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