10 - Periodontitis Flashcards
what is a multifactorial inflammatory disease associated with plaque biofilms
periodontitis
what is characterized by progressive destruction of periodontal supporting tissues
periodontitis
what is clinically detachable attachment loss, often accompanied by pocket formation, alveolar bone loss, and gingival bleeding
periodontitis
clinical features of periodontitis
- changes in color, contour, consistency of gingiva
- erythema
- blunted papillae
- rolled gingival marins
- flattened or cratered papillae
- erythema
- edema
- rolled gingival margins
- gingival recession
- calculus
- loss of attach
- BOP
- overhanging restoration
- pathologic tooth migration
- open contacts
what are factors that involve pathologic tooth migration
- inflammation
- loss of atachment and bone
- traumatic occlusion
what do open contacts lead to
food impaction
what are radiographic features of periodontitis
- bone loss (horizontal and/or vertical)
- furcation involvement
- calculus
- overhanging restoration
what this
furcation arrows
what are the 2018 classifications of periodontitis
- periodontitis
- periodontitis
- periodontitis as a manifestation of systemic disease
- no longer a disease entity
what classification:
Most common form of periodontitis
Prevalent in adults
Amount of attachment loss consistent with amount of plaque and calculus
Slow to moderate rate of progression
Chronic periodontitis 1999
what classification:
Localized: circumpubertal onset, 1st molars and/or incisor teeth
Generalized: usually affects <35 y/o attachment loss at 1st molars and incisors plus at least 3 other teth
aggresive perio 1999
local aggressive periodontitis (1999) is now called what
molar/inisor pattern periodontitis
what is the case definition of periodontitis
Interproximal CAL at 2 or more non-adjacent
teeth
-OR-
Buccal/Lingual CAL ≥3 mm with pocketing >3 mm at 2 or more teeth
CAL not attributable to: recession, subgingival caries, endo lesion, root fracture
goals of periodontitis staging
- classify severity and extent
- assess complexity
Stage I
Stage II
Stage III
Stage IV
at what stage is scaling and root planing involved
stage III periodontitis
what does a 0 pocket depth look like
at what stage could a patient have bite collapse, severe ridge defects
stage IV periodontitis
does extraction of hopeless teeth decrease stage of disease?
NO
tooth loss due to periodontitis is at least what stage
Stage III
can you reduce stages of periodontitis?
NO!
UNLESS regeneration is successful in establishing new bone and new attachment
what is added to stage as a descriptor?
extent and distribution
what are the different categories of extent and distribution
Localized (<30%)
Generalized (>/= 30%)
Molar-Incisor Pattern
goals of periodontitis grading
- estimate future risk of periodontitis progression
- estimate potential health impact of periodontitis
describe disease progression of perio
- rate: usually slow to moderate
- modified by systemic, environmental facotrs
what is the asynchrous, multiple burst model
episodic bursts of disease activity followed by periods of inactivity or remision
what are risk factors for more rapid disease progression
diabetes and smoking
what are genetic factors that cause perio? this increases tooth loss by what factor?
- genetic variation in IL-1 genotype -> 2.7x increase risk of tooth loss
- IL-1 genotype polymorphism AND smoking -> 7.7x increase risk of tooth loss
Grade A
Grade B
Grade C
what grade automatically if patient smoeks <10 cig/day and has HbA1c <7%
grade B
what is patient default grade?
B
but then look for something that increases or decreases grade then modify from B
quick way to determine grade
A: % bone loss is < AGE/4
C: % bone loss is > AGE
what are 3 steps to staging and grading a patient
- initial case overview to assess disease
- establish stage
- establish grade
what is part of step 1: initial case overview to assess disease
- full mouth probing depths
- full mouth radiographs
- missing teeth
what is part of step 2: establish stage
- Determine maximum CAL or RBL
- Confirm RBL patterns
- Assess tooth loss due to periodontitis
- Evaluate case complexity factors (e.g., severe CAL frequency, surgical challenges)
what is part of step 3: establish grade
- Based on existing data
- Based on calculated RBL (% of root length x 100) divided by age
- Assess risk factors (e.g., smoking, diabetes, other)
what does stage reflect
- Severity of the disease at the most affected area (Expressed through attachment loss and bone loss)
- Tooth loss that has occurred as a result of periodontitis
- Anticipated complexity of treatment required
is stage based on the most severe area of periodontitis
YES
BUT expand the description with additional information
can multiple stages be assigned to the patient?
NO! stage is patient-based, not tooth based
Extent/Distribution: describes the % of teeth at the ___ level.
stage-defining severity
steps to determining diagnosis
- case overview
- establish stage
- establish grade
what are the therapeutic goals/targets
- Control local and systemic modifying factors
- Minimize inflammation
- Stabilize attachment and bone
Restoration to pre-disease attachment and bone levels is [likely OR unlikely] at majority of sites
unlikely
what can you observe if periodontitis is successfully treated
- Minimal BOP
- Improved PD and attachment levels
- Long-term lack of progressive destruction
- Control of local and systemic contributing factors (Oral hygiene, Smoking, Diabetes)
what medications are drugs influenced
gingival enlargement
“pine” medications -> e.g. amlodipine
