Classification and epidemiology of periodontal diseases Flashcards
1
Q
What are the 2 basic classifications of periodontal disease?
A
- Gingivitis
2. Periodontitis
2
Q
What is the main difference between periodontitis and gingivitis?
A
Gingivitis is reversible where as periodontitis is irreversible
3
Q
Describe the clinical appearance of gingivitis
A
Redness of gingiva
Swelling of gingiva
Bleeding on probing
Inflammation of the gingival tissues
4
Q
What is the main debate surrounding gingivitis?
A
There been discussion on whether it is a disease as almost 90% of people have gingivitis
So is it a normal response or a disease?
5
Q
Which classification for periodontal disease do we use?
A
Classification of 1999 International Workshop for a Classification of Periodontal Diseases and Conditions has been used until now
6
Q
What are the 2 main 1999 classifications of periodontitis?
A
- Chronic
2. Aggressive
7
Q
Why has a new updated version of the classification been published?
A
Because we have a lot of new knowledge now that needs to be added
The new classification tries to also acknowledge what we do not know
8
Q
What are the 4 main titles given to periodontal diseases and condition according to the 2017 classification?
A
- Periodontal health, gingival diseases and conditions
- Periodontitis
- Other conditions affecting the periodontium
- Peri-implant diseases and conditions
9
Q
What categories fall under Periodontal health, gingival diseases and conditions?
A
- Periodontal health and gingival health
- Gingivitis: dental biofilm induced
- Gingivitis: non-dental biofilm induced
10
Q
What categories fall under Periodontitis?
A
- Necrotising periodontal diseases
- Periodontitis
- Periodontitis as a manifestation of systemic disease
11
Q
What categories fall under Other conditions affecting the periodontium?
A
- Systemic diseases or conditions affecting the periodontal supporting tissues
- Periodontal abscesses and endodontic periodontal lesions
- Mucogingival deformities and conditions
- Traumatic occlusal forces
- Tooth and prosthesis related factors
12
Q
What categories fall under Peri-implant diseases and conditions ?
A
- Peri-implant health
- Peri-implant mucositis
- Peri-implantitis
- Peri- implant sort and hard tissue deficiencies
13
Q
What does periodontal and gingival health describe?
A
- Patients that have clinical gingival health on an intact periodontium
- Patients that may have had periodontitis but are now stable may have Clinical gingival health on a reduced periodontium
14
Q
What is gingivitis categorised into?
A
- Dental biofilm induced
2, Non-dental biofilm induced
15
Q
What is another name for dental biofilm?
A
Dental plaque
16
Q
Describe some clinical symptoms someone with dental biofilm induced gingivitis may display
A
- False gingival pockets
- Inflamed gingiva
- Normal sulcus depth
17
Q
What is
dental biofilm induced gingivitis associated with?
A
- May be associated with dental biofilm alone
- Can be mediated by systemic or local risk factors
- Could be drug influenced gingival enlargement
18
Q
What are some local contributing factors that contribute to
dental biofilm induced gingivitis?
A
- Lack of saliva
- Tooth anatomic factors
- Dental restoration/ appliances that are harder to clean
19
Q
Name some local risk factors that cause dental plaque induced gingivitis
A
- High fraenal attachments
- Fixed orthodontic appliance
- Incompetent lips, mouth breather, lack of saliva
- Amelogenesis imperfecta
- calculus
20
Q
Name some systemic risk factors associated with dental biofilm induced gingivitis
A
- Associated with endocrine system like puberty, menstrual cycle, pregnancy, diabetes
- Associated with endocrine system like leukaemia
21
Q
What is a common condition some pregnant women may have?
A
Epulis are common
22
Q
Name some drugs that can contribute to gingival enlargement
A
- Phenytoin (for epilepsy)
- Ciclosporin (immunosuppressant for prevention of organ rejection after transplants)
- Calcium channel blockers eg amlodipine, nifedipine, diltiazem for heart problems (high blood pressure, angina prophylaxis)
23
Q
Name some drugs that can contribute to gingivitis
A
oral contraceptive associated gingivitis
24
Q
What is
dental non biofilm induced gingivitis associated with?
A
- Genetic/ developmental disorders
- Specific infections
- Inflammatory and immune conditions
- Reactive processes
- Neoplasms
Endocrine, nutritional and metabolic diseases - Traumatic (eg finger nail picking)
- Gingival pigmentation
25
Name some genetic/ developmental disorders that contribute to periodontal disease
1. hereditary gingival fibromatosis
| 2. herpetic gingivostomatitis
26
How do we classify periodontitis?
Classified by Staging and Grading as periodontitis in now on a spectrum from slow to rapid progression
27
How are the 2 theories digesting how periodontal disease spreads
1. Linear / Continuous
2. Bursts of activity (either random burst or asynchronous multiple bursts clustered during a particular period of patient’s life?
28
How are we now classifying periodontitis ?
We now classify by:
1. stages
2. Extent and distribution
3. Grades
29
What are the 3 forms of periodontitis?
1. Necrotising periodontal diseases
2. Periodontitis as manifestation of systemic diseases
3. Periodontitis
30
What are the 3 categories of necrotising periodontal diseases
1. Necrotising gingivitis
2. Necrotising periodontitis
3. Necrotising stomatitis
31
What are the 4 stages periodontitis has been split into?
