Diagnosis Of Periodontal Diseases
Question 1. Describe briefly importance of medical history in diagnosis of periodontal disease.
Answer. Medical history aids the clinician in diagnosis of oral manifestation of systemic disease. It also assists in detection of systemic conditions that may be affecting periodontal tissue response to local factors or that required specific precautions or modifications in treatment procedures.
Medical history should address the following areas in making diagnosis of periodontal disease, i.e.
- A history should be taken of all patients, medical problems including infections diseases, STDs and high-risk behavior for HIV infection.
- Any possibility of occupational disease should be noted.
- Abnormal bleeding tendencies should be noted such as nose bleeds, prolong bleeding from minor cuts, spontaneous ecchymoses, tendency towards excessive bruising and excessive menstrual bleeding.
- Any history of allergy should be resorted.
- Information should be provided regarding onset of puberty and for female patients, menopause, menstural disorders, hysterectomy, pregnancy and miscarriages.
- Patient’s family medical history should be taken, including bleeding disorders and diabetes.
Read And Learn More: Periodontics Question And Answers
Question 2. Write short note on radiographic appearance (changes) in periodontal disease.
Answer. Following are the radiographic changes in the periodontal diseases:
- Breakage in the continuity of lamina dura: Breakage is seen in the continuity of lamina dura at mesial or distal aspect of the crest of interdental septum. It can be noted as the earliest change in radiographic appearance.
- Wedge shaped radiolucent area: A wedge-shaped area is formed either at distal or at mesial aspect of crest of septal bone. Apex of wedge is pointed towards the root.
- Height of interdental septum gets reduced.
- There is presence of finger-like radiolucent projections which extends from crest into the septum.
- Interdental craters are projected as irregular areas of reduced radiopacity at alveolar bone crest.
Question 3. Write short note on levels of clinical significance.
Answer. There are four levels of clinical significance which are based on nature of benefit and size of treatment effect:
- Clinical significance level 1.
- Clinical significance level 2.
- Clinical significance level 3.
- Clinical significance level 4.
Clinical Significance Level 1
Treatment of clinical significance level 1 are the miracle cure in which the treatment provides tangential benefit and the treatment effect is large. e.g. vitamin C is given in cases of scurvy, bone marrow transplantation in cases of leukemia, etc. In above examples, treatment is beneficial and treatment effect is large.
Clinical Significance Level 2
It describes the treatment, which provides tangential benefit but its benefit from treatment is small. This is because
- Size of benefit of one therapy over another is small
- Due to the randomized control trials
- It is larger in size and rigorous in execution and analysis
For example, advantage of tissue plasminogen activator over streptokinase.
Clinical significance level 2 is an individual’s choice in which cost and side effects play major role.
Clinical Significance Level 3
Treatment at this level is the magical bullet. In this, the treatment effects are beneficial as well as intangible and are very convincing so that need for randomized control trials may appear remote.
For example, HAART therapy in AIDS patients, Chlorhexidine in prevention of caries.At this level, there is always uncertainty of whether intangible benefits convert into real, tangible patient benefits.
Clinical Significance Level 4
These are the treatments which have reliable evidence from large randomized control trials of small intangible benefits. Since the effect of treatment is less epidemiological studies or surveys are incapable of identifying treatment at this level. For example, tiny dropping of blood pressure, mild decrease in pocket depth. Treatment at this level may cause more harm.
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