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Periodontal (Gum) Disease Risk Assessment

Cigna Periodontal Disease Risk Assessment Tool

Periodontal disease (also called "gum disease") is a chronic bacterial infection of the gums and bone supporting the teeth. It is caused by certain bacteria that are found on teeth and in the spaces between the teeth and gums. Diagnosing gum disease and getting appropriate treatment is important. Why? Because if left untreated, the disease can progress, which may lead to tooth loss. On top of that, mounting research continues to show that gum disease may have an effect on several serious health conditions. This means that having regular dental check-ups and any needed treatment for gum disease is important not only for your mouth, but for your overall well-being.

Don't Become A Statistic

Gum disease is the most significant dental disease affecting adults.According to the Gum Disease Information Bureau, Gum disease is extremely common and affects 3 out of every 4 adults over the age of 35 in the UK. The good news is that it's treatable, and like many other health conditions, the earlier you diagnose and treat, the better the outcome.

Are You At Risk?

This tool is designed to help you and your dentist identify factors that might increase your risk for gum disease. Take the quiz by clicking on the link below and share the results with your dentist at your next dental check-up. Please note that this tool serves to provide a guideline as to your risk for gum disease. It is possible to have this disease without obvious warning signs, which is why regular dental checkups are so important.

Take the Quiz
 


Patient Name: Age: Date:

This information will not be used or held on Cigna records

Question and Facts about Gum Disease/Dental Health

To be answered by the patient, parent, or primary caregiver about the patient.
How old are you?
As we age, the risk of gum disease may increase steadily.
Do you smoke or use any tobacco products?
Studies show that using tobacco products may be a significant factor for gum disease1.
Do you have diabetes?
There is a direct relationship between diabetes and gum disease. Individuals who have diabetes are at greater risk for infections, including gum disease2.
If yes, how is your diabetes controlled?
The severity of your diabetes may increase the risk of gum disease. If your diabetes is controlled, it is easier to maintain healthy gums.
Do you have a family history (parents or siblings) of diabetes?
Diabetes has been shown to run in families. If someone in your family has diabetes, you may be at greater risk for diabetes and gum disease3.
Have you been diagnosed with, or do you have signs/symptoms of heart disease (high blood pressure, stroke)?
Research shows an association between gum disease and the development of heart disease and stroke.4
Have you been diagnosed with osteoporosis?
Studies suggest a connection between osteoporosis and the loss of bone in the jaw5.
Are you pregnant?
Hormonal changes that occur during pregnancy may cause changes that affect the entire body including the gums, teeth and bones. Good oral health can help to ensure a full-term pregnancy and a healthy baby.
Has a dentist or dental professional ever told you that you have gum disease or have you been treated for gum disease?
People who have had gum disease are more likely to have a recurrence of the disease. Good oral hygiene at home and regular dental visits to your dentist or dental professional can help avoid recurrence.
Do you have a family history (parents or siblings) of gum disease?
According to the British Dental Association, up to 30% of the population may be genetically susceptible to gum disease. Individuals with a family history of gum disease may be up to six times more likely to develop gum disease6.
Do your gums bleed?
Bleeding gums are a sign that you may have periodontal problems. Healthy gums usually do not bleed.
Are your gums receding or making the appearance of your teeth longer?
Although receding gums may occur in a healthy mouth, they may be a sign of gum disease.
Have you noticed that your teeth are loose or that your bite has changed?
As gum disease progresses, teeth may loosen due to loss of the supporting bone that holds them in place.
Have you had a tooth or teeth (other than your wisdom teeth) removed due to gum disease?
If gum disease is not treated or allowed to progress, it will result in the loss of teeth.
How long has it been since you've had a tooth removed due to gum disease?
The more recent your loss of a tooth due to gum disease, the greater your risk of losing more teeth from the disease.
Do you frequently have bad breath?
Bad breath is often a sign that gum disease is present.
How often do you visit your dentist?
Regular dental visits allow the dentist to help identify and/or treat gum disease at an earlier stage.
How often do you brush your teeth each day?
Frequent tooth brushing is an important part of protecting your teeth and gums. It is generally recommended that you spend two minutes brushing at least two times a day.
How often do you floss between your teeth?
Use of dental floss or other types of cleaners between your teeth helps to prevent gum disease. It is recommended that you floss at least once a day.
How often do you use an antimicrobial mouth rinse (Examples - Listerine®, CrestTM, ColgateTM , CorsodylTM )?
Using an antimicrobial mouth rinse on a daily basis may help to reduce the bacteria that cause gum disease.

