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23 Periodontology > 2 - Classification of Periodontal Diseases and Conditions > Flashcards

2 - Classification of Periodontal Diseases and Conditions Flashcards

1
Q

what are the 2 categories of periodontal health (2018)

A
  1. clinical gingival health (INTACT periodontium)
  2. clinical gingival health on a REDUCED periodontium (stable periodontitis patient)
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2
Q

what kind of patient has an absence of CLINICAL periodontal inflammation

A

clinical gingival health (intact periodontium)

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3
Q

do patients with intact periodontium have:
- No BOP, redness, swelling
- physiological immune surveillance present

A

YES

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4
Q

do patients with intact periodontium have loss of attachment or bone loss

A

NO

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5
Q

what kind of patient has periodontitis that is successfully treated?

A

clinical gingival health on reduced periodontium (stable periodontits patient)

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6
Q

describe patients with stable periodontitis

A
  1. minimal BOP
  2. PDs </= 4 mm
  3. lack of progressive destruction
  4. control of local and systemic contributing factors
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7
Q

what are the types of dental biofilm induced gingivitis

A
  1. localized gingivitis: 10-30% BOP
  2. generalized gingivitis: >30% BOP
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8
Q

is induced dental biofilm drug influenced?

A

YES

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9
Q

gingivitis on ___ periodontium has a return of inflammation to the gingival margin of reduced periodontium (BOP)

A

reduced

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10
Q

what is gingivitis modified by

A
  1. systemic factors
  2. oral factors
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11
Q

what are systemic factors

A

puberty, pregnancy, diabetes, leukemia, smoking, malnutrition, drugs

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12
Q

what are oral factors

A

overhanging restoration, subgingival restoration, hyposalivation

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13
Q

what is this

A

pyogenic granuloma (modified by pregnancy)

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14
Q

what is this

A

drug influenced gingival enlargement - phenytoin

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15
Q

what gingival enlargement appears due to pregnancy

A

pyogenic granuloma

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16
Q

differece between localized and generalized drug-influenced gingival enlargement

A

localized = single tooth or group of teeth
generlized = throughout mouth

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17
Q

difference between mild, moderate, and severe drug influenced gingival enlargement

A

mild = papilla
moderate = papilla + marginal gingiva
severe = papilla + marginal gingiva + attached gingiva

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18
Q

what are drugs associated w/ gingival enlargement

A
  1. antiepileptic drugs
  2. calcium channel-blocking drugs (antihypertensives)
  3. immunoregulating drugs
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19
Q

what are examples of antiepilectic drugs

A
  1. phenytoin (Dilantin)
  2. sodium valproate
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20
Q

what are examples of antihypertensives

A

calcium channel blocking drugs:
1. nifedipine
2. amlodipine
3. felodipine
4. verapamil
5. diltiazem

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21
Q

what are examples of immunoregulating drugs

A

cyclosporine

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22
Q

what is this

A

hereditary gingival fibromatosis

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23
Q

what is this

A

primary HSV-1 infection

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24
Q

what is this

A

recurrent HSV-1 infection

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25
Q

what is this

A

fungal candida albicans

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26
Q

where does recurrent herpes infection occur?

A

lip, palate, and pts with scaling and root planing, and after greater palatine block

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27
Q

what is this an example of

A

plasma cell gingivitis -> reaction to cinnamon in tartar control toothpaste

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28
Q

what is this

A

cicatricial pemphigoid

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29
Q

what is this

A

lichen planus

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30
Q

what are examples of traumatic lesions

A

toothbrush trauma, flossing clefts, thermal injury, chemical injury, iatrogenic

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31
Q

what is this

A

gingival ulcerations due to toothbrush trauma

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32
Q

what is this

A

flossing clefts

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33
Q

what are the 2018 necrotizing periodontal diseases

A

NG: necrotizing gingivitis
NP: necrotizing periodontitis
NS: necrotizing stomatitis

