The American Academy of Periodontology’s (AAP) self-assessment tool uses a simple five-item questionnaire to gather patient data regarding brushing and flossing behavior, dental visits, and history of bleeding gums, smoking or family members with periodontal disease. A patient identified with major risk factors should enter clinical management regimes. Obesity (body mass index or BMI >30 kg/m) is an important risk factor for periodontal disease and diabetes alike. S pecific risk indicators associated with either susceptibility or resistance to severe forms of periodontal disease were evaluated in a cross‐section of 1,426 subjects, 25 to 74 years of age, mostly metropolitan dwellers, residing in Erie County, New York, and surrounding areas. The first step in managing patients’ risk factors is to identify them. Standards of medical care in diabetes—2013. For exceedingly obese individuals, bariatric surgery is an additional weight-control alternative that may be worth exploring. Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 Update Panel, Liaisons, and Staff. Effect of periodontal disease on diabetes: a systematic review of epidemiological observational studies. Oral Health Risk Assessment Tool Guidance Timing of Risk Assessment The Bright Futures/AAP “Recommendations for Preventive Pediatric Health Care,” (ie, Periodicity Schedule) recommends all children receive a risk assessment at the 6- and 9-month visits. Therapeutic goals are evaluated periodically, and changes in therapy made accordingly to control risk factors and achieve and sustain long-term periodontal health (Figure 2). Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. FDI Newsletters Effective adjuncts include nicotine replacement therapies, such as bupropion or varenicline. Tooth-level risk assessment may or may not be carried out at the initial examination, once a BPE screen had identified a susceptible patient. Providing this information leads to the recommendation phase, which discusses what patients can and/or should do in order to reduce their risk for periodontal disease. Oral health professionals have a moral obligation to engage in tobacco cessation strategies, and to encourage all patients who smoke to quit. This consensus report is based on a large body of scientific evidence that suggests periodontal health may be helpful in controlling diabetes.16. The Mediterranean diet, which is rich in fruit and vegetable intake, has been associated with positive health parameters. Wu X, Offenbacher S, López NJ, et al. According to The Merriam-Webster Dictionary, “Prognosis” is defined as “the prospect of recovery as anticipated from the usual course of disease or peculiarities of the case.” In medicine, however, the term is commonly defined by the mortality rate. PERIODONTAL QUESTIONNAIRE Are You At Risk for Periodontal Disease? An increased host inflammatory response to the bacterial infection, as well as particular risk factors that modulate the host’s inflammatory response, are necessary for the disease to manifest clinically.1–3 This triad of periodontal infection, host inflammatory response and associated risk factors speaks to the multifactorial nature of periodontal disease (Figure 1). The next step is to recommend strategies for reducing risk. Summarize this information in simple language that is easily understood. Men ages 51 to 70 are advised to take 1000 mg calcium and 400 IU to 800 IU vitamin D per day. endstream endobj startxref This has resulted in a paradigm shift in the diagnosis and treatment of a disease once understood to be related only to the accumulation of dental plaque.4 Thus, current thinking on periodontal treatment and long-term management has shifted from exclusively controlling plaque to a multidimensional approach. Decisions in Dentistry - A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists. Current guidelines for blood pressure in patients with diabetes or cardiovascular disease suggest a target of 140/90 mmHg.18 Lipid lowering therapy is another important component of cardiovascular disease prevention and treatment. Periodontal data obtained at baseline and 1 y after treatment were available in 5,297 individuals with remaining teeth who were treated at a specialized clinic for periodontal disease. Treatment of periodontal disease for glycaemic control in people with diabetes. Institute of Medicine, Food and Nutrition Board. Using brief language, explain to patients the importance of risk reduction and empower them with strategies that will assist in achieving this goal. How healthy are you? Periodontal Therapist; Patient Treatment Advocate; ... (Caries Management by Risk Assessment) as a key to help patients prevent the infection of decay and to build value for preventive services. Another periodontal risk assessment tool uses a functional diagram to evaluate the risk for progression of periodontal disease.8 It considers the percentage of bleeding-on-probing sites; prevalence of residual pockets greater than 4 mm; loss of teeth (excluding third molars); loss of periodontal support relative to the patient’s age; systemic and genetic conditions; and environmental factors (e.g., smoking). 