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In our experience, when a dental patient hears the term “prognosis” they start to get nervous. The term is often used in the medical field to refer to the predicted outcome of a disease or likelihood of recovery. In dentistry, we use this term differently. 

A dental prognosis can be defined as the likelihood of a tooth’s survival, or the overall viability of a tooth and its risk of requiring removal. We use this classification to make smart decisions that can improve your dental health. 

For patients, it’s important to understand these classifications, as well as how we determine a prognosis. 

Prognosis Classifications

In dentistry, there is a standardized prognosis classification. These are not just used in our office. They are used around the world by dentists to determine the prognosis of teeth. This classification system is as follows:  

• Good: A tooth with a good prognosis currently has no risk of loss and is in good health. This is not a tooth we need to worry about. 

• Fair: A tooth with a fair prognosis has a low risk of loss. It’s not perfect, but there’s a strong likelihood that the patient will keep it. If there is any dentistry we can do to move the tooth from fair to good, that would be worth the investment. 

• Guarded: A tooth with a guarded prognosis has a questionable risk profile and is not predictable. The patient will have a medium risk of losing the tooth or having discomfort. This is tooth you want to invest in and have dentistry done. 

• Poor: A tooth with a poor prognosis has a high risk of loss or other problems. This tooth will require the expertise of your dentist to examine all factors and decide if it is worth investing in dentistry to save the tooth. 

• Hopeless: A tooth with a hopeless prognosis will need to be removed. This is a hard thing to tell patients, but it is good to know. Instead of investing in this tooth, it’s recommended that you have it removed and create a more predictable environment. 

How We Determine a Prognosis 

To determine a tooth’s prognosis, we look at several factors that may impact its longevity. This is evidence-based information that provides a complete picture of the tooth’s health, including: 

• The amount of bone around the tooth. The root of a tooth is surrounded by bone, and you need that bone to support your teeth and keep them in place. A good tooth will have between 80-100% of the bone structure. 

• The ratio of natural tooth to man-made material. The amount of natural tooth structure will determine the strength of a tooth. A good tooth will have between 80-100% of the natural tooth structure. A tooth with a small filling can still be classified as good. 

• The health of the nerve. All teeth have a nerve that goes through the middle, and we want to determine if that nerve is healthy. If there’s an infection in the nerve, a well-done root canal can improve the prognosis. If the infection is more complex, the tooth may have a guarded or fair prognosis. 

• The position of the tooth in your mouth. If a tooth is not positioned properly in the arch of your mouth, this may impact your prognosis. A poorly positioned tooth has a higher risk of collision and is harder to clean. It can also compromise the nearby teeth. 

Creating a Treatment Plan: The ABCs

During a new patient exam, our staff will determine the prognosis of your teeth. From there, we can establish a treatment plan that will address problem areas and create a more predictable environment.

In our practice, we triage issues and classify them as As, Bs, or Cs. 

• An A is an active problem that should be addressed as soon as possible. 
• A B is an active problem that is slowly growing and can be addressed in the next year or two. 
• A C is something that is elective (whitening or veneers) that will not cause pain or tooth loss if it is not addressed. 

Typically, a hopeless, poor or guarded prognosis will fall in the A category and a fair prognosis will fall under the B. Our goal in this process is to move teeth that may have a guarded or poor prognosis into a higher category. For teeth with a poor prognosis, the patient may want to remove that tooth now. But replacement is not always the best option. This should be discussed with your dental team. 

In our practice, our overall goal is to help you get you to 100 with all your teeth. Understanding your prognosis and treating dental problems in order of importance helps us do this. By creating a more predictable environment, we can move away from emergency dentistry and focus on single-tooth dentistry.  

Concerned about the prognosis of your teeth? Schedule an appointment with our dental office in Brandon, FL. We’ll be happy to go over your prognosis and establish a plan that works for you.