Classification

Question 1

Why do diseases need to be classified?

Answer 1

to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment

Question 2

Where were the problems with the 1999 classification system?

Answer 2

room for interpretation - no strict categories
did not eleborate on risk factors i.e smoking, diabetes

Question 3

Where is bleeding upon probing common and not usually due to gingivitis?

Answer 3

impactation of wisdom teeth

Question 4

What were the aims of the 2017 classification?

Answer 4

• Capture extent, severity
  – (amount of periodontal tissue loss)
• Patient susceptibility
  – (estimated by historical rate of progression)
• Current periodontal state
  – (pocket depths/bleeding on probing)

Question 5

What are the characteristics of healthy gingiva?

Answer 5

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.

Question 6

What are the locations of plaque induced gingivitis?

Answer 6

localised
generalised

Question 7

What is the requirement for location?

Answer 7

Bleeding on Probing
<30% - localised
>30% - generalised

Question 8

What is an intact periodontium?

Answer 8

No radiological bone loss
No interdental recession

Question 9

What are sex hormone modifying factors of gingivitis?

Answer 9

puberty
menstrual cycle
pregnancy
oral contraceptives

Question 10

What are the other systemic conditions that can modify plaque induced gingvitis?

Answer 10

hyperglycaemia (diabetes)
leukemia
smoking
malnultrutuin

Question 11

What is a pregnancy epulis?

Answer 11

mucogingival deformity

Question 12

What are the oral factors that can enhance plaque accumulation?

Answer 12

prominent subgingival restoration margins
hyposalivation

Question 13

What is score 0?

Answer 13

Pockets
<3.5mm
No calculus/overhangs, no bleeding on probing (black band entirely visible)

Question 14

What is score 1?

Answer 14

Pockets
<3.5mm
No calculus/overhangs, bleeding on probing (black band entirely visible)

Question 15

What is score 2?

Answer 15

Pockets
<3.5mm
Supra or subgingival calculus/overhangs (black band entirely visible)

Question 16

What is score 3?

Answer 16

Probing depth
3.5-5.5mm
(Black band partially visible, indicating pocket of 4-5mm)

Question 17

What is score 4?

Answer 17

Probing depth
>5.5mm
(Black band disappears, indicating a pocket of 6mm or more)

Question 18

What is *?

Answer 18

furcation involvement

Question 19

What should happen if a patient scores 3 or 4?

Answer 19

• 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

Question 20

What is the dentition divided into in BPE?

Answer 20

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)

Question 21

According to the BSP guidelines, what should happen if a sextant scores 3?

Answer 21

if a sextant scores 3, this sextant should be reviewed AFTER treatment and a pocket chart for that sextant should be made (after)

Question 22

According to SDCEP guidelines, what should happen if a sextant scores 3?

Answer 22

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)

Question 23

How is the type of periodontitis assessed?

Answer 23

staging and grading system
stage (1-4)
grade (A, B, C)

Question 24

What is stage 1?

Answer 24

early/mild
<15% or 2mm bone loss at worst site

Question 25

What is stage 2?

Answer 25

moderate
3-4 mm loss
coronal third of root bone loss

Question 26

What is stage 3?

Answer 26

severe (potential for additional tooth loss)
>5mm loss
mid third of root bone loss

Question 27

What is stage 4?

Answer 27

very severe (potential for loss of denition)
>5mm loss
apical third of root bone loss

Question 28

What stage is the PD if patient has lost teeth due to perio?

Answer 28

stage 4

Question 29

What if the only radiographs are bitewings, how should bone loss be assessed?

Answer 29

measure from CEJ

Question 30

What is grade A?

Answer 30

slow
<0.5 % bone loss / age
max bone loss less than half patients age

Question 31

What is grade B?

Answer 31

moderate
0.5 - 1 % bone loss / age

Question 32

What is grade C?

Answer 32

rapid
> 1 % max bone loss more than patients age

Question 33

What are is the extent categorisations of PD?

Answer 33

Localised – (<30% of teeth)
Generalized (more than 30% of teeth
Molar incisor pattern

Question 34

If recession is present, what code should be used?

Answer 34

code 4

Question 35

What is the first step should be undertaken if there is a PD diagnosis?

Answer 35

radiographs (periapicals or OPG)

Question 36

What are the classifications of a PD patient?

Answer 36

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

Question 37

What is the diagnostic pathway?

Answer 37

– Identify the type and extent of periodontal disease (if periodontitis then with staging and grading)
– Identification of current health/disease status (PPD and BoP)

Question 38

What is an example of a diagnosis?

Answer 38

Generalised Periodontitis; Stage IV, Grade B; currently unstable’

Question 39

What is the BPE used for?

Answer 39

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.

Question 40

Why is 4mm used?

Answer 40

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.