543 0 obj <> endobj Baker PJ, Roopenian DC. 2013;62:59–94. There is evidence to suggest that cardiovascular disease is associated with periodontal disease.17 Oral health professionals should review the therapeutic regimens and medication histories of all patients with cardiovascular disease. 581 0 obj <>stream Systemic risk factors include diabetes, obesity, cardiovascular disease, metabolic syndrome, osteoporosis, osteopenia, and low dietary intake of nutrients, such as vitamin C, D and calcium. The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: periodontitis and atherosclerotic cardiovascular disease. Most dentists and periodontists are not trained or experienced in risk assessment nor in using interventions aimed at risk reduction in the prevention and management of periodontal diseases. J Dent Res 2014;93:1045-53. This is an awesome article! Genco RJ, Borgnakke WS. Self-report questionnaires have been proposed for the surveillance of periodontal diseases in adult populations world-wide. More specifically, periodontal risk factors are environmental, behavioral, or biological factors that raise the probability of treatment failures. Douglass, Chester W., DMD, PhD, "Risk assessment and management of periodontal disease," Journal of the American Dental Association, Vol. The use of formal risk assessment tools will assist clinicians in identifying patients at greatest risk for periodontal disease, as well as those in need of targeted interventions to prevent or reduce the severity of disease. Jorenby DE, Hays JT, Rigotti NA, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. Genetic susceptibility to periodontal disease has been proposed in studies conducted on twins and evaluation of candidate genes.22–24 Recently, functional polymorphisms in the IL-1B gene have been found to be associated with moderate and severe periodontitis in different ethnic groups.22 Simple chairside tests are available to ascertain genetic risk factors for periodontal disease. This self-assessment system enables the estimation of disease risk for the general population.9. Take the simple test to find out if you exhibit the warning signs and/or symptoms of periodontal [gum] disease. Such recommendations go hand in hand with instructions in better self-care, daily oral hygiene and improved diet (Table 2 provides a summary). Based on a patient’s condition, age, health history and other factors, it may be advisable for individuals to begin a regimen of dietary supplements. Toward that end, this article provides a simple, evidence-based model for the comprehensive management of periodontal risk factors that’s easy to implement in clinical practice, as this remains a major component of successful long-term periodontal care. Treatment should therefore address all components of the multifactorial triad. Due to the risk of bisphosphonate-related osteonecrosis of the jaw, patients on bisphosphonate therapy should be closely monitored when an invasive dental procedure, such as oral surgery, is indicated. Information obtained in the questionnaire should be reviewed with the patient, with the process repeated at every visit. Important goals to consider in patients with diagnosed cardiovascular disease are controlling blood pressure, cholesterol and lipids. Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. Cigarette smoking is one of the most significant risk factor associated with periodontal disease incidence, severity, progression and negative treatment outcomes. This approach allows for individualized dental/periodontal treatment in a patient-centered holistic model that includes dental, medical and lifestyle/behavioral factors. The first line of therapy should include reduction or management of underlying risk factors. Most importantly, it allows for individualized dental/periodontal treatment in a patient-centered holistic model that includes dental, medical and lifestyle/behavioral factors. 