Risk and Risk and Periodontal Disease ManagementPeriodontal Disease Management

7/30/2019 Risk and Risk and Periodontal Disease ManagementPeriodontal Disease Management

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Treatment of periodontitis

Saleem abdullah

Group# 4

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Risk and the Natural History of

Periodontal Disease

HealthInitial

diseasestage

Gingivitis Mildperiodontitis

Risk predicts the progression from health to severe periodontitis


Moderateperiodontitis

Severeperiodontitis


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Treatment Implications of Risk

If risk is low, then treatment may not berequired, as disease is not expected to progress

If risk is high, then treatment is required, as

disease is expected to progress to a moreadvanced and possibly terminal stage

Hence, every patient receiving aggressive periodontaltreatment has been determined to be high risk

Furthermore, a standard treatment protocol for aspecific periodontal diagnosis can be establishedwhen all patients are high risk



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Summary

Risk predicts the progression of disease

Risk justifies treatment

Risk for periodontitis is stratified acrossthe US population

Treatment must be personalized for each

patient and it must be based on thepatients unique risk profile and diseaseseverity



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Persson Study

3 Groups of expert evaluators 6 periodontists with national and international

clinical, academic, and military experience 10 periodontists who participated in the

development of the OHIS tool

36 private practice general dentists who

referred patients to periodontists

Risk was assessed on a 1 (low) to 5 (high)scale by clinicians and OHIS



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Determining Diagnosis and Risk

Signs and Symptoms

Bleeding on probing

Periodontal pockets Alveolar bone loss

Pain

Gingival swelling

Risk Factors

Cigarette smoking

Diabetes Stress

Poor oral hygiene

Periodontal pockets Heredity



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What is a Risk Factor?

Risk factor is often used as a general termmeaning those characteristics that strongly

associate with groups of individuals who havedisease compared to those who do not. Riskterminology includes:

Risk Factor

Background Characteristic Risk Indicator

Risk Markers or Risk Predictors



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Risk Markers and Predictors Definition

A characteristic strongly correlated with anincreased probability of future disease but

is not part of the causal chain. Bleeding on probing

Clinical attachment loss



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Validity and Accuracy of OHIS

Determined Risk, cont.

Changes in periodontal status determined by

comparing baseline data to data at 3, 9, and 15years

Alveolar bone loss (mean bone loss, percentage of

sites with bone loss per subject)

Tooth loss (mean percent tooth loss, percentage ofsubjects with tooth loss in each risk group)



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Data Required by OHIS

Smoking Diabetes Subgingival calculus Subgingival restorations Pockets Furcation involvements Vertical bone lesions

Age Radiographic bone height History of periodontal

surgery for pockets Oral hygiene Dental care frequency

Bleeding on probing



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Doomed by high risk?

It is possible to be at high risk and not suffer theconsequences of terminal disease bymanagement of the risk factors. For example: Drugs to lower blood pressure and cholesterol can

prevent cardiovascular events Blood-sugar control can prevent diabetic

complications Daily personal oral hygiene controls bacterial plaque

preventing caries and periodontitis Periodontal surgery that eliminates pockets improves

plaque control effectiveness to prevent periodontitis



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Periodontal Disease Management

Goals

Preservation of bone and teeth

Prevent surgery Prevent inflammation

Repair damaging effects of periodontitis



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Periodontal Referrals 1980 vs. 2000

Greater loss of teeth at the initialperiodontal examination

More severe periodontitis at the initialperiodontal examination

More teeth were planned for extraction

Cobb C et al. J Periodontol 2003; 74: 1470-1474



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Severe Periodontitis

Every patient who has severe periodontitis had,at a prior time, mild periodontitis, and beforethat was healthy. The progression of diseasecould have been predicted by risk, which wouldhave allowed for more timely and effectivetreatment.

Periodontitis is generally slowly progressive,which may obscure disease worsening,especially when 168 pockets and bone heightmeasurements need to be compared.

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Risk and Risk and Periodontal Disease ManagementPeriodontal Disease Management