Classification of Periodontal Disease Flashcards
what is the classifications of periodontal diseases
- Health
- Intact periodontium
- Reduced periodontium* - Plaque-induced gingivitis: (localised / generalised gingivitis)
- Intact periodontium
- Reduced periodontium* - Non Plaque-induced gingival diseases and conditions
- Periodontitis
- Localised (<30% teeth)
- Generalised (>30% teeth)
- Molar-incisor pattern - Necrotising Periodontal Diseases
- Periodontitis as a Manifestation of Systemic Disease
- Systemic Diseases of Conditions affecting the periodontal tissues
- Periodontal abscesses
- Periodontal-endodontic lesions
- Mucogingival deformities and conditions
how should periodontal disease be treated in pregnancy
• 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
why do diseases need to be classified
- for clinicians to properly diagnose and treat patients
* For scientists to investigate aetiology, pathogenesis, natural history and treatment of the diseases and condition
what are the aims of the 2018 disease classification
• 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
what is localised periodontitis
affects less than 30% of the teeth
what is generalised periodontitis
affects more than 30% of the teeth
how is periodontitis classified
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)
explain staging
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)
if patient is known to have lost teeth due to periodontitis what stage are they assigned
stage 4
if a patient has lost teeth then you know that they will have bone loss to the apical third of the root
explain grading
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%
what grade is a patient who is 60 years old and has 20% bone loss
○ 20 / 60 = 0.3333
○ Less than half
○ Periodontitis is not progressing fast
= Grade A
what grade is a Patient who is 20 years old and has 60% bone loss
○ 60 / 20 = 3
○ More than the patients age
○ Periodontitis is rapidly progressing
= Grade C
BSP - flow chart
we hardlyyyyy have to memorise that ?? do we ???? lol
what are the outcomes for the periodontitis patient with periodontal therapy
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
once a patient has gingivitis, are they always a gingivitis patient?
no
it is a reversible process
can return to being a patient with periodontal health
BPE
There is too much on those BSP chart thingys im so sorry lol
what are the options if a patients scores a BPE 3
• 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
what is needed to make a diagnosis
- Medical history
- Dental history
- Oral examination
- Further investigations
is BPE helpful in patients who are diagnosed with periodontitis?
• 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
what is the purpose of a BPE
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
What cases can a periodontitis patient represent at any given time following therapy
○ 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)
why is the 4mm threshold critical
it determines periodontal disease stability at non-bleeding sites following successful periodontal therapy
does a higher probing depth of 5/6mm in the absence of bleeding represent active disease?
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
what is meant be reduced periodontium in health
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
