2 - Classification of Periodontal Diseases and Conditions Flashcards
what are the 2 categories of periodontal health (2018)
- clinical gingival health (INTACT periodontium)
- clinical gingival health on a REDUCED periodontium (stable periodontitis patient)
what kind of patient has an absence of CLINICAL periodontal inflammation
clinical gingival health (intact periodontium)
do patients with intact periodontium have:
- No BOP, redness, swelling
- physiological immune surveillance present
YES
do patients with intact periodontium have loss of attachment or bone loss
NO
what kind of patient has periodontitis that is successfully treated?
clinical gingival health on reduced periodontium (stable periodontits patient)
describe patients with stable periodontitis
- minimal BOP
- PDs </= 4 mm
- lack of progressive destruction
- control of local and systemic contributing factors
what are the types of dental biofilm induced gingivitis
- localized gingivitis: 10-30% BOP
- generalized gingivitis: >30% BOP
is induced dental biofilm drug influenced?
YES
gingivitis on ___ periodontium has a return of inflammation to the gingival margin of reduced periodontium (BOP)
reduced
what is gingivitis modified by
- systemic factors
- oral factors
what are systemic factors
puberty, pregnancy, diabetes, leukemia, smoking, malnutrition, drugs
what are oral factors
overhanging restoration, subgingival restoration, hyposalivation
what is this
pyogenic granuloma (modified by pregnancy)
what is this
drug influenced gingival enlargement - phenytoin
what gingival enlargement appears due to pregnancy
pyogenic granuloma
differece between localized and generalized drug-influenced gingival enlargement
localized = single tooth or group of teeth
generlized = throughout mouth
difference between mild, moderate, and severe drug influenced gingival enlargement
mild = papilla
moderate = papilla + marginal gingiva
severe = papilla + marginal gingiva + attached gingiva
what are drugs associated w/ gingival enlargement
- antiepileptic drugs
- calcium channel-blocking drugs (antihypertensives)
- immunoregulating drugs
what are examples of antiepilectic drugs
- phenytoin (Dilantin)
- sodium valproate
what are examples of antihypertensives
calcium channel blocking drugs:
1. nifedipine
2. amlodipine
3. felodipine
4. verapamil
5. diltiazem
what are examples of immunoregulating drugs
cyclosporine
what is this
hereditary gingival fibromatosis
what is this
primary HSV-1 infection
what is this
recurrent HSV-1 infection
what is this
fungal candida albicans
where does recurrent herpes infection occur?
lip, palate, and pts with scaling and root planing, and after greater palatine block
what is this an example of
plasma cell gingivitis -> reaction to cinnamon in tartar control toothpaste
what is this
cicatricial pemphigoid
what is this
lichen planus
what are examples of traumatic lesions
toothbrush trauma, flossing clefts, thermal injury, chemical injury, iatrogenic
what is this
gingival ulcerations due to toothbrush trauma
what is this
flossing clefts
what are the 2018 necrotizing periodontal diseases
NG: necrotizing gingivitis
NP: necrotizing periodontitis
NS: necrotizing stomatitis
describe pts with necrotizing periodontal disease
- ulcerated and necrotis papillary and marginal gingiva
- gray pseudomembrane
- blunting and cratering of papillae
- bleeding
- pain and fetid breath
- fever, malaise, lyphadenopathy
predisposing factors for necrotizing periodontal disease
- bacterial etiology
- psychological stress
- smoking
- immunosuppression
what type of periodontal diseases are observed among patients with HIV infection
NP - necrotizing periodontitis
NS - necrotizing stomatitis
HIV infection is indicative of CD_+ counts < ___ cells/mm3
CD4+ counts less than 200 cells/mm3
what is this
necrotizing gingivitis
what is this
bone loss w/ necrotizing papilla (necrotizing periodontitis)
what perio disease has bone denudation, osteitis, and sequestrum and is present in severely immunocompromised patients
necrotizing stomatitis
what are the different years periodontitis classifications were changed
1989, 1999, 2018
what are the different stages in 1989 classification
- adult periodontitis
- early onset periodontitis (prepubertal, juvenile, rapidly progressing)
- periodontitis associated w/ systemic disease
- refractory periodontitis
what are the different stages of 1999 classification
- chronic periodontitis
- aggressive periodontitis
- periodontitis as a manifestation of systemic disease
- no fourth stage
what are the different stages of 2018 classification
- periodontitis
- periodontitis
- periodontitis as a manigestation of systemic disease
- no fourth stage
what is a multifactorial inflammatory disease associated w/ plaque biofilms
periodontitis
what is characterized by progressive destruction of periodontal supporting tissues
periodontitis
what has clinically detectable attachment loss, often accompanied by pocket formation, alveolar bone loss, and gingival bleeding
periodontitis
what are the system of staging and grading in 2018
staging (I-IV)
grading (A-C)
what does CAL stand for
clinical attachment loss
describe CAL of each stage of 2018 periodontal staging
I: 1-2 mm
II: 3-4 mm
III: >/= 5 mm
IV: >/= 5 mm
describe radiographic bone loss of each stage of 2018 periodontal staging
I: coronal 1/3 (<15%)
II: corontal 1/3 (15-33%)
III: >/= middle 1/3
IV: >/= middle 1/3
describe tooth loss of each stage of 2018 periodontal staging
I: n/a
II: n/a
III: less than or equal to 4 teeth
IV: 5 or more teeth
