susceptibility is related to the entire person vs just the local site (host response is largely generalized)
What are some limitations/disadvantages to clinical perio probing?
- probe won’t reach the base of the sulcus
- size of tip
- tooth morphology
- angulation
- depth/pressure
- presence of calculus
- tissue resistance of JE
- differences in clinician
What is the significance of probing?
- the only reliable method of detecting pockets
- clinical and biologic probing depths are not the same
What are some diagnostic tools that have been developed to resolve some of the limitations of conventional perio probing? Limitations?
Florida Pack
- automated and computer assisted pressure sensitive probe
- standardize the proving force, registration stents to standardize angulation
- recordings are automatically entered with foot switch or voice activated command
What is the role/significance of bleeding on probing as a diagnostic tool for perio disease?
- A reliable indicator of the presence of inflammation
- Non-inflammed sites rarely bleed
- In most cases BOP is an earlier sign of inflammation than color changes
What are limitations of BOP for diagnostic purposes in perio disease?
-Not a good predictor of progressive LOA unless present in multiple sites of advanced disease
What is the significance of suppuration as a diagnostic indicator?
- Signifies the presence of large #’s of PMN’s
- Present in a low # of diseased sites, therefore not itself a good predictor or disease progression
-host response
0larger standing infection
-does not indicate seriousness of infection
What is the difference between pocket depth and CAL?
Pocket depth:
- Distance between base of pocket and margin
- May change due to changes in the position of the margin and migration of JE (margin and JE are not fixed points)
CAL
- Distance between base of pocket and CEJ
- Changes in LOA can result form gain or loss of attachment
- Because one of the measurements is from a fixed point, CAL provides better indication of the amount and/or progression of attachment loss
Briefly describe the methods and limitation in determining whether there is disease activity (active vs. inactive lesion)
- No current accurate method to determine activity or inactivity of a lesion – only indicators of risk
- Difference in CAL will show there has been disease activity but it is not predictive of further loss “isolated data”
- Lesions show signs of inflammation are at high risk for further breakdown
Briefly describe the methods and limitation in determining whether there is disease activity (active vs. inactive lesion)
- No current accurate method to determine activity or inactivity of a lesion – only indicators of risk
- Difference in CAL will show there has been disease activity but it is not predictive of further loss “isolated data”
- Lesions show signs of inflammation are at high risk for further breakdown
What is the value in radiographs when assessing perio disease?
- Diagnosis of p.d., estimation of severity, determination of prognosis & evaluation of outcome
- Most useful in evaluating interprox. bone: level and density
What are the limitation of radiographs when assessing perio disease?
- 2 dimensional picture of a 3 dimensional object
- Does not show depth & width in buc & ling direction
- Shows only hard tissue changes and not minor bone changes
- like CAL, only a measure of past loss and not current disease activity
What are the limitation of radiographs when assessing perio disease?
- 2 dimensional picture of a 3 dimensional object
- Does not show depth & width in buc & ling direction
- Shows only hard tissue changes and not minor bone changes
- like CAL, only a measure of past loss and not current disease activity
How do we currently assess whether there is active disease?
clinical visible signs of inflammation
What are the most important clinical indicators of active disease?
bleeding and redness
though healthy sites can bleed and bleeding can be masked in heavy smokers
Is there a sure method for determining whether a perio lesion is active?
no
-healthy sites can bleed and bleeding may be masked in heavy smokers
How do we, then assess whether the disease is progressing and causing breakdown of perio tissues?
disease progression is tracked by clinical attachment levels and identifying LOA after the fact
threshold to rule out error is an increase in LOA of 2mm adn we can only make judgments based on risk factors
Define risk assessment
- Probability that an individual will develop disease within a given period
- involves identification of risk factors
Define risk factors
DW “attributes or exposures that significantly increase the risk for onset and/or progression of a specific disease & affect treatment outcomes”
C “characteristics of an individual that place them at increased risk for having a disease”
Define risk factors
DW “attributes or exposures that significantly increase the risk for onset and/or progression of a specific disease & affect treatment outcomes”
C “characteristics of an individual that place them at increased risk for having a disease”
The number and type of risk factors a client has will modulate the onset, severity and progression of periodontitis
Define risk indicator
risk factors that have been identified in x-sectional studies but not confirmed through longitudinal studies
HIV/AIDS
Define risk predictors
associated with increased risk but not cause disease
BOP, medications
Define risk predictors
associated with increased risk but not cause disease
BOP, medications
How are risk factors categorized?
- modifiable
- non-modifiable
What are some modifiable risk factors?
- smoking
- diabetes
- specific bacterial pathogens/poor OHI
- osteoporosis
- HIV/AIDS
- stress
- BOP
- medications
- local factors
What are some non-modifiable risk factors?
