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BDS3 - Periodontology > Classification of Periodontal Disease > Flashcards

Classification of Periodontal Disease Flashcards

1
Q

what is the classifications of periodontal diseases

A
  1. Health
    - Intact periodontium
    - Reduced periodontium*
  2. Plaque-induced gingivitis: (localised / generalised gingivitis)
    - Intact periodontium
    - Reduced periodontium*
  3. Non Plaque-induced gingival diseases and conditions
  4. Periodontitis
    - Localised (<30% teeth)
    - Generalised (>30% teeth)
    - Molar-incisor pattern
  5. Necrotising Periodontal Diseases
  6. Periodontitis as a Manifestation of Systemic Disease
  7. Systemic Diseases of Conditions affecting the periodontal tissues
  8. Periodontal abscesses
  9. Periodontal-endodontic lesions
  10. Mucogingival deformities and conditions
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2
Q

how should periodontal disease be treated in pregnancy

A

• Treat periodontitis before patients become pregnant
- Obviously this isn’t always possible

• Provide non-surgical treatment in the second trimester

• Avoid ‘traumatic’ procedures during pregnancy
- Periodontal surgery
- Full mouth debridement (either with or without antibiotics)
§ As a minimum, provide supportive periodontal care = removal of supra calculus, teaching good oral hygiene and giving periodontal support

  • Discuss options with patient = key
  • Generally deemed to be safe
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3
Q

why do diseases need to be classified

A
  • for clinicians to properly diagnose and treat patients

* For scientists to investigate aetiology, pathogenesis, natural history and treatment of the diseases and condition

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4
Q

what are the aims of the 2018 disease classification

A

• Capture extent, severity
- Amount of periodontal tissue loss

• Patient susceptibility
- Estimated by historical rate of progression

• Current periodontal state
- Pocket depths / bleeding on probing

• A system that can be future proofed for update with new biomarker information
- Ie if new information becomes available it can easily be introduced into the classification system

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5
Q

what is localised periodontitis

A

affects less than 30% of the teeth

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6
Q

what is generalised periodontitis

A

affects more than 30% of the teeth

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7
Q

how is periodontitis classified

A

a staging and grading system is used for periodontitis that is based on bone loss
classifies the disease into
> 4 stages based on severity (I, II, III or IV)
> 3 grades based on disease susceptibility (A, B or C)

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8
Q

explain staging

A

i) Stage
ii) Severity of disease / Complexity of management
iii) Inter-proximal bone loss at worst site

i) 1
ii) Early / mild
iii) < 15% or 2mm

i) 2
ii) Moderate
iii) Coronal third of root

i) 3
ii) Severe (potential for additional tooth loss)
iii) Mid third of root

i) 4
ii) Very severe (potential for loss of dentition)
iii) Apical third of root

> use maximum bone loss at worst site (not an average)

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9
Q

if patient is known to have lost teeth due to periodontitis what stage are they assigned

A

stage 4

if a patient has lost teeth then you know that they will have bone loss to the apical third of the root

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10
Q

explain grading

A

i) Grade
ii) Captures progression
iii) Percent bone loss / age

i) A
ii) Slow
iii) <0.5 - maximum bone loss is less than half the patients age

i) B
ii) Moderate
iii) 0.5-1 - everything in between

i) C
ii) Rapid
iii) >1.0 - maximum bone loss is more than the patients age

> gives worst site of bone loss a percentrage
ie in the apical 3rd = more than 70%

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11
Q

what grade is a patient who is 60 years old and has 20% bone loss

A

○ 20 / 60 = 0.3333
○ Less than half
○ Periodontitis is not progressing fast

= Grade A

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12
Q

what grade is a Patient who is 20 years old and has 60% bone loss

A

○ 60 / 20 = 3
○ More than the patients age
○ Periodontitis is rapidly progressing

= Grade C

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13
Q

BSP - flow chart

A

we hardlyyyyy have to memorise that ?? do we ???? lol

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14
Q

what are the outcomes for the periodontitis patient with periodontal therapy

A

always going to remain a periodontitis patient but can either be

  • stable case of periodontal health
  • case with some gingival inflammation
  • unstable case of recurrent periodontitis
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15
Q

once a patient has gingivitis, are they always a gingivitis patient?

