Classification

Question 1

If BPE code 0, 1 or 2 with no obvious evidence of interdental recession, what are the possible diagnoses?

Answer 1

Clinical gingival health: <10% BOP
Localised gingivitis: 10-30% BOP
Generalised gingivitis: >30% BOP
Diagnosis should also comment on plaque retentive factors where code 2 is present

Question 2

What are the outcomes of a code 3 BPE with no obvious interdental recession?

Answer 2

• appropriate radiographic assessment
• initial periodontal therapy and review in 3 months with localised 6ppc in involved sextant
  If no pockets >4mm and no radiographic evidence of bone loss, continue code 0, 1 or 2 pathway
  If pockets >4mm remain and-or radiographic bone loss, continue with code 4 pathway

Question 3

What should you do with a code 4 BPE and/or obvious interdental recession?

Answer 3

• appropriate radiographic assessment
• detailed 6ppc
  Periodontitis Molar-Incisor Pattern: molar incisor pattern
  Localised periodontitis: <30% of teeth
  Generalised periodontitis: >30% of teeth

Question 4

How do you stage a peiodontitits?

Answer 4

• radiographic assessment of worst site of interproximal bone loss due to periodontitis
  Stage I (early/mild): <15% or <2mm attachment loss from CEJ
  Stage II (moderate): coronal third of root
  Stage III (severe): mid third of root
  Stage IV (very severe): apical third of root

Question 5

How is periodontitis graded?

Answer 5

• worst site of bone loss % / patient age
  Grade A (slow): <0.5 - less than half patients age
  Grade B (moderate): 0.5-1.0 - half to patients age
  Grade C (rapid): >1.0 - more than patients age

Question 6

How do you assess current periodontitis status?

Answer 6

Currently stable: <10% BOP, PPD <4mm, no BOP at 4mm sites
Currently in remission: >10% BOP, PPD <4mm, no BOP at 4mm sites
Currently unstable: PPD >5mm or PPD 4mm with BOP

Question 7

What is the diagnosis statement of periodontal disease?

Answer 7

Extent - periodontitis - stage - grade - stability - risk factors
e.g. Generalised periodontitis stage 3 grade B currently unstable, risks smokes 15/day

Question 8

Why is smoking a risk factor for periodontal disease?

Answer 8

• reduction in gingival blood circulation resulting in reduction in bleeding when brushing and probing
• impaired white blood cell mobility and function
• impaired wound healing
• increased production of inflammatory substances (cytokines) which results in an increased production of collagenase
  Treatment outcomes are not so good for smokers vs non smokers and the recurrence of disease is more likely.

Question 9

What are some local risk factors for plaque accumulation?

Answer 9

• calculus, enamel pearls, root grooves and concavities, malpositioned teeth, overhangs, poorly fitting/contoured restorations, removeable partial dentures

Question 10

How is mobility measured?

Answer 10

Two handles of instruments placed buccally and lingually
Grade 1: horizontal movement 0.2-1.0mm
Grade 2: horizontal movement of crown >1mm
Grade 3: horizontal movement of crown >1mm and movement in a vertical direction