Classification of Perio Disease Flashcards
How are periodontal diseases classified according to the international workshop 1999?
Gingival diseases
Chronic diseases
Aggressive periodontitis
Periodontal disease as a systemic manifestation
Necrotising periodontal disease
Periodontal abscesses
Periodontitis in association with endo lesions
Developmental or acquired deformities and conditions
How are periodontal diseases in 2017?
Periodontal health gingival diseases and conditions:
Periodontal health and gingival health
Gingivitis: Dental biofilm-induced
Gingival diseases: Non-Dental Biofilm induced
Periodontitis:
Necrotizing periodontal diseases
Periodontitis
Periodontitis as a manifestation of systemic disease.
Other conditions affecting the periodontium:
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
Peri implant Diseases and Conditions:
Peri-implant health
Peri-implant mucositis
Peri-implantitis
Peri-implant soft and hard tissue deficiencies
What are the subclasses of periodontal health and gingival health?
a. Clinical gingival health on an intact periodontium.
b. Clinical gingival health on a reduced periodontium. (stable periodontitis patient or a non-periodontitis patient)
What are the types of conditions of gingivitis - dental biofilm-induced?
Associated with biofilm only
Mediated by systemic or local risk factors
Drug-induced gingival enlargement
What are the types of conditions in gingival diseases that are non-biofilm induced?
Genetic/developmental disorders
Specific infections
Inflammatory and immune conditions
Reactive processes
Neoplasms
Endocrine, nutritional, and metabolic diseases
Traumatic lesions
Gingival pigmentation
What are the types of necrotizing periodontal diseases?
Necrotizing gingivitis
Necrotizing periodontitis
Necrotizing stomatitis
How is periodontitis as manifestation of systemic diseases classified?
Based on the primary systemic diseases according to the international statistical classification of diseases and related health problems(ICD) codes
How is periodontitis classified based on severity and complexity of management?
In stages based on severity and complexity of management:
Stage 1: Initial periodontitis
Stage 2: Moderate periodontitis
Stage 3: Severe periodontitis with potential for additional tooth loss
Stage 4: Severe periodontitis with potential for loss of the dentition.
How is periodontitis classified based on extent and distribution?
Localized
Generalized
Molar-incisor distribution
How is periodontitis classified based on evidence or risk of rapid progression?
Grade A: Slow rate of progression
Grade B: Moderate rate of progression
Grade C: Rapid rate of progression
How is periodontitis severity staged?
Interdental CAL:
Stage 1: 1 - 2mm no tooth loss with <15% radiographic bone loss. Max probing depth <=4mm with mostly horizontal bone loss.
Stage 2: 3 - 4mm no tooth loss. RBL 15 - 33%. Probing depth <=5mm with mostly horizontal bone loss.
Stage 3: >= 5mm. <=4 teeth lost due to perio. RBL extending to middle third of root and beyond. In addition to stage 2 complexity, probing depths >= 6mm, vertical bone loss >=3mm, furcation involvement class 2 or 3 with moderate ridge defects.
Stage 4: >=5mm. Extending to middle third of root and beyond. >=5 teeth lost. In addition to stage 3 complexity, need for complex rehabilitation due to masticatory dysfunction, secondary occlusal trauma, severe ridge defects, bite collapse, drifting, flaring. <20 remaining teeth
Each stage should be described as localized, generalized, or molar/incisor pattern.
What criteria are used to grade the progression of periodontitis?
Direct evidence:
Radiographic bone loss or CAL. Grade A no loss over 5 years. Grade B <2mm overy 5 years. Grade C >=2mm over 5 years.
Indirect evidence:
% bone loss/age. Grade A = <0.25, Grade B = 0.25 - 1, Grade C = >1.
Case phenotype.
What are the grade modifiers for periodontitis?
Smoking and diabetes.
Smoking: Non-smoker, <10 cigarettes per day, >10 cigarettes per day.
Diabetes. Normoglycaemic with no diabetes, HbA1c<7%, or >7% in patients with diabetes.
What is included in the practical diagnosis of periodontitis?
Stage and grade of the disease
Describe distribution of disease - generalised, localised or molar/incisal pattern
List risk factors
What are the main features looked at when classifying periodontal diseases?
Severity: CAL at site with greatest loss; radiographic bone loss and tooth loss
Complexity of management: Probing depths, pattern of bone loss, furcation lesions, number of remaining teeth, tooth mobility, ridge defects, masticatory dysfunction.
Localised: <30% teeth, generalised >30%
Risk of progression: Direct evidence by PA radiographs or CAL loss, or indirect (bone loss/age ratio)
Anticipated treatment response: Case phenotype, smoking, hyperglycaemia
What are the types of mucogingival deformities and conditions around the teeth?
Gingival phenotype
Gingival/soft tissue recession
Lack of gingiva
Decreased vestibular depth
Aberrant frenum/muscle position
Gingival excess
Abnormal colour
Condition fo the exposed root surface
What are the types of traumatic occlusal forces?
Primary occlusal trauma
Secondary occlusal trauma
Orthodontic forces
What are the types of prostheses and tooth-related factors that modify or predispose to plaque induced gingival diseases/periodontitis?
Localized tooth-related factors
Localized dental prostheses-related factors
What are the signs and symptoms of acute herpetic gingivostomatitis?
Painful oral ulceration
Pyrexia (raised body temperature)
Increased saliva
How is acute herpetic gingivostomatitis treated?
Treat symptoms
Anti-pyretic medication
Maintain fluid intake
Wait for infection to run its course
What are the causes of gingival overgrowth?
Cyclosporin
Phenytoin
Calcium channel blockers (Nifedipine)
How is gingival overgrowth managed?
Plaque control
Debridement and more plaque control
Surgery
Medication change
How is chronic periodontitis classified according to 1999 classification?
Extent:
Localized (<30%)
Generalized (>30%)
Severity:
Early (1 - 2mm CAL loss)
Moderate (3 - 4mm CAL loss)
Severe (>6mm CAL loss)
What are the features of aggressive periodontitis (GradeC)?
It is severe, rapidly progressive
Appears in clinically healthy people
Rapid LOA and bone destruction
Famliial aggregation
Who does aggressive periodontitis affect primarily?
Young patients; localized aggressive periodontitis begins during puberty affecting the first molars and/or incisors no more than 2 additional teeth affected.
Young adults: Generalized aggressive periodontitis with loss of attachment affecting 3 permanent teeth other than the first molars and incisors.
What systemic diseases can cause periodontitis?
Downs syndrome
Chediak-Higashi
Leucocyte dysfunction
Papillon Le-Fevre
What causes periodontal abscesses?
Pre-existing perio pocket
Foreign body impaction
Response to initial therapy
Compromised immune system-diabetes
What are the signs and symptoms of periodontal abscess?
Pain
Localized swelling
+/- increase in mobility
Deep perio probing depth
Can be associated with a vital tooth
How is a periodontal abscess treated?
Drainage usually by instrumentation
LA is usually needed
What kind of non-perio issues can cause periodontitis?
Endo lesions
What are some examples of developmental or acquired deformities around teeth or edentulous ridges?
Lack of keratinized gingivae
Aberrant frenum
Abnormal colour
Gingival recession/excess
Occlusal trauma
Ridge deficiency
