Classification and epidemiology of periodontal disease Flashcards
From the 1999 classification system of PD, what are the main 8 classifications?
- Gingival diseases
- Chronic periodontitis
- Aggressive periodontitis
- Periodontitis as a manifestation of systemic disease
- Necrotising periodontal diseases
- Abscesses of periodontium
- Periodontitis associated with endodontic lesion
- Developmental or acquired deformities and conditions
What is Gingival disease 1999 classification subdivided into?
A: Plaque induced
- Associated with plaque only (– modern day thoughts of a biofilm not just plaque)
- Modified by systemic factors e.g. pregnancy/diabetes
- Modified by mediations e.g. ciclosporin (immunosuppressant)
- Modified by malnutrition
B: Non-plaque induced
- Bacterial origin
- Viral origin e.g. herpes
- Fungal origin e.g. candida
- Genetic origin e.g. hereditary gingival fibromatosis
- Manifestation of systemic condition e.g. allergy, lichen planus
- Traumatic lesions – chemical/physical/thermal
- Foreign bodies
What is Chronic periodontitis 1999 classification subdivided into?
A: Localised (<30% of sites involved)
B: Generalised (>30% of sites involved)
In terms of CAL (clinical attachment level) from the CEJ to base of the pocket, what are the measurements of chronic periodontitis?
- Mild = 1-2 mm CAL
- Moderate = 3-4 mm CAL
- Severe = >5 mm CAL
What are the common and secondary features of aggressive periodontitis?
COMMON
- Rapid attachment loss and bone destruction
- Except for the presence of periodontitis, patients are otherwise clinically healthy
- Familial aggregation
SECONDARY
• Plaque levels inconsistent with severity of disease
• Increased levels of aggregatibacter actinomycetemcomitans (Aa)
• Phagocyte abnormalities
• Hyper responsive macrophages (increased PGE2 / IL-1B)
Who is prone to localised aggressive periodontitis?
Circumpubertal onset – typically seen in younger people e.g. teenagers
What teeth are mainly affected by localised aggressive periodontitis?
• Localised/presents in 1st molars and incisors
- Attachment loss on at least 2 permanent teeth = one of which is 1st molar
• Presentation on no more than 2 other permanent teeth
- Other than incisors and 1st molars
Who is prone to generalised aggressive periodontitis?
• Usually affecting patients <30 but may be older
What teeth are affected by localised aggressive periodontitis?
Generalised interproximal attachment loss affecting at least 3 other permanent teeth other than incisors and 1st molars
What is Periodontitis as a manifestation of systemic diseases 1999 classification subdivided into?
A: Associated with haematological disorders
- Acquired neutropaenia
- Leukaemia
B: Associated with genetic disorders
- Familial/cyclical neutropenia
- Downs syndrome
- Papillon LeFevre syndrome
- Ehlers Danlos Syndrome
What is papillon LeFevre syndrome?
- Hyperkeratosis (thickening of skins outer layer) of feet and hands
- Periodontitis (advanced at a young age resulting in tooth loss)
What systemic disease is not included on the list for the 1999 classification of Periodontitis as a manifestation of systemic diseases?
Diabetes is not on the list = it can be a modifier of all forms of perio (KEY risk factor) – same can be said for smoking
→ Both are risk factors for periodontitis but no such thing as ‘smoking perio’ or ‘diabetes perio’
What is necrotising PD 1999 classification subdivided into?
A: Necrotising ulcerative gingivitis (NUG)
• Limited to gingivae
B: Necrotising ulcerative periodontitis (NUP) – rarer
• Also involves supporting structures
What is the distinctive feature of NUG and NUP?
Tissue necrosis caused by bacterial infection in susceptive host (predisposing factors - immunosuppression, stress)
Grey appearance of papillae due to necrotic tissue, Very painful – NUG
Exposed bone due to necrotic gingival tissues that have corroded away revealing bone – NUP
What 3 types of abscesses are there in the 1999 classification?
A: Gingival - Localised purulent infection involving gingivae, usually acute inflammatory response to foreign body
B: Periodontal - Localised purulent infection adjacent to periodontal pocket
C: Pericoronal - Localised purulent infection surrounding crown of partially erupted tooth
*purulent - contains or discharges pus
