CLINICAL REPORT: Periodontal Risk and Disease Assessment
Prepared By		Prepared For
Dr. Washington Sheffield 123 Main St. Seattle, WA 98111,   Phone 555-555-1234Fax 555-555-5678 Exam Date  11/16/2004		John Smith Age 55 Risk Assessment ID ef1e6c5b-b709-45b7-a391-36e8c7a12929 PreViser Patient ID 2bd09ef4-2d0e-40c4-8f59-58f7f224e317

Patient History Dental Care >2 per year Smoking History Former smoker Diabetic Not diabetic Dental History Perio Surgery For Pockets No Bleeding On Probing No Furcation Involvements No Subgingival Restorations Yes Vertical Bone Lesion No Calculus On Radiographs Below Gingival Margin No Oral Hygiene Excellent

Pocket Depths <5mm <5mm 5-7mm             <5mm <5mm <5mm		Radiographic Bone Height <2mm <2mm 2-4mm <2mm <2mm 2-4mm

Risk Score 4 Disease State 13 Localized mild and moderate periodontitis

What Changed  What Changed?

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 20 13 5 4 4

Active Intervention 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 probing depth is 3 mm or less. Prophy or maintenance 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 unless not expected to be effective Surgery when SRP with adjunctive therapy as indicated is not or is not expected to be 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

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