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									Today we will talk about a word you always find at ur examination sheet.
And many of u don’t understand what is the meaning of that word. Or
what is the need of it in practice …The word is prognosis.

Today we will talk about what is that word?? And how can we use it in our
treatment management of the periodontal disease (PD).




Now before that we should know how to write the diagnosis statement :

We should write the EXTENT, then the SEVERITY, then the disease
ENTITY .

For ex;

Localized / generalized + early/ mod/ advanced + chronic
periodontitis/ marginal gingivitis.

That’s how we write the diagnosis…



Now..after we reach the diagnosis we need to understand the prognosis.

PROGNOSIS

Prediction of the probable course, duration & outcome of a disease

Means, what we can expect from that diagnosis ?? what will happen ??

and this will depend on the general knowledge of the pathogenesis of
the disease & the presence of risk factors for the disease.

    For ex; when I diagnosed a case as gingivitis, from the
pathogenesis of gingivitis & form our general knowledge, the prognosis
of that disease will be good or excellent , since we know this is a
reversible disease when we control the initiating factors or the
factors that lead to accumulation of initiating factors which is dental
plaque.
Another ex; if we diagnosed a case as a chronic periodontitis and the
pt seemed to have a diabetes that’s a risk factor that may affect the
prognosis of the disease. Without that risk factor( diabetes) I can
expect , from my general knowledge, that prognosis of this dis
( chronic periodontitis) will be much better.

So..the prognosis is established after diagnosis is made and before
the treatment plan.

Sooo..to make a good or even a perfect Tx plan I need to reach to the
prognosis result to this disease. Why??

Because as I told u sometimes the presence of the risk factors ( RF's)
and the eliminating or controlling of these RF's need to be mentioned
within the Tx plan so we can control or red off this dis.

For ex; if our pt is an uncontrolled diabetic pt and we diagnosed him as
pt with chronic periodontitis , part of our treatment is to be referral
with a physician to control the diabetes to eliminate his (CPD).

       It's based on specific information about the disease & the
        manner in which it can be treated.
       It's also influenced, for ex, when I (Dr) or a master student
        received a pt and 4th year student received a pt with the same
        dis Entity ..(chronic periodontitis). I can expect the prognosis
        of this dis in the pt with the master student will be better than
        that pt with the 4th year student. This is the clinician's previous
        experience with Tx outcomes.




   Now there's another word that associated with our understanding to
   the prognosis..it is the RISK.

Risk factors or risk indicators sometimes confused with the prognosis
also.
Prognosis as we said it's the probable outcomes of the dis that had been
diagnosed , while the RF is:
      The likelihood that an individual will get a disease in a specific
      period.
Means there are certain factors that I can see it associated with the
environment of that individual or within that individual making him
getting the dis.
So prognosis is the expectation after the individual getting the dis.

RF's are those characteristics of an individual that put them at an
increased risk for getting the dis.

 In contrast, Prognosis is the prediction of the course or outcome of
a disease.




   Lets back for the definition of PERSONS AT RISK:

   Persons who possess characteristics that heightened susceptibility
   to periodontal disease, its progression, & its recurrence.

    Greater likelihood of experiencing change in health status over
      time.

      This is example of the age, sometimes u say that the age in a PD is
      a RF and this is wrong..!!!! age per say isn’t a RF..but bcuz the pt
      with age will be exposing to more local factors that affect the
      occurring of PD .

   What are the RF's that make PD??
     They may oral, genetic, systemic, behavioral, and environmental
      attributes, which on the basis of evidence, are known to
      increase the probability of disease.

   Let's suppose that all of us have bad oral hygiene , genetic & systemic
   RF's we wont be at equal level of risk or have the same susceptability
   to getting the dis.
   The oral RF's that cause or progress the existing PD are :

           History of Previous Periodontitis

           Increased Pocket Probing Depth

           Loss of Attachment

           Infrequent Professional Care

           Other oral RF, poor OH, specific bacterial pathogens
             especially who are proved by clinical evidence to be the
             cause of PD as AA, P.gingivalis

If u remembered when we talked about the pathogenesis of PD and its
destruction it's mainly from the host response towards the bacterial
irritation. The bacterial irritation or the direct irritation from
bacteria only consuming 20-30% of the dis destruction but the
majority come from the host response.

   Now other local RF's that put pt at risk of having PD :

            Furcation anatomy.
             When the furcation area is accessible for plaque
             accumulation or gingival inflammation its susceptible to have
             PD in that area.
             For ex; the anatomy of upper 1st PM …it's consisted of 2
             roots which are the buc & palatal roots. The root trunk
             which is the distance btw CEJ and the coronal level of the
             alveolar bone .the furcation entrance is high near to the
             gingival margins , so any gingival inflammation happened in
             that area , the susceptibility of reaching to the furcation
             area will be higher, why??
             Bcuz the furcation area is nearer to gingival margin than the
             other teeth in the pt mouth.
            Intermediate bifurcation ridges.
            Cervical enamel projections.
             Sometimes called enamel pearl, since the attachment
             apparatus of the periodontum are only sharpeys fibers with
             the cementum . that means that area wont have attachment
             apparatus , so we'll have deep pockets around these areas all
             the time. ( not sure about that..!!!)
         Palatogingival grooves.
         The same problem not have attachment apparatus .

