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Perio I > 9. Diagnosis and Classification of Periodontal Disease > Flashcards

9. Diagnosis and Classification of Periodontal Disease Flashcards

1
Q

Prevalence of Periodontitis
• NHANES 1988 - 1994: ____ periodontitis in US adults age 30 and older
• NHANES 2009 - 2010: ____ periodontitis in US adults age 30 and older
• NHANES 2009 - 2010: ____ moderate or severe periodontitis in US adults
age 65 and older

• How was perio disease defined? Classification is also important; in order to interpret the research data that we get
A

35
47
65%

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2
Q

• ____ Classification (Armitage) - outcome out international workshop

A

1999

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3
Q

What is Necessary for a Periodontal Diagnosis?

____
Systemic Diseases Medication Allergies
Smoking

____
Probing Depth (PD)
Recession (REC)
Clinical Attachment Level (CAL) Bleeding On Probing (BOP) Mobility
Furcation Involvement Plaque Index Bleeding Index

____Panoramic
Full Mouth Radiographs

A

medical history
clinical examination
radiographic examination

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4
Q

Probing Depth

• Sulcus 1-3mm; >\_\_\_\_mm is a pocket
• Happens as a result of inflammation > coronal migration of gingival margin; also an apical migration of attachment apparatus > true periodontitis
	○ True pocket (different from a \_\_\_\_)
A

3

pseudopocket

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5
Q

Probing Depth vs Clinical Attachment Level

• True pocket, by \_\_\_\_ migration and \_\_\_\_ migration (causing \_\_\_\_)
A

coronal
apical
CAL

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6
Q

Pocket vs Pseudopocket

• No attachment loss, but presence of a pocket - \_\_\_\_ (bc of lack of attachment loss)
A

pseudopocket

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7
Q

“Basic” Periodontal Disease Diagnosis

Health
I. Gingivitis
Periodontitis 
II. Chronic
III. Aggressive
IV. Periodontitis as a Manifestation of Systemic Diseases
* Superficial inflammation > \_\_\_\_
* Inflammation and attachment loss > \_\_\_\_
* Every patient should be in one of these three \_\_\_\_
* This is her classification
A

gingivitis
periodontitis
categories

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8
Q

“Special” Periodontal Disease Diagnosis

V. Necrotizing Periodontal Diseases
A. ____
B. ____

VI. Abscesses of the Periodontium
A. ____
B. Periodontal
C. ____

VII. Periodontitis Associated with Endodontic Lesions
A. Combined endodontic – periodontic lesions

A

necrotizing ulcerative gingivitis (NUG)
necrotizing ulcerative periodontitis (NUP)
gingival
pericoronal

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9
Q

Gingivitis

  • ____
  • ____ Index
  • ____ Index
  • Clinical attachment level (CAL)
    • CAL = ____; CAL > ____, with no evidence of ____ attachment loss
A 
BOP
Plaque
Bleeding
0
0
progressive
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10
Q

o VIII. A. Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis
• 1. Tooth ____ factors
• 2. Dental ____
• 3. Root ____
• 4. ____ root resorption and ____ tears

A 
anatomic
restorations/appliances
fractures
cervical
cemental
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11
Q

• 2. Gingival diseases modified by systemic factors

a. associated with the endocrine system
1) puberty-associated gingivitis
- • Inflammation, swelling, that doesn’t directly correlate to amount of ____ present - when a systemic factor is affecting it

2) ____ cycle-associated gingivitis
3) pregnancy-associated
a) gingivitis
b) pyogenic granuloma
- • Associated with ____
• ____ lesion

4) ____ mellitus-associated gingivitis
b. associated with blood dyscrasias (_____)

A

plaque
menstrual
pregnancy
localized

leukemia

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12
Q

Dental Plaque Induced Gingival Diseases

• 3. Gingival diseases modified by medications
a. drug-influenced gingival enlargements
(____, ____, ____ blockers)
- • Doesn’t correlate to amounts of ____
• Used for h____ patients (nifedipine/Ca channel blockers)

b. drug-influenced gingivitis
1) oral ____-associated gingivitis
2) other

A

anticonvulsants
immunosuppressive
Ca-channel

plaque
hypetensives
contraceptives

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13
Q

Dental Plaque Induced Gingival Diseases

• 4. Gingival diseases modified by malnutrition

a. ascorbic acid-deficiency gingivitis
b. other

• Ascorbic acid - \_\_\_\_ deficiency
A

vitamin C

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14
Q

o I. B. Non-Plaque-Induced Gingival Lesions
• 1. Gingival diseases of specific bacterial origin
a. Neisseria ____-associated lesions
b. Treponema ____-associated lesions
c. ____l species-associated lesions
d. other

