Periodontal (Gum Disease) Risk and Disease Assessment
Prepared By		Prepared For
Dr. William Sheffield 123 Main St. Seattle, WA 98101, Phone555-555-1234, Fax555-555-6789 Exam Date  11/16/2004		Demonstration Patient Age 55 Risk Assessment ID 0df48a13-59b7-46e5-96ad-121a80eb0867 PreViser Patient ID fb8c1ea4-d771-4b82-9e85-44077b394477

Risk of Gum Disease: 4 Less Risk More Risk		Risk predicts your future disease state. Your risk is determined by risk factors, which are distinct from the signs and symptoms of disease. Preventing disease requires treatment that reduces your risk factors. With routine dental care, tooth loss is 10 times more likely for an individual who has very high (5) risk compared to an individual who has low (2) risk. However, when risk is used to guide the selection of special treatment, tooth loss can be reduced 50% to 100%. Your risk score of 4 is reflected against the chart to the left.

Disease State 13 Localized mild and moderate periodontitis Your disease state reflects the amount of damage caused by gum disease. As the disease state worsens, treatment increases in amount, complexity and cost. Tooth loss and the failure rate of repairs are greater for individuals with higher disease state scores. Treatment can repair the damage caused by disease, but tends not to help much in preventing new disease. Disease prevention requires treatment that reduces your risk factors. The best treatment incorporates both repair (where needed) and prevention.
Your Score 13 1 Healthy 2-3 Gingivitis 4-10 Mild Gum Disease 11-36 Moderate Gum Disease 37-100 Severe Gum Disease Tooth Loss Better Health More Disease

What Changed  The information below shows the progression of your risk scores:

Disease State Severe Gum Disease Moderate Gum Disease Mild Gum Disease Gingivitis Healthy Perio Risk   Very High Risk High Risk Moderate Risk Low Risk Very Low Risk    Disease State    Perio Risk 47 22 13 5 4 4

Characteristics Of Health	Your Health	Analysis
No bleeding during exam or flossing	No bleeding during exam	Best possible observation, but this could be incorrect and misleading if pockets are deeper than 5 mm
X-Rays show no bone destruction	Moderate bone destruction	Significant bone destruction has occurred and additional bone destruction could cause you to have a tooth extracted
No tartar below the gumline	No tartar below the gumline	Best possible observation, which could be incorrect and misleading for pockets deeper than 5 mm or that bleed
No fillings are below the gumline	A filling or crown extends below the gumline	This condition traps bacteria, which cause gum disease and decay
Not diabetic or under good control	Not diabetic	Best possible condition
Bone fully fills furcations	Bone fully fills furcations	Best possible condition
Minimal or no bacterial plaque	No bacterial plaque	Best possible condition
No pockets deeper than 5 mm	Deepest pocket is 5-7 mm	Bacteria is beyond the reach of toothbrush and floss and possibly the dentist's tools
Not a current smoker	Former smoker	Best possible situation
X-rays show bone level is flat	X-rays show bone level is flat	Best possible condition

Active Intervention You May Need Generally Most Effective May be Most Effective Less Likely to be Most Effective

Reduce Pockets 5-7mm
		Pockets in the 5 to 7 mm depth range cannot be cleaned with a toothbrush and floss, and professional tooth cleaning tools don't always reach the bottom of the pocket. Incomplete removal of plaque and calculus results in deeper pockets and tooth loss. SRP with adjunctive therapy as indicated Surgery when SRP with adjunctive therapy as indicated is not effective - Osseous Surgery - Gingival Flap Surgery - Regenerative Therapy (Special Circumstances) Extraction (Special Circumstances) Prophy or maintenance without SRP or surgery Medicaments alone (Special Circumstances) - Locally Applied Anti-microbials - Systemic Antibiotics - Host modulators

Reduce Pockets <5mm
		Pockets that are less than 5 mm deep can be thoroughly cleaned of bacteria and calculus most easily. However, all deep pockets were at one time less than 5 mm, so one should always watch for advancing disease. The optimal pocket depth is 3 mm or less. Prophy or maintenance Host modulators

Subgingival Restorations
		Fillings below the gumline trap bacteria at the junction of the tooth and filling that cannot be completely removed, thereby facilitating disease progression. This situation also increases the risk for decay. Polish or replace Gingival Flap Surgery (Special Circumstances) Crown Lengthening (Special Circumstances)

Prevention And Maintenance

Visit The Dentist
		Symptoms are warning signs that frequently appear too late in the disease process for the simplest, most predictable, least costly treatment. Regular visits to detect disease in the early stages can prevent more complex and expensive treatment. Better still are regular visits for preventive care targeted to your risk factors. Every 3 months Every 4 months Every 2 months

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