Classification of Periodontal Diseases 1&2 Flashcards
Why is a classification system necessary for periodontal diseases?
Classification systems help clinicians properly diagnose and treat patients and aid scientists in investigating the etiology, pathogenesis, natural history, and treatment of periodontal and peri-implant diseases.
What are the aims of the 2017 periodontal disease classification?
- Capture disease extent and severity (e.g., amount of periodontal tissue loss).
- Evaluate patient susceptibility using historical rates of progression.
- Assess the current periodontal state (e.g., pocket depths, bleeding on probing).
- Make the system adaptable for updates, such as with new biomarker data
How are periodontal diseases staged in the 2017 classification system?
Stage 1 (Early/Mild): Interproximal bone loss <15% or 2mm.
Stage 2 (Moderate): Bone loss to the coronal third of the root.
Stage 3 (Severe): Bone loss to the mid-third of the root, with potential for additional tooth loss.
Stage 4 (Very Severe): Bone loss to the apical third of the root, with potential for loss of the dentition.
What factors are considered when grading periodontal disease?
Grade A (Slow): Bone loss/age ratio < 0.5.
Grade B (Moderate): Bone loss/age ratio 0.5–1.0.
Grade C (Rapid): Bone loss/age ratio > 1.0.
What are the extents of periodontal disease?
Localised: <30% of teeth
Generalised: >30% of teeth
Molar incisor pattern
What is the diagnostic pathway for periodontal disease?
- Identify the type and extent of the disease.
- Stage and grade periodontitis, if present.
- Determine the current health/disease status (e.g., PPD, BoP).
- Summarize in a diagnostic statement (e.g., “Generalized Periodontitis, Stage IV, Grade B, Currently Unstable”).
What is the stepwise approach to periodontal treatment?
Step 1: Patient information, oral hygiene instruction (OHI), and professional mechanical plaque removal (PMPR). Control systemic/local risk factors
Step 2: Subgingival instrumentation ± adjunctive measures.
Step 3: Manage non-responding sites via repeated instrumentation or surgery.
Step 4: Supportive periodontal therapy (SPT) with risk-adaptive intervals (3–12 months). Continously monitor local/systemic factors and targeted PMPR>
Define the types of cases covered by periodontal treatment guidelines.
Case Type 1: Tooth hypermobility due to secondary occlusal trauma, correctable without replacement.
Case Type 2: Pathological tooth migration, amenable to orthodontic correction.
Case Type 3: Partially edentulous patients suitable for prosthetic restoration without full-arch rehabilitation.
Case Type 4: Patients needing full-arch rehabilitation (tooth- or implant-supported).
Engaging Vs Non-engaging Patient
Engaging
I: Favourable improvement in OH – indicated by ≥50%
improvement in plaque and marginal bleeding scores OR
II. Plaque levels ≤20% & bleeding levels ≤30% OR
III. Patient has met targets outlined in their personal self-care
plan as determined by their healthcare practitione
Non-Engaging
I: Insufficient improvement in OH – indicated by <50% improvement in plaque and marginal bleeding scores OR
II. Plaque levels >20% & bleeding levels >30% OR
III. Patient states preference to a palliative approach to
periodontal care
Define “clinical gingival health” in patients with an intact and reduced periodontium.
Intact Periodontium: No bleeding on probing (BoP), erythema, edema, or attachment loss. Physiological bone levels 1–3 mm apical to the CEJ.
Reduced Periodontium: Less than 10% BoP, probing depths ≤3 mm.
What are the three new definitions of periodontal health introduced in 2017?
- Health on an intact periodontium (no attachment or bone loss, <10% bleeding sites, probing depths ≤3mm).
- Health on a reduced periodontium due to non-periodontitis causes (e.g., crown lengthening).
- Health on a reduced periodontium due to periodontitis (stable condition with <10% bleeding sites, probing depths ≤4mm without bleeding).
What are the features of plaque-induced gingivitis on an intact periodontium?
- Bleeding on probing: Localised (<30%) or Generalised (>30%).
- No radiological bone loss or interdental recession.
- Probing pocket depths <3mm.
- Associated with biofilm alone or modified by factors such as puberty, pregnancy, or drugs.
What are the modifying factors of plaque-induced gingivitis?
Systemic Risk Factors: Hormonal changes (e.g., puberty, pregnancy epulis).
Local Factors: Poor restorative margins.
Drug-Induced Changes: Gingival enlargement (e.g., caused by phenytoin, nifedipine).
What defines necrotizing periodontal diseases, and what are the clinical differences among NG, NP, and NS?
Necrotizing Gingivitis (NG): Ulceration of the interdental papilla, BoP, pain, pseudomembranes, halitosis.
Necrotizing Periodontitis (NP): Includes NG symptoms plus periodontal attachment and bone destruction.
Necrotizing Stomatitis (NS): Bone denudation beyond the alveolar mucosa, extensive osteitis, and bone sequestrum formation.
What conditions fall under non-plaque-induced gingival diseases?
- Genetic/developmental (e.g., hereditary gingival fibromatosis).
- Specific infections (e.g., herpetic gingivostomatitis, Candida albicans).
- Inflammatory/immune conditions (e.g., lichen planus, pemphigoid).
- Nutritional deficiencies (e.g., vitamin C deficiency).
List systemic conditions that can manifest as periodontitis.
Genetic Diseases: Papillon-Lefevre syndrome, leukocyte adhesion deficiency.
Metabolic Disorders: Hypophosphatasia.
Syndromic Associations: Down’s syndrome, Ehlers-Danlos syndrome.
How do these systemic diseases cause periodontitis?
PLS: Immune dysfunction + keratoderma
LAD: Neutrophil migration defect
Hypophosphatasia: Alkaline phosphatase deficiency, early tooth loss
Down’s: Poor neutrophil function + mouth breathing, anatomy
EDS: Collagen defect → fragile periodontal structures
What are two notable examples of rare systemic diseases affecting periodontal tissues, and how do they manifest?
Squamous Cell Carcinoma: Bone/tooth destruction mimics perio
Langerhans Cell Histiocytosis: Alveolar bone breakdown, loose teeth, mimics aggressive periodontitis
How do common systemic diseases like uncontrolled diabetes modify the course of periodontitis?
Increases inflammation
Delays healing
Alters immune response
Serves as a staging/grading modifier in classification
What distinguishes periodontal abscesses and periodontal-endodontic lesions?
Periodontal Abscesses: Acute infection in the periodontium, typically due to occlusion of a pocket or foreign body impaction.
Endodontic-Periodontal Lesions: Combined infection involving both the pulp and periodontal tissues, often with drainage pathways.
How are mucogingival deformities classified?
Recession Type 1 (RT1): No interproximal attachment loss.
Recession Type 2 (RT2): Interproximal attachment loss ≤ buccal attachment loss.
Recession Type 3 (RT3): Interproximal attachment loss > buccal attachment loss.
