Transcript Evaluation of risk assessment for periodontal patients

Evaluation of risk assessment for
periodontal patients.
Presented by
Dr.Wasif Haq
Introduction
• Risk: Probability of an individual to get a disease
in a given period.
• Risk factors, risk indicators and risk markers.
• Risk assessment: Process by which qualitative or
quantitative assessments are made of the
likelihood for adverse events to occur as a result
of exposure to specified health hazard or by the
absence of beneficial influences.
Risk Factors For
Periodontal Disease.
Risk Factors For Periodontal Disease
• Tobacco:
• A well established risk factor.
• Local and systemic effects.
Risk Factors For Periodontal Disease
• Diabetes:
• Risk factor.
• Impaired glucose control related to increased
proinflammatory cytokines , greater pocket
depth.
• Increased oral infections.
• Duration of diabetes.
Risk Factors For Periodontal Disease
• Plaque & Calculus:
• Both are risk factors.
• Quality instead of quantity of plaque.
Risk Determinants For
Periodontal Disease.
Risk Determinants For Periodontal Disease
• Genetic factors:
• Genetic susceptibility to periodontitis e.g.
localized and generalized aggressive
periodontitis.
• Interleukin 1 association with severe chronic
periodontitis.
Risk Determinants For Periodontal Disease
• Age:
• Periodontal disease not a consequence of
ageing.
• Linear relation between prevalence &
severity.
• Prolonged exposure.
Risk Determinants For Periodontal Disease
• Gender:
• Poor oral hygiene amongst males.
• Higher attachment loss.
Risk Determinants For Periodontal Disease
• Socio-economic status:
• No independent association.
• Gingivitis and poorer oral hygiene.
• Level of dental awareness.
Risk Determinants For Periodontal Disease
• Stress:
• Putative risk factor.
• Effect on immune system.
• Periodontal therapy resistant patients.
Risk Indicators For
Periodontal Disease.
Risk Indicators For Periodontal Disease
• H.I.V.: Inconclusive evidence.
• Osteoporosis: May aggravate periodontal
disease.
• Infrequent dental visits: Mixed evidence.
Risk Markers For
Periodontal Disease.
Risk Markers For Periodontal Disease
• History of periodontal disease: Predictor for
future dental disease.
• Bleeding on probing: Best clinical indicator
especially if coupled with attachment loss.
Concept & Importance
Of Risk Assessment.
Concept Of Risk Assessment
• Host related factors can influence the onset,
clinical presentation & rate of periodontal
progression.
• Importance in diagnosis, prognosis & treatment of
underlying chronic conditions.
Importance Of Risk Assessment
• Selection of patients requiring additional
education , interventions & preventions.
• Better treatment planning decisions.
Method Of Risk Assessment
• Patient age, Smoking history, Diabetes, Pocket
depth, Poor oral hygiene, Persistent
inflammation,Bleeding on probing, Subgingival
calculus or restoration, Furcation involvement,
Radiographic bone assessment.
• Risk score :1-5 with 5 being the highest score.
Method Of Risk Assessment
Score Range
Clinical Condition
0-1
Healthy.
2-3
Gingivitis.
4-10
Mild gum disease.
11-36
Moderate gum disease.
37-100
Severe gum disease.
Conclusion
• Although more research needed to determine
effectiveness of risk assessment; it seems prudent
that utilizing risk assessment tools can help
reduce disease progression & ultimately
treatment costs.
• Risk assessment tools should be used to diagnose
& manage periodontal disease.
References
• Carranza FA, Camargo PM.Carranza’s clinical periodontology . In: Karen
F.Novak and M.John Novak: Risk Assessment.9th ed. Philadelphia:
Saunders; 2002:pp 469-72.
• Chester W. Douglass.Risk assessment and management of periodontal
disease.J Am Dent Assoc, Vol 137, No suppl_3, 27S-32S.
• Zini A, Sgan-Cohen HD, Marcenes W.Socio-economic position, smoking,
and plaque: a pathway to severe chronic periodontitis.J Clin Periodontol.
2011 Mar;38(3):229-35
• Zhang W, Song F, Windsor LJ.Effects of tobacco and P. gingivalis on
gingival fibroblasts.J Dent Res. 2010 May;89(5):527-31
• Choi YH, McKeown RE, Mayer-Davis EJ, Liese AD, Song KB, Merchant
AT.Diabetes Care. 2011 Feb;34(2):381-6
• Aspriello SD, Zizzi A, Tirabassi G, Buldreghini E, Biscotti T, Faloia E,
Stramazzotti D, Boscaro M, Piemontese M.Diabetes mellitus-associated
periodontitis: differences between type 1 and type 2 diabetes mellitus.J
Periodontal Res. 2010 Nov 26.
Thanks