09/24 - Classifictaion of Periodontal Diseases Flashcards
Successful management of periodontal disease depends on the ability of a clinician to do what 3 things?
- accurate diagnosis of periodontal disease
- predict the effect of the systemic status of the patient on the course of the disease
- confirm the prediction with assessment of therapeutic outcomes
What is the definition of periodontal diseases?
a diverse family of complex and distinct pathological entities found within the periodontium that are the result of a variety of etiologies; encompasses both gingival diseases and destructive periodontal diseases
What are the 6 characteristics common to all gingival diseases?
- signs and symptoms that are confined to the gingiva
- the presence of dental plaque to initiate and/or exacerbate the severity of the lesion
- clinical signs of inflammation
- clinical signs and symptoms associated with stable attachment levels on a periodontium with no loss of attachment
- reversibility of the disease by removing the etiology(ies)
- possible role as a precursor to attachment loss around teeth
True or false: Not all periodontitis becomes gingivitis, but most gingivitis started as periodontitis.
FALSE: Not all gingivitis becomes periodontitis, but most periodontitis started as gingivitis.
What are the 4 systemic factors that can modify gingival disease?
- the endocrine system (endocrinotropic)
- blood dyscrasias
- medications
- nutrition
What are the 5 endocrinotropic gingival diseases?
- puberty-associated gingivitis
- menstrual cycle-associated gingivitis
- pregnancy-associated gingivitis
- pregnancy-associated pyogenic granuloma
- diabetes mellitus-associated gingivitis
What gingival disease is associated with blood dyscrasias? Describe it.
- leukemia-associated gingivitis
- gingival lesions are primarily found in acute leukemia; reductions in dental plaque can limit the severity of the lesion
What gingival disease is modified by nutrition? Describe it.
- ascorbic acid-deficiency gingivitis
- malnourished individuals have a compromised host defense system which may make individuals susceptible to infectious diseases; human studies have failed to show a relationship between nutrition and periodontal diseases
What are the 4 types of destructive periodontal diseases?
- chronic periodontitis
- aggressive periodontitis
- periodontitis as a manifestation of systemic diseases
- necrotizing periodontal diseases
What are the (5) clinical manifestations of chronic periodontitis?
- pocket formation
- loss of attachment
- bleeding/suppuration
- bone loss
- tooth mobility and drifting
What age group is chronic periodontitis most common in? What type of calculus is associated with chronic periodontitis?
- adults (although it can occur in children and adolescents)
- subgingival calculus
What is the speed of progression of chronic periodontitis? What is it associated with or modified by?
- slow to moderate progression
- local predisposing factors (ex. tooth-related), systemic disease, or environmental factors
What are the 2 ways to classify chronic periodontitis?
- EXTENT: localized (if 30% mouth)
- SEVERITY: slight (1-2 mm CAL), moderate (3-4 mm CAL), and severe (5+ mm CAL)
How is aggressive periodontitis classified?
localized or generalized
What are the (3) common features of aggressive periodontitis?
- systemically healthy
- rapid attachment loss and bone destruction
- familial aggregation
What are the (6) secondary features of aggressive periodontitis?
- generally, but may not be universally, present
- microbial deposits are inconsistent with the amount of periodontal destruction
- elevated Actinobaccillus actinomycetemcomitans and Porphyromonas gingivalis
- phagocyte abnormalities
- hyper-responsive macrophage phenotype
- progression may be self-arresting
What age group is most affected by localized aggressive periodontitis? What type of serum antibody response is present toward infecting agents? Where is the disease localized?
- usually around puberty
- robust serum antibody response
- localized first molar/incisor presentation (interproximal attachment loss on at least 2 permanent teeth, one of which is a molar; involving no more than 2 teeth other than first molars and incisors)
What age group is most affected by generalized aggressive periodontitis? What type of serum antibody response is present toward infecting agents? Describe the location and progression of the disease.
- usually affects persons under 30 but patients may be older
- poor serum antibody response
- generalized interproximal attachment loss affecting at least 3 permanent teeth other than first molars and incisors
- pronounced episodic nature of destruction of attachment and bone (happens every few years and then stops)
What types of disorders is periodontitis associated with?
- hematologic disorders
- genetic disorders
Describe the periodontium in a patient with Down syndrome.
- severe inflammation
- accelerated attachment loss
- PMN chemotaxis and killing defects
Describe the periodontium in a patient with Papillon-Lefevre syndrome.
rapid periodontal destruction around primary and permanent teeth which occurs before puberty
Describe the periodontium in a patient with Chediak-Higachi syndrome.
rapid periodontal destruction around primary and permanent teeth which occurs before puberty
Describe the periodontium in a patient with Ehlers-Danlos syndrome (Types IV and VIII).
aggressive periodontitis (primary and permanent dentition); fragility of gingiva, excessive hemorrhage
What are the 2 types of necrotizing periodontal disease? What is the difference between the two?
- NECROTIZING ULCERATIVE GINGIVITIS (NUG): limited to gingival tissues
- NECROTIZING ULCERATIVE PERIODONTITIS (NUP): lesion confined to periodontal tissues
