Prognosis 2

Prognosis

• Prognosis is the prediction of the probable course, duration, and the outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease

• Diagnosis Prognosis Treatment plan • Prognosis based on specific information of the disease and the manner in which it can be treated, and the physicians previous experience with treatment outcomes as they relate to the particular case

• Risk and Prognosis is often confusing

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Prognostic factors are characteristic factors that predict the outcome of a disease once it is present Risk factors may be environmental, behavioral, or biological factors that, when present, increase the likelihood that an individual will get the disease

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Some cases risk factors & prognostic factors same 2. Tobacco smoking 3. Diabetes

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Determination of prognosis 1. Lot of factors like overall clinical condition, local factors, systemic/ environmental factors and prosthetic/ restorative factors to be considered

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excellent 1. No bone loss, excellent gingival condition, good patient cooperation, no systemic/ environmental factors

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good 1. One or more of following: adequate remaining bone support, adequate possibilities to control etiological factors and establish a maintainable dentition, adequate patient cooperation, no systemic/ environmental factors and if they are present they are well controlled

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Fair prognosis 1. One or more of following: less than adequate remaining bone support, some tooth mobility, grade1 furcation, adequate maintenance possible adequate patient cooperation, presence of limited systemic/ environmental factors

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Fair prognosis 1. One or more of following: less than adequate remaining bone support, some tooth mobility, grade1 furcation, adequate maintenance possible adequate patient cooperation, presence of limited systemic/ environmental factors

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poor prognosis 1. One or more of following: moderate to advanced bone loss, tooth mobility, grade1 & 2 furcation, difficult to maintain areas, doubtful patient cooperation, presence of systemic/ environmental factors

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questionable prognosis 1. One or more of following: advanced bone loss, tooth mobility, grade2 & 3 furcation, inaccessible areas, presence of systemic/ environmental factors

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hopeless prognosis 1. One or more of following: advanced bone loss, nonmaintainable areas, extractions indicated, presence of uncontrolled systemic/ environmental factors

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Provisional prognosis 1. Assess results of initial therapy and then give final prognosis

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Overall Vs individual tooth prognosis 1. Overall • • •

Should treatment be undertaken Is it likely to succeed When prosthetic replacements are needed, are the remaining teeth able to support the added burden of prosthesis

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Individual tooth prognosis is determined after overall prognosis and is affected by it

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Factors to be considered when determining prognosis – – – –

Overall clinical factors systemic/ environmental factors Local factors Prosthetic/ restorative factors

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Overall clinical factors – Patient Age •

Younger patient, more destruction, poor prognosis

– Disease severity •

Patients history of PDL disease – – – –

Pocket depth Level of attachment Degree of bone loss Type of bone defect

– Plaque control – Patient compliance / cooperation •

Patient attitude, desire to retain natural teeth, willingness and ability to maintain good oral hygiene.

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Systemic/ environmental factors 1. 2. 3. 4.

Tobacco smoking Systemic disease/ condition Genetic factors Stress

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local factors 1. Plaque/ calculus 2. Subgingival restoration 3. Anatomic factors

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Prosthetic/ restorative factors 1. 2. 3. 4.

Abutment selection Caries Nonvital teeth Root resorption

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Relationship between diagnosis and prognosis •

Many criteria used in diagnosis also used in prognosis. So for a given diagnosis there should be an expected prognosis under ideal conditions

• Prognosis of patients with gingival disease – Dental plaque induced gingival disease • Gingivitis associated with dental plaque only • Plaque induced gingival disease modified by systemic factors • Plaque induced gingival disease modified by medication • gingival disease modified by malnutrition

• Prognosis of patients with gingival disease – Non plaque induced gingival disease • Prognosis dependent on elimination of causative agent

• Prognosis of patients with periodontitis – Chronic periodontitis • Slight to moderate periodontitis prognosis is generally good • Severe periodontitis fair to poor prognosis

• Prognosis of patients with periodontitis – aggressive periodontitis • Localised: diagnosed early has excellent prognosis • More advanced prognosis can still be good • generalised: fair, poor or questionable prognosis

• Prognosis of patients with periodontitis – Periodontitis as a manifestation of systemic disease • Fair to poor depending on controllability of systemic disease

• Prognosis of patients with periodontitis – Necrotising periodontal disease • NUG good prognosis • Repeated NUG fair prognosis • NUP fair to poor depending on whether they are immunocompromised

• Reevaluation of prognosis after phase1 therapy – If inflammation controlled after phase 1 therapy better prognosis than previously assumed – For two patients with comparable destruction prognosis may be bettr for patient with greater degree of inflammation

• Reevaluation of prognosis after phase1 therapy – Phase 1 therapy also allows clinician to work with the patient as well as his physician for control of systemic/ environmental factors which may have a positive effect on prognosis if controlled

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