Chapter 4 Flashcards
What is the purpose of a periodontal classification system?
-Communicates clinical findings accurately to other HCPs
-Helps in formulating a diagnosis and treatment plan
-Helps in predicting treatment outcomes (prognosis)
-Helps in submitting info to insurance
What are the 4 case types?
Case 1: Gingivitis
Case 2: Early periodontitis
Case 3: Moderate periodontitis
Case 4: Advanced Periodontitis
Why were “chronic” and “Aggressive” removed from the 1999 classification?
There is little evidence that they have distinct pathophysiology.
The same things cause them, they just happen at different rates
Why were staging and grading added to the classification system?
For individualizing diagnoses and treatment planning and to address progression (grading)
What are the main categories for classification of periodontal disease and conditions as of 2017?
- Gingival disease- plaque and non-plaque induced
- Periodontitis as a manifestation of systemic disease (relationship btw systemic health and disease)
- Necrotizing periodontitis (connected with aggressive)
- Abscesses of the periodontium (perio or endo origin)
- Periodontitis associated with endodontic lesions
- Peri-implant diseases and conditions
- Staging and grading
What is peri-implant mucositis?
Inflammation of the soft tissue around implants
What is peri-implantitis?
Bone loss around an implant
Types of dental biofilm-induced gingivitis
-Associated with dental biofilm only
-Mediated by systemic or local risk factors
-Drug-influenced gingival enlargement
Types of nondental biofilm-induced gingivitis
-Genetic/developmental disorders
-Specific infections
-Inflammatory and immune conditions
-Reactive processes
-Neoplasms
-Endocrine, nutritional and metabolic diseases
-Traumatic lesions
-Gingival pigmentation
3 Types of necrotizing periodontal diseases
Necrotizing gingivitis
Necrotizing periodontitis
Necrotizing stomatitis
What are the periodontitis stages based on?
Severity (CAL, radiographic bone loss)
and
Complexity of management (PD, furcations, bone loss pattern, # of remaining teeth, mobility, masticatory dysfunction)
How are types of periodontitis identified?
By stages, grades and extent and sitribution
How is extent (how many?) and distribution (where?) of periodontits identified?
Localized (<30% of teeth), generalized (>30% of teeth), molar-incisor distribution
What does case phenotype mean?
Can affect how a patient responds to treatment
What does grading of periodontitis tell us?
Evidence of risk progression: direct evidence of radiographs in bone loss/age
Anticipated treatment response: case phenotype, smoking, hyperglycemia
5 Condition categories affecting the periodontium
1- Systemic diseases or conditions
2- Other periodontal conditions
3- Mucogingival deformities and conditions around teeth
4- Traumatic occlusal forces
5- Prostheses and tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontits
Other periodontal conditions
Periodontal abscess
Endodontic-periodontal lesions
Mucogingival deformities and conditions around teeth
1- Gingival phenotype- physical characteristics
2- Ginigval/soft tissue recession
3- Lack of gingiva
4- Decreased vestibular depth- lost teeth or AB loss can create very shallow vestibule
5- Aberrant frenum/muscle position
6- Gingival excess
7- Abnormal color- Amalgam tattoo or near endo-treated teeth
8- Condition of exposed root surface- is it notched out? does it have decay?
Traumatic occlusal forces
1- Primary occlusal trauma- clenching, grinding, occlusal forces
2- Secondary occlusal trauma- Normal chewing forces causing trauma to teeth
3- Orthodontic forces- Controlled traumatic occlusal force
Prostheses and tooth-related factors
1- Localized tooth-related factors- crown margins, overhangs etc.
2- Localized dental prostheses-related factors- sores
Peri-implant diseases and conditions
1- Peri-implant health
2- Peri-implant mucositis
3- Peri-implantitis
4- Peri-implant soft and hard tissue deficiencies
Describe stage I perio
1-2mm CAL
Bone loss in coronal 3rd
No tooth loss due to periodontitis
PD less than 4mm
Mostly horizontal BL
Describe stage II perio
3-4mm CAL
Bone loss in coronal 3rd (15-30%)
No tooth loss due to periodontitis
PD 5mm or less
Mostly horizontal BL
Describe stage III perio
5mm or more CAL
Bone loss extends to middle 3rd of root or beyond
4 or less teeth lost due to perio
PD 6mm or more
Vertical BL 3mm or more
Describe stage IV perio
5mm or more CAL
BL extends to middle 3rd of root and beyond
5 or more teeth lost due to perio
PD 6mm or more
Vertical BL 3mm or greater
Describe grade A perio
No additional bone or attachment loss over last 5 years
Low levels of tissue destruction
Non-smoker
No diabetes
Describe grade B perio
Evidence of less than 2mm additional bone/attachment loss over 5 years
Tissue destruction in line with expectations
Smokes less than 10 cigs a day
HbA1c less than 7% in diabetic pts
Describe grade C perio
2mm or more bone/attachment loss over 5 years
Tissue destruction exceeds expectation
Smokes 10+ cigs a day
HbA1c greater than 7% in diabetic pts
Descriptions of perio stages
Stage I: Initial
Stage II: Moderate
Stage III: Severe w/ potential for tooth loss
Stage IV: Advanced with extensive tooth loss and potential for loss of dentition
Description of perio grades
Grade A: Slow rate of anticipated progression
Grade B: Moderate rate
Grade C: Rapid rate
Description of “localized” perio
30% or less of teeth are involved
Description of “generalized” perio
More than 30% of teeth are involved
Description of “molar/incisor pattern” in perio
Only molars and incisors exhibit perio breakdown
