Classification of Periodontal Disease Flashcards
What is gingival health?
Intact periodontium is characterised by the absence of BOP, erythema, oedema, patient symptoms and attachment and one loss.
Bone levels should be 1-3mm apical to the CEJ.
less than 10% bleeding sites with probing depths less than or equal to 3mm.
What is plaque-induced gingivitis with an intact periodontium?
BOP- less than 30% is localised, greater than 30% is generalised.
No radiological bone loss
No interdental recession.
What is plaque induced gingivitis with modifying factors?
Factors that potentially modify plaque-induced gingivitis (other than plaque).
Sex steroid hormones- pregnancy, menstruation, puberty, oral contraceptives.
Hyperglycaemia
Leukaemia
Smoking
Malnutrition
Overhangs, poor margins on restorations
Drug-influences gingival enlargements
These factors make it worse but don’t cause it- plaque is still the causative factor.
What are non-plaque induced gingival diseases?
Hereditary gingival fibromatosis- overgrown fibrotic gingivae
Herpetic gingivostomatitis
Lichen Planus
Pemphigoid
Vitamin C deficiency
What diseases come under the heading “necrotising periodontal diseases”?
Necrotising Gingivitis and Necrotising periodontitis
What is Necrotising Gingivitis?
Necrosis and ulceration in the interdental papilla- characteristic punched out appearance.
Gingival bleeding
Pain
Pseudomembrane formation (sloughing).
Halitotis
Lesions develop quickly.
Regional lymphadenopathy (usually submandibular), fever.
What is Necrotising Periodontitis?
Same signs and symptoms as NG but additionally-
- Periodontal attachment and bone destruction- associated with deep pocket formation.
- Ulcers with central necrosis develop into craters.
- Frequent extra-oral signs
What is necrotising stomatitis?
Bone denudation extended through the alveolar mucosa, large areas of osteitis and bone sequestrum.
What factors might cause someone to have NG or NP?
In patients who are already severely immunocompromised
- HIV/AIDS
- Other conditions which would make them immunocompromised- CD4+ load is less than 200.
In children- severe malnourishment, extreme living conditions, severe viral infection.
In patients who are temporarily and/or moderately compromised patients
- stress, nutrition, smoking, habits, previous NPD, residual craters, tooth malposition.
What diseases come under the banner of “periodontitis as a manifestation of systemic disease?
Mainly diseases that affect the course of periodontitis resulting in the early presentation of severe periodontitis.
Papillon Lefevre syndrome- mutation of cathepsin C gene.
LAD syndrome
Down’s syndrome
Hypophosphatasia
What diseases come under the category of “Systemic diseases or conditions affecting the periodontal tissues”?
Rare conditions affecting the periodontal supporting tissues independently of dental plaque biofilm-induced inflammation.
Squamous cell carcinoma
Langerhans cell histiocytosis
What is the difference between a gingival abscess and a periodontal abscess?
Gingival abscess- localised purulent infection that involves the marginal gingiva or internal papilla.
Periodontal abscess- A localised accumulation of pus within the gingiva wall of a periodontal pocket resulting in the destruction of the collagen fibre attachment and the loss of alveolar bone.
How do gingival abscesses and periodontal abscesses present?
Gingival abscess-
- rapidly expanding localised area if swelling that may be shiny, smooth or pointed.
- Suppuration may be present.
Usually painful for the patient and TTP.
Periodontal abscess-
- Ovoid elevation in the gingiva along the lateral part of the root
- TTP in lateral direction
Usually associated with a deep periodontal pocket with bleeding and tenderness on probing.
- Suppuration may occur through a fistula or through the perio pocket.
- Bleeding
- Increased mobility and TTP.
- tooth may feel high in the occlusion.
- Bone loss radiographically.
- Responds to sensibility tests.
Can be acute or chronic.
What is the aetiology of gingival and periodontal abscesses?
Gingival abscess- foreign object stuck within the gingivae- bristles of toothbrush, nails in a nail biter, calculus, bits of food.
Periodontal abscess- Acute exacerbation of periodontitis, following debridement if calculus deposits pushed into perio tissues, after surgical therapy due to sutures, systemic antimicrobials without surgical debridement.
What is the emergency management of a gingival and periodontal abscess?
Gingival abscess- incise and drain the abscess, irrigate with saline, mechanical debridement. Prescribe 0.2% chlorhexidine.
Periodontal abscess- Must achieve drainage- either through the pocket or via external incision.
- Debride the pocket thoroughly but ensure you are shy of the base of the pocket.
- Occlusal adjustment may be required.
- Prescribe 0.2% chlorhexidine mouthwash.
- Recommend analgesia
No not prescribe metronidazole unless there are signs of systemic disease.