850904 11/11 periodontal (gum) disease risk assessment for customers Risk assessment instructions: For each question, write the numeric “points” associated with your response in the “points” box. Page RC, Martin JA, Loeb CF. A complete clinical periodontal examination provided the golden standard periodontitis classification: no/mild, moderate or severe periodontitis. Corbella S, Francetti L, Taschieri S, De Siena F, Fabbro MD. The dentist should establish and communicate the goals of periodontal treatment, encourage lifestyle modification (as appropriate), and involve/refer to additional health professionals as necessary. Excessive daily stress and poor coping strategies are risk factors for periodontal disease, cardiovascular disease and other conditions. Even modest goals to reduce caloric intake and increase physical exercise can lead to reductions in weight and waist circumference. You can help your hygiene staff to begin conducting risk assessments by using clinical note templates. This site uses Akismet to reduce spam. These risk factors can be changed or eliminated, and effective treatment strategies will aid in these efforts. Osteopenia, a reduction in bone density below the normal value for age and gender, is a risk factor for alveolar bone loss. Management of mild and moderate osteopenia includes adequate intake of calcium and vitamin D, and regular, moderate weight-bearing exercise. Risk factor assessment is an important part of long-term periodontal care and health, and dental hygienists—who assess, manage, and modify these risk factors—play a key role in this process. This is a crucial step, as it helps establish and reaffirm the clinician/patient relationship and builds trust. This model can easily be integrated into clinical practice and applied at each dental visit, and it does not require additional appointment time. In this approach, the patient’s oral status is integrated to his or her general health status, presence of specific risk factors, and behavioral contributory factors. Arrange for follow-up within the first week of the quit date. Clinicians need to be thorough when speaking with patients about current methods for managing risk factors, and patient charts should be updated at every visit with information detailing the current status of risk factors. Including risk in treatment planning means that the intensity and accurately predicted by the combination of risk and se- verity scores than by either score alone. Obesity, and especially abdominal obesity, is a significant risk factor for insulin resistance, and abdominal adipose tissue is considered to be the most insulin resistant. Objective: This study aimed to develop and assess the content validity and reliability of a cognitively adapted self-report questionnaire designed for surveillance of gingivitis in adolescents. Although the role that risk factors play in the development of periodontal disease is widely recognized, and growing evidence suggests a link between periodontal health and systemic health, this knowledge is still underutilized by most dental practitioners. ... Periodontal Risk Assessment Questionnaire Name _____ Date_____ IF YOU ARE A PATIENT WHO HAS DIABETES: Is your diabetes under control? The report step focuses on making patients aware of their risk factors and risk profile. Questions regarding the major risk factors for periodontal disease (e.g., smoking, diabetes, cardiovascular disease, obesity and osteoporosis) should be integrated into existing patient questionnaires. Identifying undiagnosed diabetes or prediabetes is important, as interventions have been shown to reduce the development of diabetes and could potentially reduce the onset or severity of a periodontal disease.13,14 Several reports recommend screening for diabetes in the dental setting. © 2020 - Decisions in Dentistry • All Rights Reserved. Among patients who smoke cigarettes or use tobacco, the most important factor in quitting is self-motivation. Due to the multifactorial nature of periodontal disease, identifying, assessing and managing risk factors are integral to successful therapy. Your email address will not be published. Stress High levels … More needs to be done to identify, mitigate and manage periodontal risk factors, as this will offer considerable benefits to patients’ oral health. Behavioral risk factors include smoking, while psychosocial risk factors include elevated stress levels. This method has not been validated prospectively, however, and its use is limited to a patient discussion and motivational tool. More than a dozen examples of factors that should be evaluated to determine the level of risk (high, moderate, low) are listed. Periodontol 2000. Test Your Gums Quiz. Available at: https://www.perio.org/sites/loveyourgums/gums-101.php. The American Diabetes Association recommends that individuals with diabetes achieve a goal hemoglobin A1c of <7.0%. Enjoyed reading it. FAQ: PRIVATE PRACTICE + from Pacific Dental Services, Maintaining Palatal Comfort Following Gingival Grafting, Alternative Method for Occlusal Guard Fabrication, Managing Thermal Injury Following Endodontic Post Preparation. The