Classification of Periodontal Diseases

Question 1

What is periodontal health?

Answer 1

Patients with an intact periodontium
Patients with a reduced periodontium due to causes other than periodontitis
Patients with a reduced periodontium due to periodontitis

Question 2

What is gingival health?

Answer 2

<10% bleeding sites with probing depths ≤3mm

Question 3

What characterises gingival health?

Answer 3

The absence of bleeding on probing, erythema and edema, patient symptoms and attachment loss

Question 4

Describe plaque induced gingivitis

Answer 4

Periodontium may be intact or reduced
Associated with dental biofilm alone
Mediated by systemic or local risk factors
May have drug influenced gingival enlargement
No radiological bone loss
No interdental recession

Question 5

How does BoP affect plaque induced gingivitis?

Answer 5

If <30% then localised
If >30% then generalised

Question 6

What are the modifying factors of plaque induced gingivitis?

Answer 6

Systemic conditions - sex steroid hormones, hyperglycaemia, leukaemia, smoking, malnutrition
Oral factors enhancing plaque accumulation - subgingival overhangs, hyposalivation
Drug influenced gingival enlargements

Question 7

Give examples of causes of non-dental biofilm induced gingival diseases

Answer 7

Genetic/developmental conditions eg - hereditary gingival fibromatosis
Specific infections - Candida albicans causing herpetic gingival stomatitis
Inflammatory/immune conditions eg - lichen planus
Nutritional deficiency eg - Vitamin C, scurvy

Question 8

What are the symptoms of necrotising gingivitis?

Answer 8

Necrosis and ulcers in the interdental papilla
Gingival bleeding
Pain
Halitosis
Regional lymphadenopathy

Question 9

What additional symptoms are found in necrotising periodontitis?

Answer 9

Periodontal attachment and bone destruction
Bone sequestrum may occur

Question 10

What additional symptoms are found in necrotising stomatitis?

Answer 10

Bone loss extended through the alveolar mucosa
Larger areas of osteitis and bone sequestrum

Question 11

Which systemic diseases can manifest as periodontitis?

Answer 11

Papillon Lefevre Syndrome
Leukocyte adhesion deficiency
Hypophosphatasia
Down’s syndrome
Ehlers-Danlos

Question 12

Give examples of conditions affecting the periodontal supporting tissues independently of the biofilm-induced inflammation

Answer 12

Squamous cell carcinoma
Langerhans cell histiocytosis
Uncontrolled diabetes mellitus

Question 13

How are periodontal abscesses classed?

Answer 13

Periodontal abscess in a periodontitis patient (in a pre-existing periodontal pocket)
Periodontal abscess in non-periodontitis patients (not mandatory to have a pre-existing periodontal pocket)

Question 14

How are periodontal endodontic lesions classified?

Answer 14

Endo-periodontal lesion with root damage
Endo-periodontal lesion without root damage

Question 15

Give an example of a mucogingival deformity or condition

Answer 15

Gingival recession - lack of keratinised gingiva/aberrant frenal attachment

Question 16

What are the types of gingival recession?

Answer 16

Recession type
RT1
RT2
RT3

Question 17

What is found in RT1?

Answer 17

Gingival recession with no loss of interproximal attachment
Interproximal CEJ is clinically non-detectable
Papilla are fine

Question 18

What is found in RT2?

Answer 18

Gingival recession associated with loss of interproximal attachment
Amount of interproximal loss is ≤ the buccal attachment loss
Papilla aren’t fine

Question 19

What is found in RT3?

Answer 19

Gingival recession associated with loss of interproximal attachment
Amount of interproximal attachment loss is > the buccal attachment loss
No papilla left