Classification of Periodontal Diseases

Question 1

What are the 4 stages of periodontal disease?

Answer 1

1- Early/mild, <15% interproximal bone loss at worst site
2-moderate, coronal third of tooth bone loss at worst site
3-Severe, mid third of tooth bone loss at worst site
4-Very severe, apical third of tooth bone loss at worst site

Question 2

How do you classify the extent/distribution of periodontitis?

Answer 2

Localised <30% of teeth
Generalised >30% of teeth
Molar Incisor pattern

Question 3

How do you stage periodontal disease?

Answer 3

A- Slow, <0.5 (percentage loss over age), max bone loss is less than half the patients age
B-Moderate, 0.5-1
C- Rapid, >1.0 max bone loss is more than the patients age

Question 4

In an assessment of current periodontitis status, what would currently stable be?

Answer 4

Bleeding on Probing <10%
PPD less than or equal to 4mm
No BoP at 4mm sites

Question 5

In an assessment of current periodontitis status, what would currently in remission be?

Answer 5

Bleeding on probing >10%
PPD more than 4mm
No BoP at 4mm sites

Question 6

In an assessment of current periodontitis status, what is currently unstable?

Answer 6

PPD of more than 5mm
OR
PPD more than 4 and BoP

Question 7

What are some risk factors for periodontitis?

Answer 7

Smoking
Sub-optimally controlled diabetes
Age
Stress
Medications
OH
Genetic conditions (papillon-lefevre syndrome, down’s syndrome)
DIseases (leukaemia, HIV, agranulocytosis)

Question 8

What order do you write a diagnostic statement for periodontitis?

Answer 8

Extent-Periodontitis- Stage- Grade- Stability- Risk Factors

Question 9

What is a BPE?

Answer 9

Screening tool that provides a provisional diagnosis of periodontal health, gingivitis or periodontitis.

Question 10

What effect does sub-optimally controlled diabetes have on periodontal disease?

Answer 10

Hyperglycaemia in diabetes may modulate RANKL and OPG ratio and thus contribute to alveolar bone destruction
In hyperglycaemia production of AGE increases which leads to exacerbation of inflammation

Question 11

What effect does poorly controlled periodontal disease have on diabetes?

Answer 11

Periodontal bacteria and their products produced locally in the inflamed periodontal tissues, enter the circulation and contribute to upregulated systemic inflammation.
This leads to impaired insulin signalling and insulin resistance, thus exacerbation of diabetes

Question 12

An increase in what levels causes exacerbation of diabetes?

Answer 12

HbA1c

Question 13

What drugs can result in an increased deposition of connective tissue supporting a hyperproliferative epithelium?

Answer 13

Anticonvulsant: Phenytoin
Immunosuppressants: Cyclosporin
Calcium channel blockers: Nifedipine, amlodipine

Question 14

What are the indications for surgical therapy at re-evalutation?

Answer 14

Good OH, persistent deep pockets with BOP

Question 15

What factors influence whether a patient gets periodontal surgery or not?

Answer 15

Smoking
Compliance
Oral hygiene
Systemic diseases
Suitability of site (access, soft and hard tissue factors)
Prognosis of tooth, importance of tooth
Availability of specialist treatment
Patient preference

Question 16

What is recession type 1?

Answer 16

Gingival recession with no loss of inter-proximal attachment
Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth

Question 17

What is recession type 2?

Answer 17

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

Question 18

What is recession type 3?

Answer 18

Gingival recession associated with loss of interproximal attachment
The amount of interproximal attachment loss is greater than the buccal attachment loss

Question 19

What is necrotising stomatitis?

Answer 19

When the necrosis progresses to deeper tissues beyond the mucogingival line, including the lip or cheek mucosa or the tongue etc

Question 20

What are the aims for treatment of necrotising periodontitis?

Answer 20

To arrest the disease process and tissue destruction
To control the patients general feeling of discomfort and pain that is interfering