Primary syphilitic chancre
• On the ____

Secondary oral syphilis
• Can have secondary presentations in the ____

A

gonorrhea
pallidrum
streptococcal

tongue
mucosa

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15
Q

Non-Plaque Induced gingival

• 2. Gingival diseases of viral origin a. herpesvirus infections
1) primary ____
• Mainly seen in ____, but seen in adults also
• Presents when exposed to HSV1
• Generalized in both the ____ and ____
• And very ____

2) recurrent oral herpes
• Common, >90% have recurrent oral herpes - inducer is ____
• Can happen also on ____ (keratinized tissue), not mucosa
• Happens as a response to localized stress - can occur as a response to ____ surgery
• Typical lesions - connective tissue graft for pontic development - recurrent oral herpes and a nathos lesion on the mucosa

3) ____ zoster infections
b. other

A

herpetic gingivastomatitis
children
gingiva mucosa
painful

stress
gingiva
periodontal

varicella

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16
Q

Non-plaque induced gingiva

  1. Gingival diseases of fungal origin
    a. Candida-species infections
    1) generalized gingival candidosis
    • ____ patches on gingiva or mucosa
    • Acute pseudomembranous candidio
    • No white patches > ____
    • Mainly seen in ____ patients, who may have been missing ____ > reduced vertical dimension of ____
A 
white
erythematous
elderly
teeth
occlusion
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17
Q

Non-plaque induced gingiva

  1. Gingival diseases of fungal origin a. Candida-species infections
    1) generalized gingival candidosis
    b. linear gingival erythema• Line along ____ that is red, due to fungal
A

gingival margin

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18
Q

Non-plaque induced gingival lesions

• 3. Gingival diseases of fungal origin a. Candida-species infections

1) generalized gingival candidosis
b. linear gingival erythema
c. ____
d. other

A

histoplasmosis

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19
Q

Non plaque induced gingiva

•  4. Gingival lesions of \_\_\_\_ origin 
a. hereditary gingival fibromatosis
	• Was in the patient's family - \_\_\_\_
	• 4 y/o > \_\_\_\_ lesions (reminds similar to \_\_\_\_-induced)
	• \_\_\_\_ to manage in young patients

b. other

A 
genetic
hereditary
generalized
drug
difficult
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20
Q

Non-plaque induced gingival lesions

• 5. Gingival manifestations of systemic conditions a. mucocutaneous disorders

1) ____
2) ____
3) pemphigus vulgaris
4) erythema multiforme
5) lupus erythematosus
6) drug-induced
7) other

A

lichen planus

pemphigoid

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21
Q

Characteristics of Pemphigoid
• Approximately ____ of desquamative gingivitis cases
• ____l and ____ lesions, conjunctiva lesions, genital lesions
• Subepithelial ____
• ____ deposits of ____ and ____

A 
50%
gingival
mucosal
bullae
basement membrane
IgG
C3
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22
Q

Characteristics of Lichen Planus
• Approximately ____ of desquamative gingivitis cases
• Reticular: striae of ____, sawtooth ____ [most ____]
• ____: bullous plaques with erythematous halo and striae
• ____: erosions with striae
• Different clinical manifestation - more ____ of a lesion
• Both mucosa and gingiva
• ____: tongue loses papillae, gingiva is thinned

A 
25%
wickham
rete pegs
common
bullous
erosive
red
atrophic
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23
Q

Non-plaque induced gingival lesions

• 5. Gingival manifestations of systemic conditions

a. mucocutaneous disorders
b. allergic reactions
1) ____ materials
2) reactions attributable to
a) toothpastes/dentifrices
b) mouthrinses/mouthwashes c) ____ additives
d) food additives
3) other

A

dental restorative

chewing gum

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24
Q

Allergic reaction to ____

* PFM crown that include \_\_\_\_
* \_\_\_\_ gingiva
A

nickel
nickel
erythematous

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25
Q

Allergic reaction to chewing gum additives

* \_\_\_\_ in chewing gum is a common allergen
* \_\_\_\_ - difficult diagnosis - generalized reaction
A

cinnamon

uncommon

26
Q

Non-plaque induced gingival lesions

  1. Traumatic lesions (factitious, iatrogenic, accidental)
    a. ____ injury
    b. ____ injury
    c. ____ injury
A

chemical
physical
thermal

27
Q

Self-inflicted chemical injury (aspirin)
• Must take an adequate ____ in order to determine whether it was mechanical, chemical, thermal, etc.
○ Ask specific ____
• Aspirin placed locally > self-inflicted chemical injury
• Cannot tell just by looking > need a good history

