Classification of Perio Disease Flashcards

1
Q

How are periodontal diseases classified according to the international workshop 1999?

A

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

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2
Q

How are periodontal diseases in 2017?

A

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

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3
Q

What are the subclasses of periodontal health and gingival health?

A

a. Clinical gingival health on an intact periodontium.

b. Clinical gingival health on a reduced periodontium. (stable periodontitis patient or a non-periodontitis patient)

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4
Q

What are the types of conditions of gingivitis - dental biofilm-induced?

A

Associated with biofilm only

Mediated by systemic or local risk factors

Drug-induced gingival enlargement

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5
Q

What are the types of conditions in gingival diseases that are non-biofilm induced?

A

Genetic/developmental disorders

Specific infections

Inflammatory and immune conditions

Reactive processes

Neoplasms

Endocrine, nutritional, and metabolic diseases

Traumatic lesions

Gingival pigmentation

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6
Q

What are the types of necrotizing periodontal diseases?

A

Necrotizing gingivitis

Necrotizing periodontitis

Necrotizing stomatitis

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7
Q

How is periodontitis as manifestation of systemic diseases classified?

A

Based on the primary systemic diseases according to the international statistical classification of diseases and related health problems(ICD) codes

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8
Q

How is periodontitis classified based on severity and complexity of management?

A

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.

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9
Q

How is periodontitis classified based on extent and distribution?

A

Localized

Generalized

Molar-incisor distribution

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10
Q

How is periodontitis classified based on evidence or risk of rapid progression?

A

Grade A: Slow rate of progression

Grade B: Moderate rate of progression

Grade C: Rapid rate of progression

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11
Q

How is periodontitis severity staged?

A

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.

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12
Q

What criteria are used to grade the progression of periodontitis?

A

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.

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13
Q

What are the grade modifiers for periodontitis?

A

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.

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14
Q

What is included in the practical diagnosis of periodontitis?

A

Stage and grade of the disease

Describe distribution of disease - generalised, localised or molar/incisal pattern

List risk factors

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15
Q

What are the main features looked at when classifying periodontal diseases?

A

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

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16
Q

What are the types of mucogingival deformities and conditions around the teeth?

A

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

17
Q

What are the types of traumatic occlusal forces?

A

Primary occlusal trauma

Secondary occlusal trauma

Orthodontic forces

18
Q

What are the types of prostheses and tooth-related factors that modify or predispose to plaque induced gingival diseases/periodontitis?

A

Localized tooth-related factors

Localized dental prostheses-related factors

19
Q

What are the signs and symptoms of acute herpetic gingivostomatitis?

A

Painful oral ulceration

Pyrexia (raised body temperature)

Increased saliva

20
Q

How is acute herpetic gingivostomatitis treated?

A

Treat symptoms

Anti-pyretic medication

Maintain fluid intake

Wait for infection to run its course

21
Q

What are the causes of gingival overgrowth?

A

Cyclosporin

Phenytoin

Calcium channel blockers (Nifedipine)

22
Q

How is gingival overgrowth managed?

A

Plaque control

Debridement and more plaque control

Surgery

Medication change

23
Q

How is chronic periodontitis classified according to 1999 classification?

A

Extent:

Localized (<30%)

Generalized (>30%)

Severity:

Early (1 - 2mm CAL loss)

Moderate (3 - 4mm CAL loss)

Severe (>6mm CAL loss)

24
Q

What are the features of aggressive periodontitis (GradeC)?

A

It is severe, rapidly progressive

Appears in clinically healthy people

Rapid LOA and bone destruction

Famliial aggregation

25
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.
26
What systemic diseases can cause periodontitis?
Downs syndrome Chediak-Higashi Leucocyte dysfunction Papillon Le-Fevre
27
What causes periodontal abscesses?
Pre-existing perio pocket Foreign body impaction Response to initial therapy Compromised immune system-diabetes
28
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
29
How is a periodontal abscess treated?
Drainage usually by instrumentation LA is usually needed
30
What kind of non-perio issues can cause periodontitis?
Endo lesions
31
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