RISK ASSESSMENT

RISK
Risk is the probability that an individual will

develop a specific disease in a given period. The risk of developing the disease will vary from individual to individual.

 Risk Factors may be environmental,

behavioral, or biologic factors, that, when present, increase the likelihood that an individual will develop the disease.
Exposure must occur before the disease

onset.
Identified by longitudinal studies.

 Risk Determinants / Background

Characteristics term should be reserved for those risk factors that cannot be modified.

Risk Indicators are probable or putative risk

factors that have been identified in crosssectional studies but not confirmed through longitudinal studies.

 Risk Predictors/Markers, although

associated with increased risk for disease, do not cause the disease.

RISK FACTORS

SMOKING
Well established risk factor. Direct relationship between smoking and

periodontal diseases.
Independent of other factors- age or oral hygiene. Negative impact on response to therapy

DIABETES
Clear risk factor. Severity of periodontitis significantly

higher in type I & II diabetics .

Diabetic control improves periodontal

health

BACTERIA AND TOOTH DEPOSITS

Accumulation of plaque- gingivitis Reversed with oral hygiene measures

Causal relationship.
Quality of plaque more important than

quantity.
A.Acomitans, P.gingivalis, T. forsythia

 Anatomic factors- furcations, root

concavities, developmental grooves, cervical enamel projections, enamel pearls & overhanging restoration- predispose to periodontal disease.
Calculus attachment loss.

RISK DETERMINANTS

GENETIC FACTORS
Explains why some patients develop

periodontitis and others do not.

Influence- attachment loss, bone height,

probing depth
Familial aggregation- aggressive

periodontitis

 Immunological alterations- neutophil

defects, genes encoding inflamatory pathways

Antibody respone

AGE
Prevalence & severity increases with age.

Not an inevitable sequlae of aging

Degenerative changes- increase

susceptibility.
Bone loss attachment loss- cumulative

effect of exposure to other risk factors.

Aggressive periodontitis-young indiviudials-

more bone loss- continued risk

GENDER
Men have more attachment loss than

women.
Poor oral hygiene.

SOCIOECONOMIC STATUS
Lower SES- poor oral hygiene Decreased dental awareness, decreased

frequency of dental visits

STRESS
Necrotising ulcerative gingivits emotional

/psychological stress.
Interfere with immune function. Stressful events bereavement, divorce, financial

strain, depression distress- increased attachment loss.

Patients resistant to therapy- more stressed.
Less longitudinal studies- putative risk factor

RISK INDICATORS

HIV
Immune system dysfunction increases

susceptibility to periodontal destruction

HIV pt.s with good oral hygiene-

maintanable periodontal health

OSTEOPOROSIS
Does not initiate periodontitis Reduced bone mass aggravates

periodontal destruction.
Osteoporosis as risk factor- further

studies needed.

INFREQUENT DENTAL VISITS

Failure to visit dentist regularly-

contoversial
Few studies- increased loss of attachment

Few studies- no loss of attachment.

Other risk factors taken into account. Further research needed.

RISK MARKERS/PREDICTORS

PREVIOUS HISTORY OF PERIODONTAL DISEASE

Previous periodontal disease- good

clinical predictor of risk of future disease.

Patients free of disease- decreased risk of

attachment loss

BLEEDING ON PROBING
Bleeding on probing with increased

pocket depth excellent predictor for future loss of attachment.

Lack of bleeding on probing- excellent

indicator of periodotnal health.

CLINICAL RISK ASSESSMENT FOR PERIODONTAL DISEASE

Information concerning individual risk for

developing periodontal disease is obtained through careful evaluation of the patients Demographic Medical

data.

history.

Dental

history.
examination.

Clinical

CONCLUSION
Risk assessment involves identifying elements that

either may predispose a patient to developing periodontal disease or may influence the progression of disease that already exists.
In either case, these patients require modification of

their prognosis and treatment plan.

Patients should be educated concerning their risk, and

when appropriate, suitable intervention strategies should be implemented.