Diagnosis & Prognosis

Recognizing a departure from normal in the periodontium and distinguishing one disease from another. Recognizing a departure from normal in the periodontium and distinguishing one disease from another. Based on information obtained from the medical and dental histories, clinical and radiographic examination of the patient and laboratory findings. Based on information obtained from the medical and dental histories, clinical and radiographic examination of the patient and laboratory findings. Periodontal Diagnosis:

Proper diagnosis is essential to intelligent treatment Proper diagnosis is essential to intelligent treatment Periodontal diagnosis should first determine whether disease is present; then identify its type, extent, distribution, and severity; and finally provide an understanding of the underlying pathologic processes and its cause Periodontal diagnosis should first determine whether disease is present; then identify its type, extent, distribution, and severity; and finally provide an understanding of the underlying pathologic processes and its cause

CLINICAL DIAGNOSIS Medical history Medical history Dental history Dental history extra-oral exam extra-oral exam intra-oral exam intra-oral exam –soft tissue –hard tissue Radiographic Assessment Radiographic Assessment Periodontal Survey Periodontal Survey

Medical History antibiotic prophylaxis antibiotic prophylaxis systemic disease systemic disease pregnancy pregnancy drug habit drug habit

Dental History chief complaint chief complaint oral habits oral habits history history

Extra-oral Exam lymph nodes lymph nodes

Intra-oral Exam Soft Tissue Soft Tissue –evaluate for an atypical or abnormal appearances Hard Tissue Hard Tissue –malpositioned teeth –caries –restorations –habits –Abfractions

Examination of the Periodontium plaque and calculus plaque and calculus clinical attachment loss clinical attachment loss –periodontal pockets amount of attached gingiva amount of attached gingiva furcation furcation –Class I, II, III mobility mobility –Grade I, II, III periodontal abscess periodontal abscess –suppuration

Radiographic Assessment Radiographs do not Radiographs do not 1.Show periodontal pockets 2.Distinguish between successfully treated and untreated cases 3.Show structures on buccal, lingual, and labial aspect of tooth 4.Record tooth mobilty

Radiographic Assessment full mouth series full mouth series Look At: Look At: –lamina dura –crown:root ratio –interproximal bone –hypercementosis –furcation involvement –periapical pathology –overhangs –calculus –resoption

Predisposing Conditions Tipping of teeth Tipping of teeth Open contacts Open contacts Poor contours of restorations and overhang margins Poor contours of restorations and overhang margins

Prognosis Prognosis: Prognosis: A prediction as to the progress, course and outcome of a disease. Based on: Based on: - current established criteria - therapeutic judgment and experience - documented successes and failures of the past

Over all Prognosis: Over all Prognosis: Concerned with the dentition as a whole. Individual Prognosis: Individual Prognosis: Concerned with individual tooth.

Prognosis Nature of disease process a. Rapid (-) vs. chronic (+) b. Juvenile (-) vs. Adult onset (+) Systemic Factors (-) a. Diabetes, b. Smoking c. Stress d. Nutrition e. Others

Prognosis Patient age/degree of disease a. Young (-) a. Young (-) b. Older (+) b. Older (+)

Excellent Prognosis: Excellent Prognosis: No bone loss, excellent gingival condition, adequate patient cooperation. Good Prognosis: Good Prognosis: One or more of the following: - adequate remaining bone support. - adequate possibilities to control etiologic factors and establish a maintainable dentition. - adequate patient cooperation

Fair Prognosis: Fair Prognosis: One or more of the following: - less than adequate remaining bone support - some tooth mobility - grade I furcation involvement - adequate maintenance possible - acceptable patient cooperation

Poor Prognosis: Poor Prognosis: One or more of the following: - moderate to advanced bone loss - tooth mobility - grade I and II furcation involvement - difficult to maintain areas - doubtful patient compliance

Questionable Prognosis: Questionable Prognosis: One or more of the following: - advanced bone loss - grade II and III furcation involvement - tooth mobility - inaccessible areas Hopeless Prognosis: Hopeless Prognosis: One or more of the following: - advanced bone loss - non maintainable areas