DT U.S. Edition, Nov./Dec. 2010, Vol. 5, No. 23

periodontal treatment and mainte- nance. Finally, when the prognosis is “hopeless,” extraction is indicated. Overall versus individual tooth prognosis When projecting prognosis, many factors are to be evaluated. These factors are then synthesized into a scheme for determining a periodon- tal prognosis. Although longitudinal studies have indicated that non-sur- gical and surgical treatments gener- ally were maintainable, long-term stability is still subject to many vari- ables.1,7–11 As shown in Table 2, factors influencing the overall periodon- tal prognosis include age, genetics, oral hygiene, systemic conditions, smoking, patient compliance and economic consideration. Tooth-specific influences include the amount of attachment loss, crown-root ratio, position in the arch, presence or absence of furcation invasions and other anatomic and restorative factors.2,8 These param- eters are recorded and weighed according to past clinical experience and prognosis is assigned.12 Overall prognosis Factors that need to be considered when deciding on an overall peri- odontal prognosis include the fol- lowing. • Age. Studies consistently show more periodontal disease and gen- erally greater severity of disease in older as opposed to younger peo- ple.1,2,6 Generally, an older patient probably has a better prognosis for a given level of attachment loss than a younger patient does. • Plaque control. Bacterial plaque is the primary etiologic factor asso- ciated with periodontal disease. The patient’s ability to perform adequate plaque control is important in deter- mining whether or not the disease can be arrested.2,6,13 • Smoking. Individuals who smoke more than 10 cigarettes per day have an increased risk of more severe periodontal disease, a less predictable response to initial ther- apy and a more complicated thera- peutic response. With all other fac- tors being equal, a patient who con- tinues to smoke will have a worse prognosis than one who either does not smoke or quits smoking.14–17 • Diabetes. Diabetic patients have a higher prevalence of periodontal disease and greater attachment and bone loss.18,19 Patients with diabetes, especially poorly controlled diabe- tes, will generally have a worse overall prognosis than patients who are not diabetic (Fig. 1). • Genetics. Genetic factors may play an important role in determin- ing the nature of the host response. It was suggested that genetic polymor- phisms in certain genes involved in the immune response (e.g., interleu- kins IL-1 and IL-10 ), may be asso- ciated with susceptibility to severe periodontitis in some populations.6,12 • Stress. Physical and emotional stress as well as substance abuse may alter the patient’s ability to respond to the periodontal treat- ment performed.6 A recent meta analysis of the literature suggests that psychological stress can lead to increased periodontal disease.2,20 • Patient compliance. One should consider the patient’s ability and consistency in performing plaque control when determining the over- all prognosis. The better his or her plaque control, the better the long- term prognosis.21–23 This determi- nation is an important part of the re-evaluation examination follow- ing initial root planning and oral hygiene instructions.1,2,6 • Economic consideration. Per- sons with severe periodontal disease are likely to be less conscious of their health, resulting in a worse prognosis. The complex treatment of patients with advanced periodon- tal breakdown is very expensive.24 Prognosis for individual teeth The prognosis for individual teeth is determined after the overall progno- Clinical DENTAL TRIBUNE | Nov./Dec. 201016A f DT page 14A AD g DT page 18A General Factors (overall prognosis) Local Factors (individual teeth prognosis • Age • Plaque control • Smoking • Systemic disease • Genetics • Stress • Patient compliance • Economic considerations • Plaque/calculus • Deep probing depth and attachment loss • Tooth mobility • Trauma from occlusion and para-function habits • Plaque retentive factors • Prosthetic/restorative factors Table 2: Factors that may affect a prognosis.