Diagnosis & Prognosis Recognizing a departure from normal in the periodontium and distinguishing one...
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Transcript of Diagnosis & Prognosis Recognizing a departure from normal in the periodontium and distinguishing one...
Diagnosis & Diagnosis & PrognosisPrognosis
Recognizing a departure from normal in Recognizing a departure from normal in the periodontium and distinguishing one the periodontium and distinguishing one disease from another. disease from another.
Based on information obtained from the Based on information obtained from the medical and dental histories, clinical and medical and dental histories, clinical and radiographic examination of the patient radiographic examination of the patient and laboratory findings. and laboratory findings.
Periodontal Diagnosis:Periodontal Diagnosis:
Proper diagnosis is essential to Proper diagnosis is essential to intelligent treatmentintelligent treatment
Periodontal diagnosis should first Periodontal diagnosis should first determine whether disease is present; determine whether disease is present; then identify its type, extent, then identify its type, extent, distribution, and severity; and finally distribution, and severity; and finally provide an understanding of the provide an understanding of the underlying pathologic processes and underlying pathologic processes and its cause its cause
CLINICAL DIAGNOSISCLINICAL DIAGNOSIS
Medical historyMedical history Dental historyDental history extra-oral examextra-oral exam intra-oral examintra-oral exam
– soft tissuesoft tissue– hard tissuehard tissue
Radiographic AssessmentRadiographic Assessment Periodontal SurveyPeriodontal Survey
Medical HistoryMedical History
antibiotic prophylaxisantibiotic prophylaxis systemic diseasesystemic disease pregnancypregnancy drug habitdrug habit
Dental HistoryDental History
chief complaintchief complaint oral habitsoral habits historyhistory
Extra-oral ExamExtra-oral Exam
lymph nodeslymph nodes
Intra-oral ExamIntra-oral Exam
Soft TissueSoft Tissue– evaluate for an atypical or abnormal evaluate for an atypical or abnormal
appearancesappearances Hard TissueHard Tissue
– malpositioned teethmalpositioned teeth– caries caries – restorationsrestorations– habitshabits– AbfractionsAbfractions
Examination of the Examination of the PeriodontiumPeriodontium plaque and calculusplaque and calculus clinical attachment lossclinical attachment loss
– periodontal pocketsperiodontal pockets amount of attached gingivaamount of attached gingiva furcationfurcation
– Class I, II, IIIClass I, II, III mobilitymobility
– Grade I, II, IIIGrade I, II, III periodontal abscessperiodontal abscess
– suppurationsuppuration
Radiographic Radiographic AssessmentAssessment Radiographs do notRadiographs do not
1.1. Show periodontal pocketsShow periodontal pockets
2.2. Distinguish between successfully Distinguish between successfully treated and untreated casestreated and untreated cases
3.3. Show structures on buccal, lingual, Show structures on buccal, lingual, and labial aspect of toothand labial aspect of tooth
4.4. Record tooth mobilty Record tooth mobilty
Radiographic Radiographic AssessmentAssessment full mouth full mouth
seriesseries Look At:Look At:
– lamina duralamina dura– crown:root ratiocrown:root ratio– interproximal interproximal
bonebone– hypercementosishypercementosis– furcation furcation
involvementinvolvement
– periapical periapical pathologypathology
– overhangsoverhangs– calculuscalculus– resoptionresoption
Predisposing Predisposing ConditionsConditions Tipping of teethTipping of teeth Open contactsOpen contacts Poor contours of restorations and Poor contours of restorations and
overhang marginsoverhang margins
PrognosisPrognosis
Prognosis:Prognosis:A prediction as to the progress, A prediction as to the progress, course and outcome of a disease.course and outcome of a disease.
Based on:Based on:- current established criteria- current established criteria- therapeutic judgment and - therapeutic judgment and experienceexperience- documented successes and - documented successes and failures of the pastfailures of the past
Over all Prognosis:Over all Prognosis:
Concerned with the dentition Concerned with the dentition as a whole.as a whole.
Individual Prognosis:Individual Prognosis:
Concerned with individual Concerned with individual tooth.tooth.
PrognosisPrognosis
Nature of disease processNature of disease processa. Rapid (-) vs. chronic (+)a. Rapid (-) vs. chronic (+)b. Juvenile (-) vs. Adult onset (+)b. Juvenile (-) vs. Adult onset (+)
Systemic Factors (-)Systemic Factors (-)a. Diabetes, a. Diabetes, b. Smokingb. Smokingc. Stressc. Stressd. Nutritiond. Nutritione. Otherse. Others
PrognosisPrognosis
Patient age/degree of diseasePatient age/degree of disease a. Young (-)a. Young (-)
b. Older (+)b. Older (+)
Excellent Prognosis:Excellent Prognosis:
No bone loss, excellent gingival No bone loss, excellent gingival condition, adequate patient condition, adequate patient cooperation.cooperation.
Good Prognosis:Good Prognosis:
One or more of the following:One or more of the following:
- adequate remaining bone support.- adequate remaining bone support.
- adequate possibilities to control - adequate possibilities to control etiologic factors and establish a etiologic factors and establish a maintainable dentition.maintainable dentition.
- adequate patient cooperation- adequate patient cooperation
Fair Prognosis:Fair Prognosis:
One or more of the following:One or more of the following:
- less than adequate remaining bone - less than adequate remaining bone supportsupport
- some tooth mobility - some tooth mobility
- grade I furcation involvement - grade I furcation involvement
- adequate maintenance possible- adequate maintenance possible
- acceptable patient cooperation- acceptable patient cooperation
Poor Prognosis:Poor Prognosis:
One or more of the following:One or more of the following:
- moderate to advanced bone loss- moderate to advanced bone loss
- tooth mobility- tooth mobility
- grade I and II furcation involvement- grade I and II furcation involvement
- difficult to maintain areas - difficult to maintain areas
- doubtful patient compliance- doubtful patient compliance
Questionable Prognosis:Questionable Prognosis:
One or more of the following:One or more of the following:
- advanced bone loss- advanced bone loss
- grade II and III furcation involvement- grade II and III furcation involvement
- tooth mobility- tooth mobility
- inaccessible areas- inaccessible areas Hopeless Prognosis:Hopeless Prognosis:
One or more of the following:One or more of the following:
- advanced bone loss- advanced bone loss
- non maintainable areas- non maintainable areas