Chronic Periodontitis

Question 1

Chronic Periodontitis is most common in _________, but can also occur in _________ and __________

Answer 1

adults
children
adolescents

Question 2

The amount of microbial plaque and calculus is generally consistent with ________ of the ____________

Answer 2

severity

clinical presentation

Question 3

How does CHRONIC Perio affect bone and gingiva?

Answer 3

• 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

Question 4

What are the characteristics of Chronic Perio?

Answer 4

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)

Question 5

PD is the distance between the _____________ and __________ of the pocket

Answer 5

• Gingival margin

- Base of the pocket

Question 6

Slight severity of chronic periodontitis = __________

Moderate severity of chronic periodontitis = ________

Advanced severity of chronic periodontitis = ________

Answer 6

1-2 mm CAL

3-4 mm CAL

> 5 mm of CAL

Question 7

What is a pseudo pocket?

Answer 7

• 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)

Question 8

What is a periodontal pocket?

Answer 8

• Excessive PD w/ loss of clinical attachment
• Associated w. chronic and aggressive perio
• 2 types: 1) Suprabony pocket 2) Intrabony pocket

Question 9

What is Horizontal bone loss?

Answer 9

Probe depth stops at the base of pocket is coronal to height of bone (supra bony)

Question 10

What is Vertical bone loss?

Answer 10

• 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.

Question 11

________ %of maxillary intrabony defects

Answer 11

35

Question 12

________ %of mandibular intrabony defects

Answer 12

63

Question 13

Intrabony pockets are classified by what ?

Answer 13

The # of remaining bony walls

Question 14

The MOST common bony defect involving posterior teeth _____________?

Answer 14

Interdental Crater (63%)

Question 15

What is the treatment outcome of Horizontal Bone Loss?

Answer 15

• Resect

- Cut away soft tissue loss reposition apically to match bone level

Question 16

What is the treatment outcome of Vertical Bone Loss?

Answer 16

• Regenerate

- May be able to regenerate do a bone graft

Question 17

What is the rate of progression for untreated chronic periodontitis?

Answer 17

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

Question 18

What is the non-surgical Tx of chronic perio?

Answer 18

1) Root planning- smoothing surface of root that has accretions
2) Scaling- removing the debris

Question 19

What is the Effect of Chronic Perio?

Answer 19

• 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

Question 20

What is the Aggressive Periodontitis Red Complex pathogens?

Answer 20

Porphyromonas gingivalis (Pg)
Tannerella forsythia (Tf)
Treponema denticola (Td)

Question 21

Localized Aggressive Periodontitis can be seen with patients that are _________ years old.
Commonly seen with _____________

Answer 21

• circumpubertal (around the time of puberty) onset

- localized first molar/incisor presentation

Question 22

Generalized Aggressive Periodontitis can be seen with patients that are ________ years old

Answer 22

• Affects patients under 30 years of age

- Generalized presentation affecting at least 3 permanent teeth other than first molars and incisors.

Question 23

HOW does NUP(periodontitis) differ from ANUG (gingivitis)?

Answer 23

• 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

Question 24

What are the clinical characteristics of NUP with HIV/AIDS ?

Answer 24

• 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

Question 25

What are the Clinical Symptoms of NUP?

Answer 25

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)

Question 26

What are the Microbes associated with NUP?

Answer 26

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.

Question 27

What is the TX for NUP?

Answer 27

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