Periodontal (Gum Disease) Risk and Disease Assessment
Prepared By		Prepared For
Dr. John Martin 20849 Cascade Ridge Drive, Mount Vernon,, Washington, 98274, Phone360.941.4715, Email carlf@previser.com Exam Date  8/21/2007		Sally Adams Age 53 Risk Assessment ID 8c80f6d2-0bdb-4e41-afa5-a5bfe0485eca PreViser Patient ID 8c2fb32a-b376-4b40-bdc4-a105fda2d0ab

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 21 Localized 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 21 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 35 25 21 4 4 4

Characteristics Of Health	Your Health	Analysis
No bleeding during exam or flossing	Bleeding during exam	Bacteria are causing an infection, which can worsen your disease state
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	Tartar below the gumline	Calculus is a major cause of disease state worsening
No fillings are below the gumline	No fillings are below the gumline	Best possible condition
Not diabetic or under good control	Not diabetic	Best possible condition
Bone fully fills furcations	Bone destruction in a furcation	Cleaning the bacteria from these sites might not be possible leading to a worse condition
Minimal or no bacterial plaque	Minimal bacterial plaque	Disease management and prevention is slightly compromised
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	Never smoked	Best possible situation
X-rays show bone level is flat	X-rays show bone level is uneven	Usually consistent with deep pockets that worsen

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

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. Professional cleaning Host modulators

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 - Bone surgery - 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

Furcations
		Furcations are the junctions of roots in multi-rooted teeth (molars). The term "furcation involvement" describes loss of the bone filling these junctions. They are more challenging to clean than deep pockets, which means bacteria and calculus are not completely removed. Furcation lesions generally worsen until the tooth is lost. Surgery when SRP and/or adjunctive therapies are not effective - Regenerative Therapy - Molar root removal - Bone surgery Extraction Surgery when SRP and/or adjunctive therapies are not effective - Flap surgery SRP with adjunctive therapy as indicated Locally applied anti-microbials alone

Vertical Bone Lesion
		Vertical bone lesions are deep holes in the bone and are associated with deep pockets. This condition will worsen until the tooth is lost. Repair of the bone lesion will decrease pocket depth, improving its cleansability. Surgery when SRP and/or adjunctive therapies are not effective - Regenerative Therapy - Bone surgery Extraction Surgery when SRP and/or adjunctive therapies are not effective - Flap surgery SRP to bone crest with adjunctive therapy as indicated Orthodontics (Special Circumstances) SRP with adjunctive therapy as indicated Locally applied anti-microbials alone

Tartar (Subgingival Calculus)
		Below gumline calculus (tartar) is a breeding surface for disease-causing bacteria. Complete calculus removal is essential to successful treatment. Calculus, a hard, rock-like material resists toothbrushing, requiring special dental instruments for removal. Total removal is increasingly difficult as pockets deepen past 5mm. Deep cleaning Gingival Flap Surgery (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

Oral Hygiene
		Oral Hygiene is of particular importance to you. You should learn improved methods of maintaining your teeth and gums.