029.periodontal diagnosis and prognosis

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PERIODONTAL DIAGNOSIS Dx defined as,

“identifying disease from antests and procedures.”

PERIODONTAL DIAGNOSIS and PROGNOSIS

identifying disease from an evaluation of the history, signs and symptoms, laboratory

evaluation of the history, signs and symptoms, laboratory


History Recording


Examination


Investigation


Diagnosis


Tx Plan


PROGNOSIS “It is a prediction of the probable course, duration andknowledge of the pathogenesis of the disease and the presence It is established after the diagnosis is made and before

PROGNOSIS

It is a prediction of the probable course, duration and outcome of a disease based on a general pathogenesis of the disease and the presence of risk factors

It is established after the diagnosis is made and before the treatment plan is established

outcome of a disease based on a general of risk factors for the disease.”

the treatment plan is established


Determination Of Prognosis

i. Excellent prognosis: No bone loss, excellent gingival condition, good patient cooperation, no systemic/ environmental factors.

ii. Good prognosis: One or more of the following: adequate remaining bone support, possibilities to control etiologic factors and establish a maintainable dentition, adequate patient co-operation, no systemic/ environmental factors or if present are well-controlled.

iii. Fair prognosis: One or more of the following: less than adequate remaining bone support, some tooth mobility, grade I furcation involvement, adequate maintenance, acceptable patient co-operation, presence of limited systemic/environmental factors.


iv. Poor prognosis: One or more of the following: moderate to advanced bone loss, tooth mobility, grade I and II furcation involvements, doubtful patient co-operation, difficult to maintain areas, presence of systemic/environmental factors.

v. Questionable prognosis: One or more of the following: advanced bone loss, grade II and III furcation involvements, tooth mobility, inaccessible areas, systemic/environmental factors.

vi. Hopeless prognosis: One or more of the following: advanced bone loss, non-maintainable areas, extraction indicated presence of uncontrolled systemic/environmental factors.


Risk Factors Associated with Periodontal Diseases

Risk

“The probability that an individual will develop a specific disease in a given period which may vary from one individual to another”

Risk assessment “Identifying elements that either may predispose a patient to developing periodontal disease or may influence progression of disease that already exists.” Risk Factors “increases the likelihood that an individual will develop the disease” Risk factors may be

environmental,

behavioral or

biologic factors, when present


Following are the risk factors

Tobacco smoking

Diabetes

Pathogenic bacteria and microbial tooth deposits

Anatomic factors:

Presence of calculus


Risk Determinants It is defined as those risk factors that cannot be modified. 1. Genetic factors: 2. Age: 3. Gender: 4. Socioeconomic status:

Decreased dental awareness.

Decreased dental visits. 5. Stress:


Risk Indicators For Periodontal Disease 1. HIV/acquired immunodeficiency syndrome: 2. Osteoporosis: 3. Infrequent dental visits:

Risk Markers/Predictors These are associated with increased risk for disease, but do not cause the disease. 1. Previous history of periodontal disease. 2. Bleeding on probing: Bleeding on probing along with increased pocket depth may serve as an Excellent predictor for future loss of attachment.


AIDS USED IN CLINICAL DIAGNOSIS a. Millimeter probe for gingival bleeding. b. Measurement of gingival crevicular fluid flow with the help of a filter paper. Newer method is by use of a periotron 6000. c. Measurement of temperature by pressure-sensitive probes. PeriotempTM probe (AbiodentTM). d. Mouth odors—olfactometer. e. Tooth mobility—mobilometer/periodontometer. f. PSR (Periodontal screening and recording).


Uses of Probes 1. Periodontal probes are used to measure the pocket depth. 2. Quantification of bacterial plaque and gingival inflammation. 3. Determination of mucogingival relationship. 4. Measurement of gingival recession. 5. Location of calculus. 6. Identification of tooth irregularities. 7. Identification of tissue characteristics. 8. Determination of bleeding tendency. 9. Evaluation of bone support in the furcation areas of bifurcated and trifurcated teeth.


Periodontal Screening and Recording (PSR) designed for easier and faster screening and recording of the periodontal status of a patient or a group of population.

It uses a specially designed probe that has a 0.5 mm ball tip and is color-coded from 3.5 to 5.5 mm

The patient's mouth is divided into six sextants


The deepest finding is recorded in each sextant,

Code 0:

The colored area of the probe remains completely visible in the deepest crevice of the sextant

no calculus or defective margins detected.

The gingival tissues are healthy with no bleeding after gentle probing.

Code 1:

The colored area of the probe remains completely visible in the deepest probing depth in the sextant.

There is no calculus or defective margins detected.

However, there is bleeding after probing.

The deepest finding is recorded in each sextant, according to the following code.

The colored area of the probe remains completely visible in the deepest crevice of the sextant

no calculus or defective margins detected.

gingival tissues are healthy with no bleeding


calculus or defective margins detected.

However, there is bleeding after probing.

according to the following code.


Code 2:


Supragingival or subgingival calculus and/or defective margins are detected.

Code 3:

The colored area of the probe remains partly visible in the deepest probing depth in the sextant


Supragingival or subgingival calculus and/or defective margins are detected.

The colored area of the probe remains partly visible in the deepest probing depth in the sextant


Code 4:

The colored area of the probe completely disappears indicating a probing depth of greater than 5.5 mm.

Code*: When any of the abnormalities are seen, an asteriskcode number, for example,

furcation involvement,

tooth mobility,

mucogingival problem or

gingival recession extending to the colo

The colored area of the probe completely disappears indicating a probing depth of

When any of the abnormalities are seen, an asterisk (*) is entered, in addition to the

ingival recession extending to the colored band of the probe

(*) is entered, in addition to the


Advantages and Limitations • Early detection: Since all sites are evaluated, the risk of periodontal disease can be made early and appropriate treatment can be performed. • Speed: Once the technique of the PSR system is learned, it should take only a few minutes to perform the screening. This saves time versus a comprehensive examination. • Simplicity: It is easy to do and understand for patients. • Cost-effectiveness: It is not necessary to purchase expensive equipment since all that is needed is a ball-tipped probe.


• Ease of recording: Only one number is recorded for an entire sextant. • Risk management: The dental team is monitoring and recording a patient’s periodontal status for legal requirements

029.periodontal diagnosis and prognosis

Health & Medicine

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