Classification Flashcards
Why do diseases need to be classified?
to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment
Where were the problems with the 1999 classification system?
room for interpretation - no strict categories
did not eleborate on risk factors i.e smoking, diabetes
Where is bleeding upon probing common and not usually due to gingivitis?
impactation of wisdom teeth
What were the aims of the 2017 classification?
- Capture extent, severity
– (amount of periodontal tissue loss) - Patient susceptibility
– (estimated by historical rate of progression) - Current periodontal state
– (pocket depths/bleeding on probing)
What are the characteristics of healthy gingiva?
absence of bleeding on probing, erythema and edema, patient symptoms, and attachment and bone loss.
physiological bone levels range from 1.0 to 3.0 mm apical to the cemento-enamel junction.
For an intact periodontium and a reduced and stable periodontium, gingival health is defined as < 10% bleeding sites with probing depths ≤3 mm.
What are the locations of plaque induced gingivitis?
localised
generalised
What is the requirement for location?
Bleeding on Probing
<30% - localised
>30% - generalised
What is an intact periodontium?
No radiological bone loss
No interdental recession
What are sex hormone modifying factors of gingivitis?
puberty
menstrual cycle
pregnancy
oral contraceptives
What are the other systemic conditions that can modify plaque induced gingvitis?
hyperglycaemia (diabetes)
leukemia
smoking
malnultrutuin
What is a pregnancy epulis?
mucogingival deformity
What are the oral factors that can enhance plaque accumulation?
prominent subgingival restoration margins
hyposalivation
What is score 0?
Pockets
<3.5mm
No calculus/overhangs, no bleeding on probing (black band entirely visible)
What is score 1?
Pockets
<3.5mm
No calculus/overhangs, bleeding on probing (black band entirely visible)
What is score 2?
Pockets
<3.5mm
Supra or subgingival calculus/overhangs (black band entirely visible)
What is score 3?
Probing depth
3.5-5.5mm
(Black band partially visible, indicating pocket of 4-5mm)
What is score 4?
Probing depth
>5.5mm
(Black band disappears, indicating a pocket of 6mm or more)
What is *?
furcation involvement
What should happen if a patient scores 3 or 4?
- Code 3: Initial therapy including self-care advice (oral hygiene instruction and risk factor control) then, post-initial therapy, record a 6-point pocket chart in that sextant only
- Code 4: If there is a Code 4 in any sextant then record a 6-point pocket chart throughout the entire dentition
What is the dentition divided into in BPE?
The dentition is divided into 6 sextants and the highest score for each sextant is recorded:
Upper right (17 to 14)
Lower right (47 to 44)
Upper anterior (13 to 23)
Lower anterior (43 to 33)
Upper left (24 to 27)
Lower left (34 to 37)
According to the BSP guidelines, what should happen if a sextant scores 3?
if a sextant scores 3, this sextant should be reviewed AFTER treatment and a pocket chart for that sextant should be made (after)
According to SDCEP guidelines, what should happen if a sextant scores 3?
If a sextant scores 3, a 6 point pocket chart should be completed for that sextant BEFORE treatment and AFTER. ‘full periodontal examination of all teeth and root surface instrumentation where necessary (N.B. Where code 3 is observed in only one sextant, carry out full periodontal examination and root surface instrumentation of affected teeth in that sextant only)
How is the type of periodontitis assessed?
staging and grading system
stage (1-4)
grade (A, B, C)
What is stage 1?
early/mild
<15% or 2mm bone loss at worst site
What is stage 2?
moderate
3-4 mm loss
coronal third of root bone loss
What is stage 3?
severe (potential for additional tooth loss)
>5mm loss
mid third of root bone loss
What is stage 4?
very severe (potential for loss of denition)
>5mm loss
apical third of root bone loss
What stage is the PD if patient has lost teeth due to perio?
stage 4
What if the only radiographs are bitewings, how should bone loss be assessed?
measure from CEJ
What is grade A?
slow
<0.5 % bone loss / age
max bone loss less than half patients age
What is grade B?
moderate
0.5 - 1 % bone loss / age
What is grade C?
rapid
> 1 % max bone loss more than patients age
What are is the extent categorisations of PD?
Localised – (<30% of teeth)
Generalized (more than 30% of teeth
Molar incisor pattern
If recession is present, what code should be used?
code 4
What is the first step should be undertaken if there is a PD diagnosis?
radiographs (periapicals or OPG)
What are the classifications of a PD patient?
stable = (treated case of periodontal health) BOP <10% PPD < 4mm
remission = (case with some gingival inflammation and BOP) BOP >10% PPD < 4mm with no BOP at site
unstable = (case of recurrent periodontitis) BOP >10% PPD > 5mm OR > 4mm with BOP at site
What is the diagnostic pathway?
– Identify the type and extent of periodontal disease (if periodontitis then with staging and grading)
– Identification of current health/disease status (PPD and BoP)
What is an example of a diagnosis?
Generalised Periodontitis; Stage IV, Grade B; currently unstable’
What is the BPE used for?
a screening tool to arrive at a provisional diagnosis of periodontal health, gingivitis or periodontitis, (i.e., irrespective of staging and grading).
the BPE guides the need for further diagnostic measures prior to establishing a definitive periodontal diagnosis and appropriate treatment planning.
Why is 4mm used?
determines periodontal disease stability at non-bleeding sites following successful periodontal therapy.
higher probing depth of 5mm or 6mm in the absence of bleeding may not always represent active disease - in particular soon after periodontal treatment.