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34
Q

describe pts with necrotizing periodontal disease

A
  1. ulcerated and necrotis papillary and marginal gingiva
  2. gray pseudomembrane
  3. blunting and cratering of papillae
  4. bleeding
  5. pain and fetid breath
  6. fever, malaise, lyphadenopathy
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35
Q

predisposing factors for necrotizing periodontal disease

A
  1. bacterial etiology
  2. psychological stress
  3. smoking
  4. immunosuppression
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36
Q

what type of periodontal diseases are observed among patients with HIV infection

A

NP - necrotizing periodontitis
NS - necrotizing stomatitis

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37
Q

HIV infection is indicative of CD_+ counts < ___ cells/mm3

A

CD4+ counts less than 200 cells/mm3

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38
Q

what is this

A

necrotizing gingivitis

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39
Q

what is this

A

bone loss w/ necrotizing papilla (necrotizing periodontitis)

40
Q

what perio disease has bone denudation, osteitis, and sequestrum and is present in severely immunocompromised patients

A

necrotizing stomatitis

41
Q

what are the different years periodontitis classifications were changed

A

1989, 1999, 2018

42
Q

what are the different stages in 1989 classification

A
  1. adult periodontitis
  2. early onset periodontitis (prepubertal, juvenile, rapidly progressing)
  3. periodontitis associated w/ systemic disease
  4. refractory periodontitis
43
Q

what are the different stages of 1999 classification

A
  1. chronic periodontitis
  2. aggressive periodontitis
  3. periodontitis as a manifestation of systemic disease
  4. no fourth stage
44
Q

what are the different stages of 2018 classification

A
  1. periodontitis
  2. periodontitis
  3. periodontitis as a manigestation of systemic disease
  4. no fourth stage
45
Q

what is a multifactorial inflammatory disease associated w/ plaque biofilms

A

periodontitis

46
Q

what is characterized by progressive destruction of periodontal supporting tissues

A

periodontitis

47
Q

what has clinically detectable attachment loss, often accompanied by pocket formation, alveolar bone loss, and gingival bleeding

A

periodontitis

48
Q

what are the system of staging and grading in 2018

A

staging (I-IV)
grading (A-C)

49
Q

what does CAL stand for

A

clinical attachment loss

50
Q

describe CAL of each stage of 2018 periodontal staging

A

I: 1-2 mm
II: 3-4 mm
III: >/= 5 mm
IV: >/= 5 mm

51
Q

describe radiographic bone loss of each stage of 2018 periodontal staging

A

I: coronal 1/3 (<15%)
II: corontal 1/3 (15-33%)
III: >/= middle 1/3
IV: >/= middle 1/3

52
Q

describe tooth loss of each stage of 2018 periodontal staging

A

I: n/a
II: n/a
III: less than or equal to 4 teeth
IV: 5 or more teeth

53
Q

describe the probe depth of each stage of 2018 periodontal staging

A

I: </= 4mm
II: </= 5 mm
III: greater or equal to 6 mm
IV: greater or equal to 6 mm

54
Q

describe the compexity of each stage of 2018 periodontal staging

A

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

55
Q

if a patient loses a tooth due to periodontitis, what stage is he immediately moved to

A

Stage III

56
Q

describe the radiographic bone loss or CAL for each periodontitis grade level

A

A - 0 mm over 5 years
B - <2mm over 5 years
C - >/= 2mm over 5 years

57
Q

describe the % bone loss/age for each periodontitis grade level

A

A - <0.25
B - 0.25-1.0
C - >1.0

58
Q

describe the biofilm for each periodontitis grade level

A

A: hevby biofilm, low destruction
B: destruction commensurate with biofilm
C: low biofilm, heavy destruction, rapid destruction, early onset

59
Q

what can modifiy the periodontitis grading

A

smoking and diabetes

60
Q

describe the periodontal grade for smokers

A

A: non-smoker
B: smoker <10 cigarettes/day (less than half pack)
C: smoker greater or equal to 10 cigs a day

61
Q

describer the periodontal grade for diabetics

A

A: non-diabetic
B: diabetic HbA1c <7%
C: Diabetic HbA1c >/= 7%

62
Q

what is the stage and grade of this patient

A

generalized Stave IV, Grade C

63
Q

what is the stage and grade of this 14 year old pt

A

stage III, grade C molar-incisor pattern periodontitis

64
Q

what diagnosis do you use when the systemic condition is the major predisposing factor

A

periodontitis as a manifestation of systemic disease

65
Q

do patients who have periodontitis as a manifestation of systemic disease have an ABSENCE of large amounts of plaque and calculus

A

YES

66
Q

what are examples of periodontitis as a manifestation of systemic diseases? who contributes to the greatest amount?