Self-inflicted chemical injury (H2O2)
• H2O2 > use as a mouthrise ____ > take good history

Facticious physical injury (floss)

Self-inflicted thermal injury
• ____ mucosa > hot food

Iatrogenic thermal injury (ultrasonic)
• Ultrasoinc without proper irrigation, or handpiece
• Can be both ____ and ____

A 
history
questions
undiluted
palatal
extraoral
intraoral
28
Q

Non-plaque induced gingival lesions

• 7. Foreign body reactions

  • Gingival enlargement, foreign body
    • ____ treatment
A

orthodontic

29
Q

Chronic Perio

____
____

A

clinical attachment loss (CAL)

bleeding on probing (BOP)

30
Q

Chronic Periodontitis
1. Extent
• Generalized
CAL in > ____% of sites

Localized
CAL in ≤ ____% of sites

2.  Severity
Slight
CAL = \_\_\_\_ mm
Moderate CAL = \_\_\_\_ mm
Severe CAL ≥ \_\_\_\_ mm
A 
30
30
1-2
3-4
5
31
Q

Characteristics of Chronic Periodontitis

  • ____ progression rate with possible periods of ____ progression
  • More prevalent in ____ but can occur in younger individuals
  • Amount of destruction consistent with ____ factors
  • Associated with a variable ____ pattern
  • ____ calculus frequently present
    • Not a ____ bacteria responsible > large numbers of bacterium involved
    • Subging calculus - visual, tactile and radiograph (a lot if ____)
A 
slow
rapid
adults
local
microbial
subgingival

specific
radiograph

32
Q

Generalized Slight Chronic Periodontitis
• Some local factors present - plaque, calculus
• May have some bone loss (or loss)
○ Attachemtn loss preceds bone loss by ____ months

Generalized Moderate Chronic Periodontitis
• A little bit older
• Generalized recession, and generalized bone loss

Generalized Severe Chronic Periodontitis
• Wouldn’t suspect ____ > not a lot of plaque, and no ____; would have to insert probe
• Not a lot of plaque > may have just had their prophy done
• FMX > a lot of bone loss, generalized and lcoalized bone loss
• Shouldn’t judge by age, or just by looking - have to do ____ measurements (probing) and ____

A 
6
visually
recession
clinical
FMX
33
Q

Periodontitis Update

  • Probing depth (PD)
  • CAL
  • BOP
  • Full mouth radiographs• Safest bet to stick with clinical attachment loss
    • Table summarizes update and the 1999 classification
    • Update: three categories, slight (mild),moderate severe (advanced)
    • Keep same guidelaines for CAL (1-2, mild, 3-4, mod >5 severe), keep BOP
    • Include ____, and ____
    ○ More >3mm <5mm, that can be slight perio; 5-6 is mod; >7 severe; probing depth by itself doesn’t mean much, need radiograph
    ○ 15% silgt, 16-30 mod, >30 severe
    ○ Combine > use own ____ if not agreeing > then you look at ____
A

probing depth
radiographic bone loss
judgement
CAL

34
Q

Inflammation on Reduced Periodontium Update

  • Probing depth (PD) (=< ____mm)
  • CAL (>____)
  • BOP
  • Full mouth radiographs
A

3

0

35
Q

Healthy but Reduced Periodontium Update

  • Probing depth (PD) (=< ____)
  • CAL (>____)
  • NO ____!!!!
  • Full mouth radiographs
A

3
0
BOP

36
Q

Aggressive Periodontitis

Systemic Diseases
Medication

CAL
BOP
Plaque Index

Radiographs

• For aggressive, you also need absence of \_\_\_\_, no \_\_\_\_ that affecting periodontium, and \_\_\_\_ index (very little relative to disease, opposite of chronic)
	○ Little amounts, but a lot of disease
• Radiograph - bone loss, but also typical characteristic patterns of bone loss
A

systemic diseases
medications
plaque

37
Q

SAME EXTENT AND SEVERITE FOR AGGRESSIVE PERIO AS THERE IS FOR CHRONIC!!

