Chronic Periodontitis Flashcards
Chronic Periodontitis is most common in _________, but can also occur in _________ and __________
adults
children
adolescents
The amount of microbial plaque and calculus is generally consistent with ________ of the ____________
severity
clinical presentation
How does CHRONIC Perio affect bone and gingiva?
- Loss of furcation bone
- Gingiva appearance is consistent with acute or chronic inflammation (red or red-purple in color, edematous or fibrotic inconsistency, and exhibit altered architecture and contours)
- Gingival recession
- Loss of supporting alveolar bone. Extent & distribution of bone loss can be highly variable
What are the characteristics of Chronic Perio?
1) BOP
2) May express exudate from pockets
3) Disease is not amenable to TX with systemic ABX
4) Tooth mobility leading to migration and extrusion in extreme cases
5) Periodontal abscess formation
6) Painless except during formation of a periodontal abscess
7) Suprabony or intrabony pocket formation ( > or equal to 4 mm PD)
PD is the distance between the _____________ and __________ of the pocket
- Gingival margin
- Base of the pocket
Slight severity of chronic periodontitis = __________
Moderate severity of chronic periodontitis = ________
Advanced severity of chronic periodontitis = ________
1-2 mm CAL
3-4 mm CAL
> 5 mm of CAL
What is a pseudo pocket?
- AKA gingival pocket
- Excessive PD w/out loss of clinical attachment
- sulcus is deepened bc of INCREASED bulk of gingiva
- Seen with gingival edema, overgrowth or inflammatory hyperplasia (soft tissue loss not bone)
What is a periodontal pocket?
- Excessive PD w/ loss of clinical attachment
- Associated w. chronic and aggressive perio
- 2 types: 1) Suprabony pocket 2) Intrabony pocket
What is Horizontal bone loss?
Probe depth stops at the base of pocket is coronal to height of bone (supra bony)
What is Vertical bone loss?
- Base of pocket is apical to height of bone (Intrabony)
- Infrabony defects when bone resorption occurs unevenly, an oblique direction. In infrabony defects of bone resorption primarily affects 1 tooth.
________ %of maxillary intrabony defects
35
________ %of mandibular intrabony defects
63
Intrabony pockets are classified by what ?
The # of remaining bony walls
The MOST common bony defect involving posterior teeth _____________?
Interdental Crater (63%)
What is the treatment outcome of Horizontal Bone Loss?
- Resect
- Cut away soft tissue loss reposition apically to match bone level
What is the treatment outcome of Vertical Bone Loss?
- Regenerate
- May be able to regenerate do a bone graft
What is the rate of progression for untreated chronic periodontitis?
Rate of CAL = 0.1 to 0.3 mm per year for Facial & Lingual surfaces and 0.3 mm per yr for inter proximal areas
What is the non-surgical Tx of chronic perio?
1) Root planning- smoothing surface of root that has accretions
2) Scaling- removing the debris
What is the Effect of Chronic Perio?
- Untreated perio patients will lose 3.5 times MORE teeth than those who receive treatment
- In a 10 yr period UNTREATED will loose 3-4 teeth while TREATED will loose 1 tooth
What is the Aggressive Periodontitis Red Complex pathogens?
Porphyromonas gingivalis (Pg) Tannerella forsythia (Tf) Treponema denticola (Td)
Localized Aggressive Periodontitis can be seen with patients that are _________ years old.
Commonly seen with _____________
- circumpubertal (around the time of puberty) onset
- localized first molar/incisor presentation
Generalized Aggressive Periodontitis can be seen with patients that are ________ years old
- Affects patients under 30 years of age
- Generalized presentation affecting at least 3 permanent teeth other than first molars and incisors.
HOW does NUP(periodontitis) differ from ANUG (gingivitis)?
- CAL and alveolar bone loss is a consistent feature
- All other characteristics appear to be the same
- May be seen in patients with severe malnutrition
- Generally associated w/ severe immune suppression
What are the clinical characteristics of NUP with HIV/AIDS ?
- Ulceration and necrosis of gingival tissue
- Rapid destruction and/or exposure of alveolar bone
- CD4+ counts below 200 cells/mm3
- 73% of patients due within 24 months of diagnosis of NUP
What are the Clinical Symptoms of NUP?
1) low grade fever
2) lymphadenopathy
3) Moderate to severe pain
4) Multiple periodontal abscesses
5) Aggressive necrosis and ulceration of the marginal, papillary, and attached gingiva
6) Aggressive loss of alveolar bone
7) Exposure of inter proximal alveolar bone (Necrotizing Stomatitis)
What are the Microbes associated with NUP?
1) Gram (-) anaerobic enterics
a) Clostridium spp
b) Klebsiella spp
c) Enterococcus spp
2) Candida albicans
3) Epstein- Barr virus
Note: NUP has same microbes as advanced stage chronic perio plus the additional microbes above.
What is the TX for NUP?
1) Metronidazole. 250 mg, #40, q. 6 h
2) Fluconazole (Diflucan), 100 mg,. #28 q. 12 h
3) CHX oral rinse, b.i.d., for 1 month
4) Soft tissue debridement
5) Scaling & root planing
6) 2 month perio maintenance interval