following information will help you assess your gum disease risk. American Academy of Periodontology. The recommend portion need not to take more than few minutes of chairtime — and that’s time well spent in ensuring treatment success. Learn how your comment data is processed. Risk factors for periodontal disease. Periodontal manifestations of systemic disease. Identifying risk factors as early as possible in the treatment process contributes to patient awareness of a problem and the need for change. Mahmoudi M, Coleman CI, Sobieraj DM. After reviewing, reporting and recommending, the final step is recording. To better help clinicians assist their patients with smoking cessation, the U.S. Public Health Services’ “Clinical Practice Guideline for Treating Tobacco Use and Dependence,”10 recommends the following: Pharmacotherapy may be recommended to patients who need additional support to achieve smoking cessation. The approach is dynamic in nature because it requires regular monitoring and evaluation of oral findings and general health, and a reduction or adequate management of existing risk factors. Presence of major risk factors may be elicited on patient questionnaires that include a section for medical conditions (systemic risk factors), including diabetes, cardiovascular disease, obesity, metabolic syndrome, osteoporosis and autoimmune diseases. Pharmacotherapy includes bone sparing agents, bisphosphonates (alendronate, ibandronate and risedronate), and selective estrogen receptor modulators. Data suggest the latter pharmacotherapy is most effective at achieving smoking cessation.11,12, Diabetes and prediabetes are important risk factors for periodontal disease. 137, November 2006, p. 275-325.; Osteoporosis is an important risk factor for periodontal bone loss, tooth loss and implant failure.19 Management of osteoporosis includes lifestyle measures, adequate intake of calcium and vitamin D, weight-bearing exercise, and preventing falls. An individualized, patient-centered treatment regime is developed and carried out. Adult Periodontal Disease; Oral Cancer; Dental Benefits are provided by Horizon Heathcare Dental, Inc. and Horizon Blue Cross Blue Shield of New Jersey, both of which are independent licensees of the Blue Cross and Blue Shield Association. The periodontal risk assessment model proposed in this article builds on procedures that are already part of a routine dental visit. Wactawski-Wende J. Periodontal diseases and osteoporosis: association and mechanisms. Consecutive, new patients from our outpatient clinic were recruited. Borgnakke WS, Ylostalo PV, Taylor GW, Genco RJ. Systemic risk factors include diabetes, obesity, cardiovascular disease, metabolic syndrome, osteoporosis, osteopenia, and low dietary intake of nutrients, such as vitamin C, D and calcium. Friedewald VE, Kornman KS, Beck JD, et al. Risk assessment in pre-doctoral didactic and clinical curriculum ... 21/44 have a RA questionnaire 28/45 use electronic recording of RA. Periodontal disease pathogenesis: genetic risk factors and paradigm shift. Periodontal disease, if left untreated, will lead to bone loss and ultimately the loss of teeth. As such, oral health professionals should recommend that patients experiencing highstress seek professional help and implement self-help measures. Is Periodontal Risk Assessment an Important %PDF-1.5 %���� We now have amazing options for patient treatment, assessment, and diagnosis. Periodontal disease (PD) is multifactorial and the leading cause of tooth loss.1Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe periodontitis in 1990–2010: A systematic review and meta-regression. risk for gum disease. Association of interleukin-1 gene variations with moderate to severe chronic periodontitis in multiple ethnicities. Page RC, Krall EA, Martin J, Manci L, Garcia RI. For patients with diabetes and periodontal disease, glucose control and periodontal disease management are extremely important.15, A joint report from the AAP and European Federation of Periodontology16 found that periodontal health plays an important role in the management of diabetes. Accessed November 19, 2015. Oral Health Prev Dent 1: 7-16 (2003). Validity and accuracy of a risk calculator in predicting periodontal disease. Risk assessment covers many areas of concern, but for treatment planning and monitoring purposes periodontal probing as a specific indicator of gingival inflammation and a measurement for attachment loss is an essential part of the diagnostic process. The Philips CARE (Customized Assessment and Risk Evaluator) tool can help you provide more comprehensive care for your patients at all stages of life. Oral Health Risk Assessments. 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