Source:
1 www.ncbi.nlm.nih.gov/pubmed/18997922; 2 www.ncbi.nlm.nih.gov/pubmed/19177848; 3 www.ncbi.nlm.nih.gov/pubmed/11199666;
4 www.ncbi.nlm.nih.gov/pubmed/11128917; 5 www.ncbi.nlm.nih.gov/pubmed/18362312; 6 www.bda.org



please print this page and share it with your dentist at your next dental check-up

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Patient Name: Age: Date: Score:
 
Low Risk
-5 to 0		 Low to Moderate Risk
1 to 6		 Moderate Risk
7 to 11		 High Risk
12 or greater
 
How old are you?
As we age, the risk of gum disease may increase steadily.
Do you smoke or use any tobacco products?
Studies show that using tobacco products may be a significant factor for gum disease1.
Do you have diabetes?
There is a direct relationship between diabetes and gum disease. Individuals who have diabetes are at greater risk for infections, including gum disease2.
If yes, how is your diabetes controlled?
The severity of your diabetes may increase the risk of gum disease. If your diabetes is controlled, it is easier to maintain healthy gums.
Do you have a family history (parents or siblings) of diabetes?
Diabetes has been shown to run in families. If someone in your family has diabetes, you may be at greater risk for diabetes and gum disease3.
Have you been diagnosed with, or do you have signs/symptoms of heart disease (high blood pressure, stroke)?
Research shows an association between gum disease and the development of heart disease and stroke4.
Have you been diagnosed with osteoporosis?
Studies suggest a connection between osteoporosis and the loss of bone in the jaw5.
Are you pregnant?
Hormonal changes that occur during pregnancy may cause changes that affect the entire body including the gums, teeth and bones. Good oral health can help to ensure a full-term pregnancy and a healthy baby.
Has a dentist or dental professional ever told you that you have gum disease or have you been treated for gum disease?
People who have had gum disease are more likely to have a recurrence of the disease. Good oral hygiene at home and regular dental visits to your dentist or dental professional can help avoid recurrence.
Do you have a family history (parents or siblings) of gum disease?
According to the British Dental Association, up to 30% of the population may be genetically susceptible to gum disease. Individuals with a family history of gum disease may be up to six times more likely to develop gum disease6.
Do your gums bleed?
Bleeding gums are a sign that you may have periodontal problems. Healthy gums usually do not bleed.
Are your gums receding or making the appearance of your teeth longer?
Although receding gums may occur in a healthy mouth, they may be a sign of gum disease.
Have you noticed that your teeth are loose or that your bite has changed?
As gum disease progresses, teeth may loosen due to loss of the supporting bone that holds them in place.
Have you had a tooth or teeth (other than your wisdom teeth) removed due to gum disease?
If gum disease is not treated or allowed to progress, it will result in the loss of teeth.
How long has it been since you've had a tooth removed due to gum disease?
The more recent your loss of a tooth due to gum disease, the greater your risk of losing more teeth from the disease.
Do you frequently have bad breath?
Bad breath is often a sign that gum disease is present.
How often do you visit your dentist?
Regular dental visits allow the dentist to help identify and/or treat gum disease at an earlier stage.
How often do you brush your teeth each day?
Frequent tooth brushing is an important part of protecting your teeth and gums. It is generally recommended that you spend two minutes brushing at least two times a day.
How often do you floss between your teeth?
Use of dental floss or other types of cleaners between your teeth helps to prevent gum disease. It is recommended that you floss at least once a day.
How often do you use an antimicrobial mouth rinse (Examples - Listerine®, ColgateTM , CorsodylTM )?
Using an antimicrobial mouth rinse on a daily basis may help to reduce the bacteria that cause gum disease.
 
*Point Values are not validated