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

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