- history of perio
- age (not a risk factor for perio disease)
- gender
- race
- genetic disorders
- genetic markers
Briefly describe the parameters of risk factors (what can be included or considered a risk factor)
- May be environmental, behavioral, or biologic factors increase the likelihood of disease
- Are part of the causal chain and directly related to disease occurrence
- Are identified through longitudinal studies of patients with the disease
- Exposure to RF may be singular or multiple over a long period of time
- Removal/reduction of RF should decrease risk
- Must be present prior to the onset of disease
What is the relevance of risk factors to DH care?
clinicians may use information:
- to predict which clients are at risk for disease
- aid in diagnosis
- prevent disease by including interventions that decrease risk
Expand on the relevance of risk factors to perio assessment and the process of DH Care
- Assessment & analysis of RF provides info about susceptibility beyond traditional clinical assessment parameters
- # & type of RF present modulate onset, degree & severity of disease
- RF are important b/c conditions assoc. with increased risk may affect Tx, client management and outcomes
What client information forms the basis for a risk factor assessment?
Interviews, MH, DH and clinical & radiographic examination
Based on current knowledge – therefore may change
Which risk factors are considered the most significant?
- Diabetes
- Smoking
- Pathogenic microbes
- Genetic marker for IL-1
What is the relevance of smoking in perio disease?
- Direct relationship
- Surgical & non-surgical therapy is less effective
- Recurrence more common
- Earlier onset of disease
- Altered host response & direct local damage: decreased antibodies, impaired neutrophil function
- Fibrotic gingiva, decreased bleeding (less O2)
- Impaired healing related to decreased blood flow
What is the relevance of diabetes in perio disease?
- Strong RF when blood glucose is poorly controlled
- increase susceptibility linked to immune dysfunction; impaired neutrophil chemostaxis & phagocytosis
- Decreased/altered collagen metabolism, altered bone metabolism
- Poor wound healing due to altered production of fibroblasts
- Increased production of pro-inflammatory cytokines
What is the significance of specific bacterial pathogens, poor OHI and local factors on perio disease?
- A.a., P.g., T. forsythia, T. denticola cause direct tissue damage via enzymes & toxins as well as triggered an unregulated immune response
- Presence of above in biofilm no guarantee that disease will occur – need other host and environmental factors
- Good OH greatly decreases risk
- Anatomical features of teeth may predispose to plaque accumulation
What is the significance of osteoporosis on perio disease?
- Assoc. between osteoporosis and alveolar bone loss
- Estrogen deficiency has also been linked to decreased alveolar bone density
- Extremely high risk for osteoporetic women who smoke
- Not confirmed as true RF
What is the significance of HIV/AIDS with perio disease?
- Suspected risk indicator for p.d.
- Linear gingival erythema may be present
- Disproportionate amount of plaque compared with degree of inflammation
- 3-17% have necrotizing ulcerating periodontitis (severe, rapid destruction)
What is the significance of stress with perio disease?
- Associated with depression of immune system
- Financial stress in adults with poor coping skills is a risk indicator for more severe perio disease
What is the significance of BOP with perio disease?
- Minimal value alone as a predictor of periodontal disease but in combination with increasing pocket depths, it does increase risk for continued destruction
- Cessation of bleeding correlates with decreased gingival inflammation, repair of CT and pocket reduction
What is the significance of medications with perio disease?
- xerostomia
- enlargement
What is the significance of genetic markers & factors and perio disease?
-Familial aggregation seen in aggressive p.d.
-Interleukin-1 (a key regulator in inflam. process and in increased #’s causes tissue destruction) is assoc. with severe chronic p.d.
(30% of Caucasians test +)
-PST can identify high risk clients and therefore the need for more aggressive tx.
-Test is prognostic versus diagnostic and is not as important as smoking or diabetes when evaluating risk
What is the significance of history or periodontitis in perio disease?
puts individual at greater risk
What is the significance of age in perio disease
assoc. with increased susceptibility not from aging itself but from the cumulative effects of periodontal breakdown over a lifetime
What is the significance of gender and race in perio disease?
male, A. American may increase risk but SES may be more of factor than race
What are four cardinal signs of periodontal health??
- A functional dentition
- The painless functioning of the dentition
- The stability of the periodontal attachment apparatus
- The psychological and social well-being of the individual
How is the paradigm shifting when defining periodontal health?
-Suggest a more pragmatic approach is to focus on what is necessary to maintain periodontal health instead of focusing on disease
-Present definition may have meaning for dental health professionals but less so for clients
-Gingivitis is endemic and its clinical significance is as a disease is questionable
Wow!
