Periodontal risk calculator versus periodontal risk assessment.

INTRODUCTION: The purpose of study was twofold: To determine the extent of inter valuator and inter group variation in risk scores assigned to study subjects by PRC and PRA. To explore the relationship between risk scores assigned by PRC and using the PRA.
MATERIALS AND METHODS: 57 patients (33 male patients and 24 Female patients between 20 and 65 years age group) were assessed with PRC and PRA tools during their first visit. RESULTS AND
CONCLUSION: We entered the resulting information in to the PRC and PRA to obtained a riskscore for each subject at first visit. The chi-square test significance between PRC and PRA is < 0.05 indicatesthe accuracy of the both tools.

RCT Entities:   Population Interventions Outcomes

The likelihood that a person will get a disease in a specified time period is called risk. The characteristics of individuals that place them at increased risk of getting a disease are called risk factor. The process of predicting an individual's probability of disease is called risk assessment. Methodology that has been in use in the dental clinics over the past decades to assess risk have been to look for clinical indicators such as bleeding on probing, pocket depth, that is, previous periodontal disease activity, amount of plaque retention and plaque retentive factors as well as to look for the presence of specific microorganisms in plaque. While such individual prognostic factors have been studied, the objective and quantitative assessment of risk in multi-factorial risk assessment models has been proposed, by Page et al. Periodontal risk calculator (PRC) and by Lang et al. The periodontal risk assessment (PRA). The assessment of risk in these models was based on mathematically developed algorithms. These tools assigned relative weights to different factors. These included prognostic factors derived from clinical examination as well as environmental and genetic factors.

Periodontal Risk Calculator

Page et al. (2002)[1] developed a computer-based risk assessment tool, the PRC, for objective quantitative assessment of risk. The calculation of risk using this model is based on mathematically derived algorithms that assign relative weights to nine factors including the patient.[2] (Ref: J Clin Periodontol 2005:32 (Suppl. 6):196-209, Dent Clin N Am 49 (2005) 573–594).

Age

Smoking history[3]

Diagnosis of diabetes[4]

History of periodontal surgery

Pocket depths

Furcation involvements

Restorations or calculus below the gingival margin

Radiographic bone height and

Vertical bone lesions.[5]

Risk Scores for Periodontal Risk Calculator [6]

1 to 5

5 - High risk

4, 3 - Medium risk

2, 1 - Low risk

Disease state - 1 to 100.

Periodontal Risk Assessment

Lang and Tonetti (2003) described a functional diagram based on six parameters for progression of Periodontitis.[7]

Proportion of sites with bleeding on probing

The prevalence of residual periodontal pockets

Tooth loss

An estimation of the loss of periodontal support

An evolution of systemic and genetic condition[8]

An evolution of the environmental/behavioral factor.

(Ref:-J Clin Periodontol 2005:32 (Suppl. 6):196-209.

Dent Clin N Am 49 (2005) 573–594).

Calculation of Periodontal Risk Assessment

Low Risk Individual: All parameters are within the low risk categories or at the most one parameter is in the moderate-risk category.

Moderate-risk individual: At least two parameters are in the moderate risk category but at most one parameter is in the high risk category.

High risk individual: At least two parameters are in the high risk category.

Objectives of this study

We attempt to study the differences in risk in patients assessed by both the PRC and the PRA

We further attempt to identify the factors that result in the differences in risk as assessed by these two tools.

Material and Methods

In our OP, 57 patients (33 male patients and 24 Female patients between 20 and 65 years age group) were assessed with PRC and PRA tools during their first visit.

Statistical analysis

Patient data including risk scores and risk variables analysis was performed using commercially available software package Microsoft office XP-Excel 2000 and SPSS version 11–2003.

Periodontal risk assessment proforma

Patient report

Periodontal risk calculator patient proforma

Periodontal risk calculator patient case report

Statistical analysis

Patient data including risk scores and risk variables analysis was performed using commercially available software package Microsoft Office XP-Excel 2000 and SPSS version 11–2003.

Discussion

Our understanding of periodontal disease has increased by leaps and bounds in the past 2 decades. Periodontal disease is multifactorial disease involving microbial factors, environmental factors, and genetic factors.[9] In this study, we assessed the PRC and the PRA for 57 patients. Both the PRC and the PRA categorize patients into low, medium, high risk. In the PRC, 14 are in low risk and in the PRA 8 are in low risk, in the PRC 17 are in medium risk and in the PRA 28 are in medium risk, in the PRC 26 are in high risk and in the PRA 21 are in high risk. This may be because of the variability in the parameters taken to calculate the PRC and the PRA.[10] In PRC parameters like previous history of periodontal surgery, furcation involvements,[11] subgingival restorations and calculus on radiographs or below the gingival margins have been included. Whereas in PRA greater detail about bleeding sites than PRC and also details of the genetic makeup of the patient were used. While in the PRC pocket depth are assessed segment wise in the PRA pocket depth is assessed tooth wise. Other differences are that while PRA assesses for tooth loss the PRC does not. Out of the 26 patients in the high risk group of PRC all had more than 6 mm of pocket depths and 4 mm bone loss. Of these only 21 were in the high risk group of the PRA. And all are have more than 40% bone loss and more than 10 sites with more than 6 mm pockets present. Diabetes and smoking both who have in PRC and PRA are in high risk group. In PRC, low risk group out of 14 patients all have <4 mm pockets and <2 mm bone loss and in PRA out of 8 low risk patients all are <20% bone loss and one or two more than 5 mm pocket sites. In PRC, medium risk group out of 17 patients all have <4 mm pockets and <5–7 mm bone loss, in PRA out of 28 patients all are <40% bone loss and <5 sites with more than 5mm pockets. The differences in the prognostication of risk between the different tools used are because of the different parameters evaluated.

Conclusions and Practice Implication

Use of the risk assessment tools over time may result in more uniform and accurate periodontal clinical decision-making 2, improved oral health, reduction in the need for complex therapy,[12] reduction in health care cost, and a hastening of the transition from a repair model to a wellness model of care. A future tool which incorporates the best aspects of the above-mentioned tools would probably be a better way forward in this regard.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.