Classification and Clinical Features of Periodontal Disease Flashcards
what percentage of adults show significant periodontal disease
10-12%
Most common inflammatory disease seen in humans
Periodontal disease
Gingivitis
inflammatory response of the marginal gingiva,
reversible condition.
Periodontitis
Inflammatory condition resulting in the irreversible loss of the tooth supporting structures, periodontal ligament and alveolar bone
Periodontitis stages
Currently stable, currently in remission, currently unstable
periodontitis currently stable
BOP <10%
PPD <= 4mm
no BOP at 4mm sites
Periodontitis currently in remission
BOP >10%
PPD <= 4mm
no BOP at 4mm sites
Periodontitis currently unstable
PPD>5mm
PPD>4mm and BOP
Why is prevention and management of periodontal disease essential?
can cause tooth mobility, drifting of teeth, tooth loss
can lead to low self esteem, reduction in functional capacity, impacts social relationships and quality of life
Classification of periodontal and peri-implant disease and conditions
- periodontal health and ginigival health
- gingivitis: dental biofilm induced
- gingival disease: non-dental biofilm induced
Plaque retentive factors
calculus poor restoration margins tooth position/angulation developmental anomalies oral appliances (dentures, orthodontic) xerostomia (drug induced, head and neck radiation)
Supraginigval calculus
attached to tooth (commonly found on lingual surfaces of lower anterior teeth and buccal surfaces of upper first molars) creamy-yellow fairly hard easily removed brittle visible
Subgingival
attached to root surfaces, not related to saliva/salivary gland brown/black very hard tenacious detected by gentle probing/radiograph
risk factors for gingival inflammation
increased plaque retention poor restorative dentistry sub-gingival crown margins drug-induced gingival overgrowth fixed appliance therapy amalgam overhangs incompetent lip posture
Gingival diseases non-dental biofilm induced
a. Genetic/developmental disorders
b. Specific infections – bacterial, viral, fungal
c. Inflammatory and immune conditions
d. Reactive processes
e. Neoplasms
f. Endocrine, nutritional & metabolic diseases
g. Traumatic lesions
h. Gingival pigmentation
clinical presentation of periodontitis
Formation of periodontal pockets Bleeding on probing Gingival inflammation Drifting of teeth Tooth Mobility Gingival recession
radiographic presentation of periodontitis
Loss of alveolar bone - >1.5mm apical to CEJ
diagnosis of periodontitis using 2017 classification
pattern, stage, grade, stability, risk factor profile
pattern of periodontitis
localised <30% teeth
generalised >30% teeth
molar-incisor (only involving molars or incisors
staging in full
Assessment of greatest site of clinical attachment loss
Assessment of radiographic bone loss
Assessment of tooth loss due to periodontitis
Maximum pocket depth
Furcation involvement
Occlusal trauma
staging in BSP modification
assessment of radiographic bone loss
stage of periodontitis using worst site of inter-proximal bone loss due to periodontitis
Stage I
(early/mild)<15% or <2mm –> only use mms if only bitewing radiograph available or no radiographs clinically justified
Stage II
(moderate)Coronal third of root
Stage III
(severe)Mid third of root
Stage IV
(very severe)Apical third of root
Grading BSP modification
ratio of percentage bone loss to age
grade of periodontitis using worst site of bone loss divided by age
Grade A (slow) <0.5 Grade B (moderate) 0.5-1.0 Grade C (rapid) >1.0
Grade A: Maximum bone loss is less that half the patient’s age
Grade C: Maximum bone loss is greater than the patient’s age
Grade B: All other situations
risk factor for periodontitis status
Smoking Poorly-controlled diabetes Family history Poor plaque control Subgingival deposits of calculus Local factors: mouth-breathing, crowding
determining a diagnosis
- condition
- distribution
- classification (stage, grade)
- stability
- risk factor profile