A
  1. hematologic disorders
  2. genetic disorders (mostly)
  3. neoplasms and other disorders
67
Q

if patient has a hematologic or genetic disorder or neoplasms AND periodontitis, what does the patient have?

A

systemic manifestation of disease

68
Q

what is this

A

pt has cyclic neutropenia - manifestation of systemic disease

69
Q

what are systemic diseases/conditions that affect periodontal supporting tissues

A
  1. DM
  2. smoking
  3. obesity
  4. osteoporosis
  5. rheumatoid arthritis
  6. stress and depression
  7. medications
70
Q

what is a localized acute and purulent infection within the gingival wall of periodontal pocket

A

periodontal abseces

71
Q

what periodontal disease affects supporting structures of periodontium (PDL, bone)? is this a slow or rapid destruction?

A

periodontal abscess - rapid destruction

72
Q

what are signs and symptoms of periodontal abscess

A

pain, swelling, tooth elevation, suppuration, BOP, mobility

73
Q

what does EPL stand for

A

endodontic periodontal lesions

74
Q

EPL involves what tissues

A

pulp and periodontal tissues

75
Q

what are acute EPLs

A

associated w/ trauma (root fracture) or iatrogenic (endodontic perforation)

76
Q

what are chronic EPLs

A

associated with pulpal infection or deep periodontal pockets reaching apex

77
Q

etiology of EPL

A
  • pulpal infection that secondarily affects periodontium
  • progressing periodontitis that secondarily affects the pulp (less common)
  • both event concomitantly = COMBINED LESION
78
Q

signs and symptoms of EPLs

A
  • 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
79
Q

what are mucogingival deformities? what is the most common?

A
  1. gingival recession (most common)
  2. lack of keratinized gingiva
  3. decreased vestibular depth
  4. aberrant frenum
  5. gingival excess
  6. abnormal color
80
Q

what is this example of

A

mucogingival deformities = gingival recession

81
Q

what is this an example of

A

mucogingival deformities = lack of keratinized gingiva

82
Q

what are causes of gingival recession

A
  • aggressive tooth brushing
  • tooth malposition
  • aberrant frenum attachment
  • iatrogenic factors (restorations, prosthesis, ortho)
  • rooth planing shallow sites
  • periodontitis
83
Q

what is this

A

aberrant frenum

84
Q

what are examples of gingival excess mucogingival deformities

A

pseudopocket
inconsistent gingival margin
excessibe gingival display
gingival enlargement

85
Q

what is this example of

A

excessive gingival display

86
Q

occlusal trauma results in injury to what

A

tissue changes withing PDL, alveolar bone and cementum

87
Q

what type of occlusal trauma:

excessive occlusal forces; normal periodontal support

A

primary occlusal trauma

88
Q

what type of occlusal trauma

nocrmal or excessive occlusal forcesl teeth with reduced periodontal support

A

secondary occlusal trauma

89
Q

what is this example of

A

widened PDL = primary occlusal trauma

90
Q

what are tooth and prosthesis related factors that cause perio

A
  1. impinged supracrestal attached tissues
  2. overhang
  3. subgingival margin
  4. partial removable dental prostheses
91
Q

tooth-related factors predisposed patients to what

A

plaque-induced gingival diseases of periodontitis

92
Q

what is this

A

placement of crown margin within supracrestal attached tissues causes perio

93
Q

what is this

A

root fracture causing perio

94
Q

what is this

A

external root resoprtion causing perio

95
Q

what is this? why is it a problem

A

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

96
Q

what is this diagnosis (assume no bone loss and no BOP). Tooth #5 KG = 5 mm, PD = 2 mm

A

this means 3 mm of attachment
recession
diagnosis = mucogingival deformity and condition

23 Periodontology (13 decks)

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