Transcript Diagnosis
Diagnosis & Prognosis Periodontal Diagnosis: Recognizing a departure from normal in the periodontium and distinguishing one disease from another. Based on information obtained from the medical and dental histories, clinical and radiographic examination of the patient and laboratory findings. Proper diagnosis is essential to intelligent treatment Periodontal diagnosis should first determine whether disease is present; then identify its type, extent, distribution, and severity; and finally provide an understanding of the underlying pathologic processes and its cause CLINICAL DIAGNOSIS Medical history Dental history extra-oral exam intra-oral exam – soft tissue – hard tissue Radiographic Assessment Periodontal Survey Medical History antibiotic prophylaxis systemic disease pregnancy drug habit Dental History chief complaint oral habits history Extra-oral Exam lymph nodes Intra-oral Exam Soft Tissue – evaluate for an atypical or abnormal appearances Hard Tissue – – – – – malpositioned teeth caries restorations habits Abfractions Examination of the Periodontium plaque and calculus clinical attachment loss – periodontal pockets amount of attached gingiva furcation – Class I, II, III mobility – Grade I, II, III periodontal abscess – suppuration Radiographic Assessment Radiographs do not 1. Show periodontal pockets 2. Distinguish between successfully treated and untreated cases 3. Show structures on buccal, lingual, and labial aspect of tooth 4. Record tooth mobilty Radiographic Assessment full mouth series Look At: – – – – – lamina dura crown:root ratio interproximal bone hypercementosis furcation involvement – periapical pathology – overhangs – calculus – resoption Predisposing Conditions Tipping of teeth Open contacts Poor contours of restorations and overhang margins Prognosis Prognosis: A prediction as to the progress, course and outcome of a disease. Based on: - current established criteria - therapeutic judgment and experience - documented successes and failures of the past Over all Prognosis: Concerned with the dentition as a whole. Individual Prognosis: Concerned with individual tooth. Prognosis Nature of disease process a. Rapid (-) vs. chronic (+) b. Juvenile (-) vs. Adult onset (+) Systemic Factors (-) a. Diabetes, b. Smoking c. Stress d. Nutrition e. Others Prognosis Patient age/degree of disease a. Young (-) b. Older (+) Excellent Prognosis: No bone loss, excellent gingival condition, adequate patient cooperation. Good Prognosis: One or more of the following: - adequate remaining bone support. - adequate possibilities to control etiologic factors and establish a maintainable dentition. - adequate patient cooperation Fair Prognosis: One or more of the following: - less than adequate remaining bone support - some tooth mobility - grade I furcation involvement - adequate maintenance possible - acceptable patient cooperation Poor Prognosis: One or more of the following: - moderate to advanced bone loss - tooth mobility - grade I and II furcation involvement - difficult to maintain areas - doubtful patient compliance Questionable Prognosis: One or more of the following: - advanced bone loss - grade II and III furcation involvement - tooth mobility - inaccessible areas Hopeless Prognosis: One or more of the following: - advanced bone loss - non maintainable areas