        Open contact and food impaction.
        Accessory root canals.
         the effect of any endodontic pathology will affect the
         periodontal tissue around the roots.
        Kissing roots. What is it???????
         Sometimes the interseptal or interproximal bone between a
         proximately 2 roots of 2 teeth which are so close this will
         increase the chance of getting periodontal problems. Or when
         the 2 roots are so closed to each other the inter-radicular
         bone will be so diminished so.......periodontal disease that’s
         what we called kissing roots…too proximity of 2 roots
         either of adjacent 2 teeth or of the same tooth.



Other iatrogenic factors considered RF's :

       Overhangs

       Violation of biological width

       Occlusal trauma

       Other: removable partial dentures ( ill- fitting), fixed bridges
         ( incorrectly designed), removal of 3rd molars in adults ( may lead
         to formation of pockets or distalaization of adjacent tooth),
         orthodontic movement of periodontally involved teeth.

Is there any genetic factors?????
         Yes, the studies found that :

        Twins with chronic periodontitis.
        Studies of aggressive peridontitis have been found.
        Periodontitis associated with genetic disorders have been
         found also.

 according to many studies..it had been found that 50% of the
risk especially sever PD is hereditary.
   Other RF's :

      o Presence of certain inflammatory mediators for ex; IL1,
        cytokine .
      o 30% of population is IL-1 genotype + and they getting a
        high risk of PD. And this inflammatory mediator associated
        with the pathogenesis of PD.




  Now osteoporotic pt with low bone mass associated with tooth
    loss, fractures & disability.

  Cortical bone may be an objective marker for bone density to
    detect the osteoporotic pt who considered a risk indicator to
    progression of PD.


 The STRESS as a RF…:

    Relationship between stress and any disease especially PD :

  Elevated levels of blood glucose. Make pt more susceptible to have PD.

  Elevated corticosteriods suppress immune system. Increase the necrotic
    & ulcerative type of PD ( gingivitis & periodontitis).

  And increase the risk of CVD which may also have effects of PD.

So we should take attention when we see pt with stress in
his M.H
BACTERIA & INFLAMMATION

 Biofilm (dental plaque):

Is from most important RF beside it is the initiating factor for PD . we
know that dental plaque a complex community of MO which is :

            Self-sufficient

            Self-sustaining

            Highly resistant to each microbial agent which need to be
                 mechanically disturbed before any microbial agent to get
                 red off PD.

    We concentrate more ,in our perio Tx , on: pt OH control beside
    debridement scaling & root planning. Its not only to remove plaque &
    calculus but also to disturb this complex biofilm dental plaque …..so
    it's a RF.



   Does PD presence cause any systemic effects ??
    Yes, May cause distant sites problems :

            Carotid artery

            Heart valves

            Arteries

            Lungs



Sometimes when u have a certain infection in ur body and then the
physician wants to test the type of the infection ..if is it chronic
infection..he ask u to do a blood test (CR ) the Cemental Rate which
gives indicate to chronic infection or to go for something called C-
Reactive Protein ( CRP)…it's a protein made by the immune system
that increases during systemic inflammation .
            Pts with elevated CRP predicted to have CVD
            Also People with periodontal disease have increased CRP
               levels.
From all that we can link that PD have systemic effects on the host..so
there are new recommendations for pt with CVD to go for perio
management.



     SMOKING

          Tobacco-significant risk factor
              Nicotine + other chemicals imbed the root surfaces
              Nicotine constricts
                    blood vessels
              O2 deprivation
              Cytotoxic



Unfortunately the record stopped here, so u should back to ur slides to
continue.. 

I tried my best to collect extra information about the rest of the slides,
but it seems that everyone depends on the record..

 Here are what I got..:

    Types of prognosis :

DIAGNOSTIC PROGNOSISA : what is the prognosis of the some
diseases.

For ex, pt when diagnosed with some disease have better prognosis than
other disease.

THERAPUTIC PROGNOSIS : the prognosis of aggressive is good when
treated with antibiotic in combination with scaling and root planning alone.

PROSTHETIC PROGNOSIS : related to prosthetic work.

    What is important in prognosis is the stability of periodontal
     apparatus.
   Diabetes & smoking are both risk & prognostic factor.


                                                         From : dana
                                                           el jabali &
                                                    thekraiat bni hani




That's it please let me know if u have something
extra to add or any mistake to correct..



TRY UR BEST TO LEARN JOYFULLY, AVOID STRESS AND
DEPRESSION AS MUCH AS U CAN….AND REMEMBER….

 IT'S OUR LAST YEAR UNDER THE GRADUATION
..!!!.


                     GOOD LUCK ALL..

                         RAWAN S. MUSLEH

								
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