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Perio Final > Prognosis > Flashcards

Prognosis Flashcards

1
Q

Prognosis definition

A

Prediction of course, duration, outcome of a disease

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2
Q

What is prognosis based on?

A

The pathogenesis of the disease and presence/absence of risk factors (specific to that disease)

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3
Q

When is prognosis established?

A

After diagnosis, but before the treatment plan

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4
Q

What are the 2 types of of prognosis

A

Overal prognosis

Individual tooth prognosis

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5
Q

If a patient has a hopeless overall prognosis, what should you do or not do?

A

Do not have to do the prognosis of individual teeth

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6
Q

What effect the overall prognosis?

A 
Patient age (older is better)
Current severity of disease, systemic factors, smoking
Local factors (calculus, plaque, etc)
Patient compliance 
Prosthetic possibilities
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7
Q

When is individual tooth prognosis made?

A

After overall prognosis (don’t do if overall is hopeless)

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8
Q

T/F - individual prognosis is effected by the overall prognosis

A

True

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9
Q

What is taken into account for individual tooth prognosis?

A 
Mobility
Pocket depths
Bone loss
Furcations
Local factors
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10
Q

What are the two types of Prognosis Classification systems?

A

Becker, Berg, and Becker

McGuire and Nunn

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11
Q

Becker, Berg, and Becker Prognosis classification system

A

Good –> Questionable –> Hopeless
Cannot use this system without radiographs -need to assess bone levels
Use bone levels/probe depths as primary basis

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12
Q

McGuire and Nunn Prognosis classification system

A

Good –> Fair –> Poor –> Hopeless
Used at OSU
CAL is used as the primary basis

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13
Q

BB+B’s Good Classification

A

Need 2 of the following:

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14
Q

Where does the bone loss percentage come from for the BB+B Classification

A

Bone loss levels are the average around the entire tooth

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15
Q

BB+B’s Questionable Classification

A

Need 2 of the following:

50% bone loss
6-8 mm probe depths
Class 2 furcation
Anatomical variables (any anatomy that can promote perio problems - deep palatal groove on max incisors, furcation of max 1st PMs)

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16
Q

BB+B’s Hopeless Classification

A 
>75% bone loss
> 8mm probe depth
Class III Furcation
Poor crown:root ratio (1:1 is minimally acceptable)
Unfavorable root proximity
Repeated perio abscess formation
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17
Q

Which teeth are most likely to have unfavorable root proximity?

A

Maxillary 1st and 2nd molars

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18
Q

McGuire and Nunn Good Prognosis

A

“Adequeate” Remaining bone support
“Adequate” possibilities to control etiologic factors/create a maintainable dentition
“Adequate” patient cooperation
NO systemic factors or well-controlled systemic factors (diabetes)

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19
Q

McGuire and Nunn Fair Prognosis

A

25-50% CAL
Class I or “easily accessible” Class II furcations
“Adequate” possible maintenance present
Few systemic factors

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20
Q

McGuire and Nunn Poor Prognosis

A

> 50% CAL
Class I or Class II furcations
Difficult areas to maintain and/or poor patient compliance
Presence of systemic (environmental factors)

21
Q

McGuire and Nunn Hopeless Prognosis

A 
>75% CAL
Mobility (2+)
Class II or Class III furcations
Difficult areas to maintain and/or poor patient compliance
Unfavorable Root Proximity
22
Q

How does patient age effect prognosis?

A

If two patients (one older, one younger) have the same levels, the older patient has a better prognosis

  • longer time frame for destruction
  • this is because if it’s a younger patient, it’s a more aggressive disease
23
Q

What helps us determine Disease severity?

A

CAL - for approximate extent of root surface w/o PDL

Radiographic exam - for amount of root surface still enveloped by bone

24
Q

Why is CAL better to use than PD?

A

PD is subject to hyperplasia

25
Q

How do you measure CAL?

A

CAL = PD + gingival recession

26
Q

What has a worse prognosis…vertical or horizontal bone loss?

A

Horizontal

27
Q

What is the prognosis of horizontal bone loss based on?

A

It depends on the height of existing bone

28
Q

What is the prognosis of vertical bone loss based on?

A

of remaining walls

29
Q

What is the relation of prognosis and Crot?

A

The closer the center of rotation is to the crown, the better the prognosis

  • better distribution of force to the periodontiium
  • less mobility
30
Q

What is the primary etiologic factor for perio disease?

A

Plaque

-effective daily removal of plaque by patient is critical to success and prognosis

31
Q

How is patient compliance related to prognosis?

A

Prognosis is dependent on pt’s attitude/desire and ability to maintain good hygiene
-without this, treatment will not succeed

32
Q

What does the dentist have the option to do?

A 
Refuse to accept the patient for treatment (fear of litigation)
Extract teeth (helpless or poor) and perform SRP on remaining dentition
33
Q

What is the prognosis (McGuire and Nunn) of a patient who is a smoker with slight to moderate perio issues?

A

Fair-poor prognosis

34
Q

What is the prognosis (McGuire and Nunn) of a patient who is a smoker with severe perio issues?

A

Poor-hopeless

35
Q

How would the prognosis change for a patient who was a smoker but stopped?

A

Can go up an entire class
fair-poor –> good ; with slight to moderate perio
poor-hopeless –> fair ; with severe peio

36
Q

How does well-controlled diabetes effect a patient with slight to moderate perio?

A

Should still have a good prognosis if it’s well-controlled

37
Q

How does Parkinson’s effect prognosis?

A

It limit patient’s performance of oral procedures due to limited dexterity
Worsens the prognosis - electric toothbrushes may help

38
Q

How can plaque/calculus effect prognosis

A

Microbial challenge of plaque/calculus is the most important local factor for perio disease
More plaque retentive factors decreases prognosis

39
Q

What anatomic factors effect prognosis?

A

Short tapered roots / large rowns (unfavorable crown:root ratio)
Cervical enamel projections/enamel pearls/ bifurcation ridges
Root concavities

40
Q

Poor crown:root ratio effect on prognosis

A

If unfavorable is leads to a poor prognosis

  • decreased amount of root surface for perio support
  • periodontium is more susceptible to trauma form occlusion
41
Q

How do Cervical enamel projections, enamel pearls, and bifurcation ridges effect prognosis?

A

Interfere with SRP

Prevent regeneration of cementum and PDL

42
Q

How common are CEPs?

A

found on 73% of molars

43
Q

How do root concavities effect prognosis?

A

Increase attachment area and create a root shape that is more resistant to torquing forces

  • covered in alveolar bone so there is more “staying power”
  • especially max 1st PM and MB root of max 1st molar
44
Q

For plaque-induced gingival diseases, what does prognosis depend on?

A

It depends on plaque control and control of systemic disease

45
Q

What is the prognosis for aggresive periodontitis

A

Always poor

46
Q

What is the prognosis of perio disease due to systemic disease

A

Fair-poor

47
Q

What is the primary factor of NUG?

A

Bacterial plaque

48
Q

What is the secondary factor of NUG?

A

Acute stress, smoking, poor nutrition - leading to immunosuppression

49
Q

What is the prognosis of NUG?

A

Good

Repeated episodes = fair

Perio Final (7 decks)

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