Risk of severe periodontal

Periodontology 2000, Vol. 25, 2001, 37–58 Printed in Denmark ¡ All rights reserved

Copyright C Munksgaard 2001

PERIODONTOLOGY 2000
ISSN 0906-6713

Periodontal risk assessment, diagnosis and treatment planning
B RUCE L . P IHLSTROM
In today’s health- and cost-conscious environment, it is essential that rational and cost-effective decisions be made for prevention and treatment of theperiodontal diseases. The prevention and treatment of disease is based on accurate diagnosis, reduction or elimination of causative agents, risk management and correction of the harmful effects of disease. Since there are many types of periodontal diseases that require different treatment methods, it is critical that an accurate diagnosis be established. The purpose of this chapter is to providethe general dental practitioner with an overview and update of risk assessment, diagnostic methods and treatment planning for patients with various types of periodontal diseases. ruses in subgingival plaque. There is a biologically plausible explanation why herpesviruses may be causally related to periodontal disease, but so far, the evidence of association with disease is based on cross-sectionalstudies (31). A risk predictor is a factor that has no current biological plausibility as a causative agent but has been associated with disease on a cross-sectional or longitudinal basis. Risk predictors may be either markers of disease or other historical measures of disease (14). Examples are the number of missing teeth or past evidence of periodontal disease. The number of missing teeth is arisk predictor for disease, but has little or no biological plausibility as a causative agent for periodontitis. The risk for disease is often quantified using relative risks and/or odds ratios. Relative risk is the probability of developing disease if one is exposed to a given factor compared with the probability of developing the disease if one is not exposed to the factor. In the example givenin Table 1, smokers and nonsmokers were matched for age, sex, plaque and calculus. The relative risk for smokers to have deeper pockets was 15/63º7/126 or about 4.3. This means that smokers were 4.3 times more likely to have deeper pockets than nonsmokers. An odds ratio is defined as the odds of having disease if one is exposed to a risk factor compared with the odds of having the disease if oneis not exposed to the same factor. The odds ratio for smokers to have

Periodontal risk assessment
Risk assessment is a way of examining risks so that they may be avoided, reduced, or managed (119). Risk can be identified in terms of risk factors, risk indicators, or risk predictors (14). A risk factor is thought to be causal for a disease. As such, it should satisfy two criteria: 1) it isbiologically plausible as a causal agent for disease and, 2) it has been shown to precede the development of disease in prospective (forward design) clinical studies. Smoking is an example of a risk factor for periodontal disease, since there are a number of biologically plausible explanations for it as a causative agent for periodontal disease, and prospective clinical studies have shown that smokersare more likely to develop periodontitis than nonsmokers. A risk indicator is a factor that is biologically plausible as a causative agent for disease but has only been shown to be associated with disease in cross-sectional studies. Some risk indicators may be proven to be risk factors if prospective studies are able to confirm that they precede the development of disease. An example of a riskindicator of periodontal disease is the presence of herpesvi-

Table 1. Data from a cross-sectional study of periodontal disease
Patients with deep average probing depth 15 7 Patients with shallow aver- Total age probing number of depth patients 48 119 63 126

Patient type Smokers Nonsmokers

Relative risk of disease in smokersΩ15/63º7/126Ω4.3; odds ratio of disease between smokers and...