A

no
it is a reversible process
can return to being a patient with periodontal health

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16
Q

BPE

A

There is too much on those BSP chart thingys im so sorry lol

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17
Q

what are the options if a patients scores a BPE 3

A

• Option 1
○ If a sextant scores 3, this sextant should be reviewed AFTER initial treatment and a 6PPC completed for that sextant only (and only after treatment)
○ Ie remove all plaque, do all treatment then review

• Option 2
○ If a sextant scores 3, a 6PPC should be completed for that sextant BEFORE treatment and AFTER
○ Full periodontal examination of all teeth and root surface instrumentation where necessary
○ NB: where code 3 is observed in only one sextant, carry out full periodontal examination and root surface instrumentation of affected teeth in that sextant only

Both options are correct

18
Q

what is needed to make a diagnosis

A
  • Medical history
  • Dental history
  • Oral examination
  • Further investigations
19
Q

is BPE helpful in patients who are diagnosed with periodontitis?

A

• BPE is of limited value in patients who have already been diagnosed with periodontitis
○ If a patient has interproximal attachment loss you are as well doing a 6PPC
○ If you are unable to do anything else then do a BPE but you are screening for a disease you know the patient already has

20
Q

what is the purpose of a BPE

A

The BPE is a screening tool employed to rapidly guide clinicians to arrive at a provisional diagnosis of periodontal health, gingivitis or periodontitis, irrespective of historical attachment loss and bone loss
Ie irrespective of staging and grading

the BPE guides the need for further diagnostic measures prior to establishing a definitive periodontal diagnosis and appropriate treatment planning

21
Q

What cases can a periodontitis patient represent at any given time following therapy

A

○ Health in a successfully treated patient (stable)

○ Recurrent gingival inflammation (BOP > 10%) at sites with PPD <3mm and no PPD >4mm (disease remission)

○ Recurrent periodontitis, bleeding sites >4mm or any PPD >5mm (unstable)

22
Q

why is the 4mm threshold critical

A

it determines periodontal disease stability at non-bleeding sites following successful periodontal therapy

23
Q

does a higher probing depth of 5/6mm in the absence of bleeding represent active disease?

A

not always
especially soon after periodontal therapy

need to exercise clinical judgement when considering need / lack of need for additional treatment

sites may just need to heal

24
Q

what is meant be reduced periodontium in health

A

Due to causes other than periodontitis - ie can see gingival / interdental recession but this is not due to periodontitis

Eg crown lengthening surgery
Eg having a wisdom tooth extracted that was impacted that leaves a defect on the distal of the 7

25
Q

define periodontal health

A
  • Patients with an intact periodontium
  • Patients with a reduced periodontium due to causes other than periodontitis
  • Patients with a reduced periodontium due to periodontitis
26
Q

what is clinical gingival health on an intact periodontium characterised by

A
  • The absence of bleeding on probing
  • Erythema and edema
  • Patient symptoms
  • Attachment
  • And bone loss

Physiological bone levels range from 1.0 to 3.0mm apical to the cemento-enamel junction

For an intact periodontium and a reduced and stable periodontium, gingival health is defined as < 10% bleeding sites and no pocket depths exceeding 3mm

27
Q

how does plaque induced gingivitis present in a patient

A
  • Redness and inflammation at papilla
  • Loss of knife edge stippling
  • Rolled appearance due to inflammation
28
Q

what are modifying factors of plaque induced gingivitis

A
  1. Systemic conditions
    a. Sex steroid hormones
    i. Puberty
    ii. Menstrual cycle
    iii. Pregnancy
    iv. Oral contraceptives
    b. Hyperglycaemia
    c. Leukemia
    d. Smoking
    e. Malnutrition
  2. Oral factors enhancing plaque accumulation
    a. Prominent subgingival restoration margins
    • Tends to be things dentist do wrong
      b. Hyposalivation
29
Q

what are non plaque induced gingival diseases and conditions

A

Non dental biofilm induced

A. Genetic / developmental disorders
B. Specific infections
C. Inflammatory and immune conditions
D. Reactive processes
E. Neoplasms 
F. Endocrine, nutritional and metabolic diseases
G. Traumatic lesions
H. Gingival pigmentation
30
Q

what genetic / developmental disorder can cause non plaque induced gingival diseases and conditions

