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| IMC Wiki | Risk assessment and prognosis

Risk assessment and prognosis

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What does risk mean?

In addition to determining patients at a defined point in time, it is desirable to predict which persons who are still healthy at the present time will be affected by the disease. The probability that a person will develop a disease in future is designated as risk.
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Risk factors

Variables of which it is assumed that they are associated with the development of disease in an individual.

Risk indicators

Potential risk factors that are found in cross-sectional studies but have not yet been confirmed longitudinally.

Risk predictors

These are factors linked with increased probability of a disease but are not part of the cause.

Risk factors in periodontology

The Page and Kornman pathogenesis model of 1997 includes epidemiological risk factors in the development of periodontal disease. It describes the association of
  • Microflora ("microbial challenge")
  • Acquired risk factors and environmental factors
  • Genetic risk factors
  • Immune and inflammatory reaction
  • Connective tissue and bone metabolism
  • Clinical signs of disease
The detailed relationships are as follows:
  • Microflora
    • Combatted by antibodies of the immune and inflammatory reaction
    • Combatted by PMNs of the immune and inflammatory reaction
    • Causes inflammation and an immune system response by antigens, lipopolysaccharides and other virulence factors
  • Immune and inflammatory reaction
    • Combats the microflora with antibodies
    • Combats the microflora with PMNs
    • Is increased by antigens, lipopolysaccharides and other virulence factors
    • Increases connective tissue and bone metabolism with cytokines
    • Increases connective tissue and bone metabolism with prostaglandins
    • Increases connective tissue and bone metabolism with matrix metalloproteases (MMPs)
    • Is modified by genetic risk factors and acquired risk factors and by environmental factors
  • Connective tissue and bone metabolism
    • Is increased by cytokines of the immune and inflammatory reaction
    • Is increased by prostaglandins of the immune and inflammatory reaction
    • Is increased by matrix metalloproteases (MMPs) of the immune and inflammatory reaction
    • The consequences of connective tissue and bone metabolism are expressed in the typical clinical signs of periodontitis.
      Is modified by genetic risk factors and acquired risk factors and by environmental factors
  • Clinical signs of periodontitis
    • Tissue destruction
    • Change in the microbiology
  • Genetic risk factors and acquired risk factors and environmental factors
    • Modify the immune and inflammatory reaction
    • Modify connective tissue and bone metabolism
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Endogenous risk factors

The most important endogenous risk factors for periodontitis are:
  • Diabetes mellitus
  • Osteoporosis
  • Genetics
  • PMN dysfunction

Prognosis

Prognosis describes the course and outcome of a disease in persons who already have the disease.
According to McGuire and Nunn, the prognosis of a tooth that can be expected can be determined from the initial findings.
The following evaluation criteria were established:
  • Good prognosis (one or more of the following criteria are met)
    • Control of etiological factors
    • Clinically and radiologically adequate periodontium that allows good oral hygiene
    • Supportive periodontitis therapy
  • Fair prognosis (one or more of the following criteria are met)
    • 25 % attachment loss
    • Furcation grade I
    • Good compliance and good maintainability
  • Poor prognosis (one or more of the following criteria are met)
    • 50 % attachment loss
    • Furcation grade II
    • The furcation can be maintained, but access is difficult
  • Questionable prognosis (one or more of the following criteria are met)
    • More than 50 % attachment loss
    • Poor crown-to-root ratio
    • Poorly accessible furcation grade II
    • Furcation grade III
    • Loosening grade 2 or more
  • Hopeless prognosis:
    • Insufficient attachment to preserve the tooth. Extraction is necessary.
(McGuire and Nunn 1996a, p. 659)

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sources

  • McGuire, M. K.; Nunn, M. E. (1996a): Prognosis versus actual outcome. II. The effectiveness of clinical parameters in developing an accurate prognosis. In: Journal of periodontology 67 (7), S. 658–665. DOI: 10.1902/jop.1996.67.7.658
  • McGuire, M. K.; Nunn, M. E. (1996b): Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. In: Journal of periodontology 67 (7), S. 666–674. DOI: 10.1902/jop.1996.67.7.666