CLINICAL RISK ASSESSMENT

Harshavardhan PatwalDEPATMENT OF PERIODONTOLOGTY

CONTENTS INTRODUCTION DEFINTIONS MEASURES OF EXPRESSING HEALTH RISK RISK ASSESMENT & OBJECTIVE LINES OF HUMAN EVIDENCE RISK IN PERIODONTITIS ASSESMENT OF FACTOR INFLUENCING

PERIODONTITIS RISK ELEMENTS OF PERIODONTAL DISEASE CLINICAL RISK ASSESMENT FOR PERIODONTAL

DISEASE

INTRODUCTION Periodontal disease is multi-factorial with

microbial dental plaque as a initiator .

However the manifestation , progression of periodontal disease and treatment outcome is influenced by wide variety of determinants.

my seminar attempts to provide an overview of different risk factors & their methods of assesment.

Risk

Its defined as probability that an event will occur in the future (or) the probability that an individual develops given disease (or)experience a change in health status during a specified interval of time .

Kleinbaum D 1982

Periodontal risk group

Its defined as subgroup (of a larger population) whose members on an average have a higher probability of developing periodontitis/and or loss of periodontal support with in a given time period then the remaining population

DISEASE A condition of the body or some part/organ of

the body in which its function are disrupted/deranged

MEASURES OF EXPRESSING HEALTH RISK Among the main measures used to express ,

health risk are absolute risk, relative risk, odds ratio , & attributable risk

ABSOLUTE RISK It’s the probability that an individual will

develop the disease over a specific period of time

Relative risk It’s a comparison of the health risk between

two population. This measure is common place in prospective and cohort studies and is assessed as ratio of the disease incidence in these population .

A higher relative risk in these types of studies is often used to suggest a strong evidence for causation of the out come measure.

Can be measured only when the outcome is dichotomous.

classificationRisk factors smokingDiabetes mellitusPathogenic bacteria

Risk derminantsGenetic factorAgegender

Risk indicatorosteoporosis

Risk markersPrevious history of periodontal diseaseBleeding on probing

Trombelli L, Farina R, Ferrari S, Pasetti P, Calura GComparison between two methods for periodontal risk assessment.Minerva Stomatologica 2009;58:277-287

Risk assessment according to the UniFe method

HEXAGONAL RISK DIAGRAM Lang and Tonetti in 2003 described a functional

diagram based on six parameters for use in estimating an individual risk for progression of periodontitis

The PRA model consists of an assessment level of infection, the prevalence of residual pockets, tooth loss, an estimation of loss of periodontal support in relation to patients age, an evaluation of systemic and genetic conditions and an evaluation of the environmental/behavioural factor smoking

All parameters have their own scale for low, moderate and high risk profiles

HEAGONAL RISK DIAGRAM DEVELOPED BY LANG AND TONETTI

Lang and bragger in 1992

CONTINOUS MULTILEVEL RISK ASSESSMENT

The risk assessment models uses retrospective and current data to assess the risk and is based on the simple scale of 0-5

A functional diagram was developed depending on the area of the polygon it categorizes to low, medium, high risk categoriesSandhya and Sripriya in 2011

Conclusion

“ Measurement, Assessment, Elimination or reducing as many risks as possible will improve disease prevention and treatment outcomes”

References American Academy of Periodontology statement on risk assessment.

Journal of Periodontology 2008; 79: 202. W. M. Thomson, S. J. Edwards, D. P. Dobson-Le, G. R. Tompkins, R. Poulton,

D. A. Knight and A. W. Braithwaite: IL-1 genotype and adult periodontitis among young New Zealanders. J Dent Res. 2001 ;80(8):1700-3

Andreas Siebold, Are you at risk for periodontal disease: interactive patient risk assessment tool: south African Society of Periodontology: 2006

Page R, Krall EA, Martin J, Mancl L, Garcia RI. Validity of Periodontal Assessment Tool® (PAT®) in predicting periodontal disease. Journal of the American Dental Association 2002; 133(5): 569-576

Page R, Martin J, Krall EA, Mancl L, Garcia RI. Longitudinal Validation of risk calculator for periodontal disease. J Clin periodontol 2003; 30(9): 819-27

Trombelli L, Farina R, Ferrari S, Pasetti P, Calura G. Comparison between two methods for periodontal risk assessment. Minerva Stomotol. 2009; 58; 277-287.

References… Lang NP, Tonetti MS. Periodontal risk assessment (PRA) for patients in

supportive periodontal therapy (SPT). Oral Health Prev Dent. 2003;1:7-16 Chandra RV. Evaluation of a novel periodontal risk assessment model in

patients presenting for dental care. Oral Health Prev Dent. 2007;5: 39-48. Uno G H Fors, Sandberg Hans C. H. computer aided risk management- a

software tool for the Hidep model: Quintessence Int 2001; 32; 309-320. Sandberg Hans C. H. The HIDEP model-a straightforward dental health care

model for prevention based practice management. Swedish Dental Journal. 2007, 31(4), 171-179.

Cronin AJ, Claffey N, Stassen LF. Who is at risk? Periodontal disease risk analysis made accessible for the general dental practitioner. Br Dent J. 2008 205(3):131-7

Lang NP, Bragger U, Salvi G, Tonetti MS. Supportive periodontal theraphy. In: LIndhe J, Karring T, Lang NP, editors. Clinical Periodontology and implantology. 4th ed. Oxford: Blackwell Munksgarrd; 2003. pp. 781–805

Rajesh S, Lalit Kumar Mathur, Manju A N, Neema Rai, Aditi Mathur. Periodontitis Risk Assessment using two artificial Neural Networks: Int J of Dent clinics 2010; 2(4): 36-40.