2017 perio classification

Question 1

What are the features of gingival health with intact periodontium and reduced periodontium?

Answer 1

• absence of BOP, erythema, oedema, symptoms, attachment and bone loss
• <10% bleeding sites wit probing depths <3mm
• bone levels 1-3mm apical to CEJ

Question 2

What BOP% indicates localised vs generalised?

Answer 2

Localised <30%

Generalised >30%

Question 3

What are non plaque induced gingival diseases and conditions?

Answer 3

Hereditary gingival fibromatosis
Infections: Candida, LP, pemphigoid
Nutritional deficiency: Vit C

Question 4

What are the signs or necrotising gingivitis?

Answer 4

Necrosis and punched out ulcer in inter dental papilla 
Gingival bleeding
Pain 
Pseudo membrane formation 
Halitosis 
Extra oral regional lymphadenopathy

Question 5

What systemic diseases can affect periodontal supporting tissues?

Answer 5

Papillon Lefvre syndrome 
Leukocyte adhesion deficiency 
Down syndrome 
Diabetes mellitus 
Obesity 
Osteoporosis 
RA

Question 6

What is a periodontal abscess?

Answer 6

Localised acute exacerbation of a pre existing pocket caused by trauma to the pocket epithelium or obstruction or pocket entrance.

Question 7

What are the 4 BPE codes and treatment for each?

Answer 7

Code 0:

• pockets <3.5mm, no BOP, no plaque/calculus or restorative overhangs
• no Tx required

Code 1:

• pockets <3.5mm, yes BOP, no plaque/calculus or restorative overhangs
• PGI and OHI

Code 2:

• pockets <3.5mm, yes plaque/calculus or restorative overhangs
• PGI, OHI, supra scaling and sub gingival where required, modification of restorative overhangs

Code 3:

• pockets 3.5-5.5mm, possible BOP, plaque/calculus or restorative overhangs
• PGI, 6PPC, RSD where necessary, OHI, supra scaling, modification of overhangs
• xrays of pockets >4mm

Code 4:

• pockets >5.5mm, possible BOP, plaque/calculus or restorative overhangs
• PGI, 6PPC, RSD where required, OHI, supra scaling and modification of restorative overhangs
• vertical bitewings and supplemental PAs

Question 8

What is the grading of furcation involvement?

Answer 8

Grade 1:
- initial furcation: opening can be felt but less than 1/3rd of tooth width

Grade 2:
- partial furcation: loss of support exceeds 1/3rd of tooth width but not full width

Grade 3:
- through and through involvement

Question 9

What probe is used for grading furcation?

Answer 9

Nabers probe with banding 3-6mm and 9-12mm

Question 10

What is the grading for tooth mobility?

Answer 10

Grade 0:
- physiological mobility within alveolar 0.1-0.2mm horizontal direction

Grade 1:
- increased mobility at most 1mm in horizontal direction

Grade 2:
- visually increased mobility exceeding 1mm in horizontal direction

Grade 3:
- severe mobility in both horizontal and vertical directions

Question 11

For a periodontal condition diagnostic statement, what is required?

Answer 11

Indicative periodontitis diagnosis
Stage
Grade 
Stability 
Risk factors

Question 12

What is the staging of periodontal disease?

Answer 12

Indicates severity of disease by using % bone loss assessed on xrays

Stage 1 (early/mild)
- <15% or <2mm attachment loss from CEJ

Stage 2 (moderate)
- coronal third of root 

Stage 3 (severe)
- mid third of root 

Stage 4 (very severe)
- apical third of root

Question 13

What is the grading system of periodontal disease?

Answer 13

Aims to identify how susceptible patient is to perio and the date at which it is likely to progress.
Using worst site % bone loss/patients age

Grade A (slow rate)
- <0.5

Grade B (moderate rate)
- 0.5-1

Grade C (rapid rate)
- >1

Question 14

What are the 3 categories of stability with periodontal diagnosis?

Answer 14

Currently stable:

• BOP <10%
• PPD <4mm
• non BOP at 4mm sites

Currently in remission:

• BOP >10%
• PPD <4mm
• No BOP at 4mm sites

Currently unstable
- PPD >5mm or PPD >4mm and BOP

Question 15

What are the common risk factors for periodontal disease?

Answer 15

Type 2 diabetes
Family history of perio
Smoker
Systemic disease e.g. papillon Lefvre syndrome

Question 16

A Pt has a vertical bony defect down to apex of molar on X-ray with BPE 2 1 2 4* 2 2 with no significant recession - what is the stage and grading?

Answer 16

Stage IV

Grade C

Question 17

What would be the most likely outcome following a recent a restoration with inadequate occlusal contour?

Answer 17

Acute traumatic periodontitis

Question 18

39yr old female, type 1 diabetic, gingival bleeding, poor OH, mobility of 11 and 21 and all 4 first molars have been lost. What is the most likely periodontal diagnosis?

Answer 18

Systemically related periodontal disease due to diabetes.

Question 19

What immune cells are evident in the pathogenesis of periodontitis?

Answer 19

Periodontitis lesions demonstrate a dense infiltration of eosinophils.

Question 20

What pressure should be used when probing for BPE?

Answer 20

25g

Question 21

When carrying out periradicular surgery what is the main reason for resecting a portion of root end?

Answer 21

3mm resection to remove apical deltas

Question 22

62yr old male, liver transplant 2yrs previously, presenting with generalised swollen gingivae, poor OH and extensive plaque accumulation, what is the most likely periodontal diagnosis?

Answer 22

Drug related gingival overgrowth as patient is likely of immunosuppressant medication for liver transplant.