A

hereditary gingival fibromatosis

31
Q

what specific infections can cause non plaque induced gingival diseases and conditions

A

herpetic gingival stomatitis

candida albicans

32
Q

what inflammatory / immune conditions cause non plaque induced gingival diseases and conditions

A

lichen planus
benign mucous membrane pemphigoid
vitamin C deficiency

33
Q

what are the types of necrotising periodontal diseases

A 
Necrotising gingivitis (NG)
Necrotising periodontitis (NP)
Necrotising stomatitis (NS)
34
Q

what is necrotising gingivitis

A 
○ Necrosis and ulcer in the interdental papilla 
○ Gingival bleeding 
○ Pain 
○ Pseudomembrane formation
○ Halitosis 
○ Extraoral
	§ Regional lymphadenopathy 
	§ Fever
○ In children
	§ Pain and halitosis less frequent
	§ Fever, lymphadenopathy and sialorrhea (excessive salivation) more frequent
35
Q

what is necrotising periodontitis

A

○ As well as the signs and symptoms of NG
○ Periodontal attachment and bone destruction
○ Frequent extraoral signs
○ In severely immune-compromised patients, bone sequestrum (a piece of dead bone tissue formed within a diseased or injured bone) may occur

been in mouth longer than necrotising gingivitis, doesn’t look as active but this doesn’t mean that is it is not active
can happen quickly

36
Q

what is necrotising stomatitis

A

Bone denudation extended through the alveolar mucosa

Larger areas of osteitis and bone sequestrum

37
Q

classification of periodontitis as a manifestation of systemic disease is based on what

A

the primary systemic disease

Mainly rare diseases that affect the course of periodontitis resulting in the early presentation of severe periodontitis

38
Q

what rare diseases can affect the course of periodontitis

A
  • Papillon Leferve syndrome
  • Leucocyte adhesion deficiency
  • Hypophosphatasia
  • Down’s syndrome
  • Ehlers-Danlos
39
Q

what is included in systemic diseases or conditions affecting the periodontal tissues

A

Mainly rare conditions affecting the periodontal supporting tissues independently of dental plaque biofilm-induced inflammation

This is a more heterogenous group of conditions which result in breakdown of periodontal tissues and some of which may mimic the clinical presentation of periodontitis

  • Squamous cell carcinoma
  • Langerhans cell histiocytosis
40
Q

what are the 2 groups of patients with periodontal abscesses

A
  1. periodontal abscess in periodontitis patients (in a pre-exisiting periodontal pocket)
  2. periodontal abscess in non-periodontitis patients (not mandatory to have a pre-exisitng periodontal pocket)
41
Q

what are the 2 groups of patients with periodontal-endodontic lesions

A
  1. endo-periodontal lesion with root damage

2. endo-periodontal lesion without root damage

42
Q

what are the 3 gingival recession types associated with mucogingival deformities and conditions around teteh lack of keratinisde gingiva / aberrant frenal attachment

A

• Recession type 1 (RT1)
○ Gingival recession with no loss of inter-proximal attachment
○ Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth

• Recession type 2 (RT2)
○ Gingival recession associated with loss of interproximal attachment
○ The amount of interproximal attachment loss (measured from the interproximal CEJ to the depth of the interproximal sulcus / pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus / pocket)

• Recession type 3 (RT3)
○ Gingival recession associated with loss of interproximal attachment
The amount of interproximal attachment loss (measured from the interproximal CEJ to the apical end of the sulcus / pocket) is greater than the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus / pocket)

BDS3 - Periodontology (8 decks)

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