A

YAY

38
Q

Characteristics of Aggressive Periodontitis

Otherwise ____ healthy patient
Rapid attachment loss and bone destruction
Amount of microbial deposits ____ with disease severity
____ aggregation of diseased individuals

* No systemic disease or medication affecting CAL
* Rapid attachment loss and bone destruction (v diff from chronic)
* Need at least \_\_\_\_ examinations (in order to determine rate)
* Small plaque, a lot of disease; cannot be explained by this only
* Family lost teeth at very early age
A

systemically
inconsistent
familial

39
Q

Characteristics of Aggressive Periodontitis

Localized Juvenille Periodontitis (LJP, 1989 Classification)
Age of onset in the ____ period
____ and ____, usually ____
Associated with ____ Abnormalities in neutrophil or monocyte function

* Not a current term - not used to diagnose - comes from \_\_\_\_ classification
* Around puberty
* AA > certain type of lozalized aggressive perio, this LJP
A 
circumpubertal
first molars
incisors
bilateral
AA
89
40
Q

Periodontitis as a Manifestation of Systemic Diseases
o IV. A. Associated with hematological disorders
• 1. Acquired ____
• 2. Leukemias
• 3. Other

o  IV. B. Associated with genetic disorders
•  1. Familial and cyclic neutropenia
•  2. \_\_\_\_ syndrome
•  3. Leukocyte adhesion deficiency syndromes
•  4. \_\_\_\_ syndrome
•  5. Chediak-Higashi syndrome
•  6. \_\_\_\_ syndromes
•  7. Glycogen storage disease
•  8. Infantile genetic agranulocytosis
•  9. \_\_\_\_ syndrome
•  10. Ehlers-Danlos syndrome (Types IV and VIII)
•  11. \_\_\_\_
•  12. Other
A 
neutropenia
down
papillon
hisocytosis
cohen
hypophosphatasia
41
Q

Perio as a manifestation of systemic disease

____ disease
____
____

SAME EXTENT AND SEVERITY FOR PERIO!

A

systemic
CAL
BOP

42
Q

“Special” Periodontal Disease Diagnosis

V. Necrotizing Periodontal Diseases
A. ____
B. ____

A

Necrotizing ulcerative gingivitis (NUG)

necrotizing ulcerative periodontitis (NUP)

43
Q

Clinical Characteristics of NUG
• Interproximal necrosis and ulceration, ____ and ____ papillae
• ____ – spontaneous or on slight provocation
• ____ gingiva

  • Gray ____
  • Fetor oris (bad ____)
  • Slight fever, ____ , lymphadenopathy
    • First three must be present for NUG ***
    • Periodontal disease - no pain
    • The last three may be present, but not necessary
    • Systemic ____ > slight fever, malaise, lymphadenopathy
A

punched-out
cratered
bleeding
painful

pseudomembrane
breath
malaise

manifestations

44
Q

Pathogenesis of NUG

  • Usually ____ individuals
  • Associated with impaired ____
  • Associated with ____ factors, such as stress, smoking, fatigue
  • Associated with ____, spirochetes, ____ intermedia
    • Typical in students around ____ period
    • Specific bacteria
A 
younger
host response
predisposing
fusiform bacilli
prevotella
exam
45
Q

Clinical Characteristics of NUP
• Interproximal necrosis and ulceration, punched-out and cratered papillae
• Bleeding – spontaneous or on slight provocation
• Painful gingiva
• Gray pseudomembrane
• Fetor oris (bad breath)
• Slight fever, malaise , lymphadenopathy

• In addition, ____ and ____

A

clinical attachment loss

alveolar bone loss

46
Q

Abscesses of the Periodontium
A localized purulent infection

  • ____: involves the marginal gingiva or interdental papilla
  • ____: within the tissues adjacent to the periodontal pocket that may lead to the destruction of periodontal ligament and alveolar bone
  • ____: within the tissue surrounding the crown of a partially erupted tooth

abscesses Usually seen with ____

A

gingival
periodontal
pericoronal

third molars

47
Q 
Characteristics of Periodontal Abscesses
•  \_\_\_\_
•  Swelling
•  \_\_\_\_
•  BOP
•  \_\_\_\_
•  Tooth mobility
A

Pain
pocket
suppuration

48
Q

Etiology of Periodontal Abscesses

Absence of periodontitis
____ impaction
Associated with ____ lesions

Presence of periodontitis
Untreated ____ after systemic antibiotic therapy
Residual apical calculus in deep pockets after non-surgical ____

* A lot of local factors > receive antibiotics > the marginal tissue is reduced, and the tissue can tighten > formation of an abscess when theres' subging calc in the pocket
* IF some calculus is left, then the ifnlammation goes down but then it forms an abscess***
A

foreign object
endodontic
periodontitis
SRP

49
Q

Periodontitis Associated with Endodontic Lesions
• Primary Endodontic Lesion
• Primary Endodontic Lesion with Secondary Periodontal Involvement
• Primary Periodontal Lesion
• Primary Periodontal Lesion with Secondary Endodontic Involvement
• “True” Combined Endodontic and Periodontal Involvement

* PPL > \_\_\_\_ pocket that can be an endodontic lesion, if it hits the pulp
* True - bacteria from pulp and perio and \_\_\_\_
* \_\_\_\_ origin of lesion can tell you the course of treatment
A

deep
meet
primary

50
Q

What is Gingival Recession?