describe the probe depth of each stage of 2018 periodontal staging
I: </= 4mm
II: </= 5 mm
III: greater or equal to 6 mm
IV: greater or equal to 6 mm
describe the compexity of each stage of 2018 periodontal staging
I. horizontal bone loss
II. horizontal bone loss
III. vertical bone loss, Class II or II furcation infolvement
IV. vertical bone loss, class II or II furcation involvement, secondary occlusal trauma, mobility is greater or equal to class 2, drifting, flaring, <20 teeth remain, severe ridge defects
if a patient loses a tooth due to periodontitis, what stage is he immediately moved to
Stage III
describe the radiographic bone loss or CAL for each periodontitis grade level
A - 0 mm over 5 years
B - <2mm over 5 years
C - >/= 2mm over 5 years
describe the % bone loss/age for each periodontitis grade level
A - <0.25
B - 0.25-1.0
C - >1.0
describe the biofilm for each periodontitis grade level
A: hevby biofilm, low destruction
B: destruction commensurate with biofilm
C: low biofilm, heavy destruction, rapid destruction, early onset
what can modifiy the periodontitis grading
smoking and diabetes
describe the periodontal grade for smokers
A: non-smoker
B: smoker <10 cigarettes/day (less than half pack)
C: smoker greater or equal to 10 cigs a day
describer the periodontal grade for diabetics
A: non-diabetic
B: diabetic HbA1c <7%
C: Diabetic HbA1c >/= 7%
what is the stage and grade of this patient
generalized Stave IV, Grade C
what is the stage and grade of this 14 year old pt
stage III, grade C molar-incisor pattern periodontitis
what diagnosis do you use when the systemic condition is the major predisposing factor
periodontitis as a manifestation of systemic disease
do patients who have periodontitis as a manifestation of systemic disease have an ABSENCE of large amounts of plaque and calculus
YES
what are examples of periodontitis as a manifestation of systemic diseases? who contributes to the greatest amount?
- hematologic disorders
- genetic disorders (mostly)
- neoplasms and other disorders
if patient has a hematologic or genetic disorder or neoplasms AND periodontitis, what does the patient have?
systemic manifestation of disease
what is this
pt has cyclic neutropenia - manifestation of systemic disease
what are systemic diseases/conditions that affect periodontal supporting tissues
- DM
- smoking
- obesity
- osteoporosis
- rheumatoid arthritis
- stress and depression
- medications
what is a localized acute and purulent infection within the gingival wall of periodontal pocket
periodontal abseces
what periodontal disease affects supporting structures of periodontium (PDL, bone)? is this a slow or rapid destruction?
periodontal abscess - rapid destruction
what are signs and symptoms of periodontal abscess
pain, swelling, tooth elevation, suppuration, BOP, mobility
what does EPL stand for
endodontic periodontal lesions
EPL involves what tissues
pulp and periodontal tissues
what are acute EPLs
associated w/ trauma (root fracture) or iatrogenic (endodontic perforation)
what are chronic EPLs
associated with pulpal infection or deep periodontal pockets reaching apex
etiology of EPL
- pulpal infection that secondarily affects periodontium
- progressing periodontitis that secondarily affects the pulp (less common)
- both event concomitantly = COMBINED LESION
signs and symptoms of EPLs
- deep perio pocket near apex
- negative/altered response to pulp vitality tests
- bone resorption (apical and/or furcation)
- pain (spontaneous, percussion, palpation)
- suppuration
- mobililty
- sinus tract
what are mucogingival deformities? what is the most common?
- gingival recession (most common)
- lack of keratinized gingiva
- decreased vestibular depth
- aberrant frenum
- gingival excess
- abnormal color
what is this example of
mucogingival deformities = gingival recession
what is this an example of
mucogingival deformities = lack of keratinized gingiva
what are causes of gingival recession
- aggressive tooth brushing
- tooth malposition
- aberrant frenum attachment
- iatrogenic factors (restorations, prosthesis, ortho)
- rooth planing shallow sites
- periodontitis
what is this
aberrant frenum
what are examples of gingival excess mucogingival deformities
pseudopocket
inconsistent gingival margin
excessibe gingival display
gingival enlargement
what is this example of
excessive gingival display
occlusal trauma results in injury to what
tissue changes withing PDL, alveolar bone and cementum
what type of occlusal trauma:
excessive occlusal forces; normal periodontal support
primary occlusal trauma
what type of occlusal trauma
nocrmal or excessive occlusal forcesl teeth with reduced periodontal support
secondary occlusal trauma
what is this example of
widened PDL = primary occlusal trauma
what are tooth and prosthesis related factors that cause perio
- impinged supracrestal attached tissues
- overhang
- subgingival margin
- partial removable dental prostheses
tooth-related factors predisposed patients to what
plaque-induced gingival diseases of periodontitis
what is this
placement of crown margin within supracrestal attached tissues causes perio
what is this
root fracture causing perio
what is this
external root resoprtion causing perio
what is this? why is it a problem
cervical enamel projection
problem bc you can’t attach to enamel or have normal JE+CT connection because it can only attach to dentin or cementum not enamel
what is this diagnosis (assume no bone loss and no BOP). Tooth #5 KG = 5 mm, PD = 2 mm
this means 3 mm of attachment
recession
diagnosis = mucogingival deformity and condition