1. Initial
2. Moderate
3. Severe: potential for additional tooth loss
4. Severe: potential for loss of dentition
32
What are the 3 phrases used to describe the extent and distribution of periodontitis?
1. Localised
2. Generalised
3. Molar / incisor
33
What are the 3 grades we use to describe periodontitis?
A. Slow rate of progression (<0.5)
B. Moderate rate of progression (0.5 – 1.0)
C. Rapid rate of progression (>1.0)
34
How do we stage a tooth?
We look at the worst tooth and assess extent of bone loss
| We see if bone loss is in the coronal, mid or apical third of the root
35
How do we grade a tooth?
We look at the percentage of bone loss per age rain
36
What can necrotising periodontal disease be associated with?
May be associated with HIV positive status
37
What does necrotising ulcerative gingivitis associated with?
starts with changes in gingival contour
38
Describe the clinical symptoms of necrotising ulcerative gingivitis
Necrosis “punched out” interdental papillae
ulceration
bleeding, pain
possible secondary factors, pseudomembrane
39
Describe the clinical symptoms of necrotising ulcerative periodontitis
necrosis gingival tissues
| periodontal ligament and bone break down that doesn't heal well
40
What stage number and grade describes periodontitis in the new classification?
Stage 3 or 4
| Grade B
41
Where is periodontitis more prevalent?
Prevalent in adults but can occur in adolescence
42
Describe the progression of grade B periodontitis
Slow to moderate progression & exacerbations
43
What are some modifying that can influence periodontitis?
local factors (supragingival & subgingival calculus are frequent findings);
systemic factors;
smoking;
stress
44
At what clinical attachment loss is a patient considered to have true periodontitis?
>3mm
45
What is recession?
Measurement from the CEJ to the gingival margin
46
What is the clinical attachment loss in adolescents with periodontitis?
> 1 mm
47
What is the prevalence of periodontitis in adolescents ?
39% in 15-yr-old Caucasians,
| 78% in 15-yr-old Indo-Pakistanis
48
What is the probing depth in adolescents with periodontitis?
4mm-5mm
49
What type of bone loss may adolescent with periodontitis have?
Incipient crestal alveolar bone loss
| which may be detected on serial bitewing radiographs
50
Name some Complex subgingival microflora in teenagers
P. gingivalis,
P. intermedia,
A. actinomycetemcomitans
51
What are some common features of aggressive periodontitis?
1. patients healthy except for periodontitis
2. rapid attachment loss and bone destruction
3. familial aggregation
52
What are the 2 forms of aggressive periodontitis?
1. Localised form
| 2. Generalised form
53
What are some secondary features general present alongside aggressive periodontitis?
1. amounts microbial deposits inconsistent with severity of destruction
2. elevated proportions A. actinomycetemcomitans and in some populations, P.gingivalis
3. phagocyte abnormalities
4. hyper-responsive macrophage phenotype
5. progression of attachment loss and bone loss may be self limiting
54
What are some specific features associated with localised aggressive periodontitis?
1. circumpubertal onset
2. robust serum antibody response to infecting agent (A. actinomycetemcomitans)
3. localised first molar/incisor presentation
55
What is the new 2018 classification fro 'aggressive' periodontitis?
Stage 4 (or sometimes 3) cases
Extent: Molar/incisor if localised or Generalised
Grade will be C for rapid
56
What are some specific features associated with generalised aggressive periodontitis?
1. usually affects age < 30 yrs, may be older
2. poor serum antibody response to infecting agents
3. pronounced episodic nature of destruction
4. generalised interproximal attachment loss affecting at least three teeth other than first molars and incisors
57
What is Periodontitis occurring pre-pubertally is mostly a manifestation of?
Systemic conditions like leucocyte adhesion deficiency; neutropenia; Papillon-Lefevre syndrome; Downs syndrome; hypophosphatasia; Chediak Higashi syndrome
58
What is epidemiology of periodontal diseases a study of?
The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems.
59
What are the types of periodontal epidemiology?
1. Cross-sectional study
2. Longitudinal study
3. Descriptive
4. Analytical
60
What is a cross sectional study?
A study conducted at a particular time point
61
What is a Longitudinal study?
A study that extends over a period of time
62
What are cross sectional studies often described as?
Bein descriptive
63
What are longitudinal studies often described as?
As analytical
64
What can we look at when we look at the distribution of periodontal diseases
Differences according to:
1. age
2. ethnic status,
3. developing/developed countries
4. social class
5. various risk factors
65
What percentage of the uK public is periodontally healthy according to the national survey?
17%
66
What percentage of the uK public had bleeding according to the national survey?
54%
67
What percentage of the uK public had bleeding shallow pockets of 4mm or more according to the national survey?
45%
68
What percentage of the uK public had bleeding deep pockets of 6mm or more according to the national survey?
9%
69
What percentage of dentate adults in England aged 55 years and over had loss of attachment of 4mm or more according to the national survey?
65%
70
What percentage of dentate adults in England aged 55 years and over had loss of attachment of 6mm or more according to the national survey?
20%
71
What percentage of dentate adults in England aged 55 years and over had loss of attachment of 9mm or more according to the national survey?
4%