Gingival Recession: location of the gingival margin (GM)
____ to the cementoenamel junction (CEJ)

A

apical

51
Q

What is Gingival Recession?
Gingival Recession: location of the gingival margin (GM)
apical to the cementoenamel junction (CEJ)

• due to periodontitis, that affects all ____ surfaces and is usually
____
• primarily related to ____ factors, that affects facial or lingual surfaces and is ____ or partially reversible with periodontal reconstructive surgery

• Or mechanical (facial or lignual) > \_\_\_\_ > can treat with grafting and can cover roots
A 
tooth
irreversible
mechanical
reversible
reversible
52
Q

MILLER CLASS FROM WANG!

Class I: ____ root coverage can be anticipated
Class II: ____ root coverage can be anticipated
Class III: ____ root coverage can be anticipated
Class IV: Root coverage ____ be anticipated

A

100%
100%
partial
cannot

53
Q

VIII. B. Mucogingival deformities and conditions around teeth
2. Lack of keratinized gingiva
• Inability of patient to ____ effectively, and in placing a ____ - the soft tissue surrounding may not be able to withstand ____

A

brush
restoration
forces

54
Q

VIII. B. Mucogingival deformities and conditions around teeth
4. Aberrant frenum/muscle position
• Bt max central incisors, or wherever ____ - ____ type defects

A

frenum

recession

55
Q

o VIII. B. Mucogingival deformities and conditions around teeth
5. Gingival excess
a. pseudopocket
• Gingival ____

b. inconsistent gingival margin
• Gingival ____
• More aesthetic conditions
• Can be ____

c. excessive gingival display
• Gummy smile, showing a lot of ____
• Can be ____

d. gingival enlargement
• ____ patients - related to rotho appliances

A 
excess
excess
treated
soft tissue
treated
ortho
56
Q

o VIII. B. Mucogingival deformities and conditions around teeth
6. Abnormal color
• ____ tattoo - used for apilocteomy
• Discoloration to ____ used

A

amalgam

restoration material

57
Q

o VIII. C. Mucogingival deformities and conditions on edentulous ridges
• 1. Vertical and/or horizontal ridge deficiency

Class I: ____ (____)
Class II: ____ (____)
Class III: ____

* Cannot find II > when tooth extracted, horizontal doesn't always happen by itself, rare, \_\_\_\_ usually always happens
* III> deficiency in both
* In order to prepare for implant, need \_\_\_\_
A 
bucco-lingual
horizontal
apico-coronal
vertical
combination

vertical
ridge dimensions

58
Q

VIII. Developmental or Acquired Deformities and Conditions
D. Occlusal Trauma
Injury resulting in tissue changes within the
attachment apparatus as a result of ____

A

occlusal forces

59
Q

VIII. D. Occlusal Trauma
• 1.Primary occlusal trauma: injury resulting in tissue changes from excessive ____ applied to a tooth or teeth with ____ support
• 2.Secondary occlusal trauma: injury resulting in tissue changes from ____ or ____ occlusal forces applied to a tooth or teeth with ____ support

* Primary - in the absence of \_\_\_\_
* Secondary - pt with \_\_\_\_, even normal forces, the perio cannot withstand bc its reduced
A 
occlusal forces
normal
normal
excessive
reduced

periodontitis
perio

60
Q 
Clinical Signs of Occlusal Trauma
•  \_\_\_\_
•  Fremitus
•  Occlusalprematurities
•  \_\_\_\_ (in presence of other clinical indicators) 
	• Seen on \_\_\_\_/\_\_\_\_
  • Tooth migration
  • Fractured tooth(teeth)
  • ____ sensitivity
    • How do we diagnose? Not easy, no ____ measures
    • Clinical or radiograph signs used to diagnose
    • Fremitus - when you bite and your teeth move a lot; and ____ mobility
    • Wear facets in presence of others, not by themselves
    • Need to have some of these signs present
A 
mobility (progressive)
wear facets
functional cusps
incisal edges
thermal
objective
functional
61
Q

Radiographic Signs of Occlusal Trauma
• Widened ____ space
• Bone loss (____; vertical; ____)
• Root ____

• PDL is widened when compared to other teeth
A

PDL
furcation
circumferential
resorption

Perio I (10 decks)

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