Classification of Periodontal Diseases (2) Flashcards
Can you have periodontal health on a reduced periodontium?
- Yes
- Can have recession but due to a cause other than periodontitis e.g. crown lengthening surgery or wisdom tooth extraction that leaves a defect on the distal of the 7
If a patient has a reduced periodontium due to periodontitis will they always be a periodontitis patient?
- Yes
What are the new definitions of periodontal health? (3)
- Patients with an intact periodontium
- Patients with a reduced periodontium due to causes other than periodontitis and
- Patients with a reduced periodontium due to periodontitis
What is the definition/requirements for gingival health?
- Clinical gingival health in an intact periodontium is characterised by the absence of bleeding on probing, erythema and edema, patient symptoms and attachment and bone loss
- Physiological bone levels range from 1.0-3.0mm 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
What 2 types of periodontium can be included as ‘plaque-induced gingivitis’ (localised/generalised)?
- Intact periodontium
- Reduced periodontium
What can cause plaque-induced gingivitis? (3)
- Associated with dental biofilm alone
- Mediated by systemic or local risk factors
- Drug influenced gingival enlargement
When is bleeding on probing localised?
When there are less than 30% of sites affected
When is bleeding on probing generalised?
When there are more than 30% of sites affected
Is gingivitis stable if there is bleeding on probing?
- No
What do the probing pocket depths need to be if periodontitis is stable?
- Need to be 4mm or less
What are modifying factors for plaque-induced gingivitis?
- Systemic conditions
a) Sex steroid hormones
1) Puberty
2) Menstrual cycle
3) Pregnancy
4) Oral contraceptives
b) Hyperglycaemia
c) Leukaemia
d) Smoking
e) Malnutrition
- Oral factors enhancing plaque accumulation
a) Prominent subgingival restoration margins
b) Hyposalivation - Drug-influenced gingival enlargements
Will hormonal changes itself cause gingivitis?
- No
- The plaque causes the gingivitis and change in hormones may exaggerate the response
What is a pregnancy epulis considered as?
- Considered a mucogingival deformity
Are Pregnancy epulis’s common?
- Yes
- They are made worse by the presence of plaque
Drug influenced gingival enlargement is relatively common. What are 2 types of drug that can cause this?
- Calcium channel blockers
- Immunosuppressants
What are possible causes of non-dental biofilm induced gingival diseases? (8)
- Genetic/developmental disorders
- Specific infections
- Inflammatory and immune conditions
- Reactive processes
- Neoplasms
- Endocrine, nutritional & metabolic diseases
- Traumatic lesions
- Gingival pigmentation
What is an example of an inflammatory/immune condition that can cause non-plaque induced gingival diseases?
- Lichen planus
What nutritional deficiency can cause plaque indices gingival diseases?
- Vitamin C deficiency
What is usually present in a patient with necrotising gingivitis? (7)
- Necrosis and ulcer in the interdental papilla
- Gingival bleeding
- Pain
- Pseudo membrane formation
- Halitosis
- Extra oral - regional lymphadenopathy/ fever
- In children, pain and halitosis less frequent, whereas fever, lymphadenopathy and sialorrhea were more frequent
What is halitosis?
- Offensive smelling breath
What is usually present in a patient with necrotising periodontitis? (4)
- In addition to S&S of necrotising gingivitis:
- Periodontal attachment and bone destruction (this can happen rapidly)
- Frequent extraoral signs
- In severely immune-compromised patients, bone sequestrum may occur
What is usually present in patients with necrotising stomatitis? (2)
- Bone destruction extended through the alveolar mucosa
- Larger areas of osteitis and bone sequestrum
What are characteristics of necrotising gingivitis? (6)
- Quite distinctive
- Sluffing of the gingival margin
- White/grey fibrin coating
- Looks very sore
- Ulceration
- Papilla have lost their normal architecture
What are characteristics of necrotising periodontitis? (3)
- Get negative architecture
- Crater like defect
- Very localised and very dramatic loss of bone and tissue
Give examples of rare diseases that affect the course of periodontitis resulting in the early presentation of severe periodontitis? (5)
- Papillon Lefevre syndrome
- Leukocyte adhesion deficiency
- Hypophosphatasia
- Down’s syndrome
- Ehlers-Danlos
There are rare conditions that affect the periodontal supporting tissues independently of dental plaque biofilm-induced inflammation. Give 2 examples of these?
- 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
Are periodontal abscesses common?
- Yes
How do periodontal abscesses often present?
Present often with pus draining through a pocket or sinus
When might we see periodontal abscesses? (3)
- People with periodontitis who don’t get periodontal treatment will get abscesses
- People who do get periodontal treatment might get some but much less
- Sometimes see periodontal abscesses in people who don’t have periodontitis - this could be because something is stuck there or could be the dentists fault e.g. leaving a bit of dam or floss to get stuck there
What is a periodontal endodontic lesion?
- Essentially a non-vital tooth with abscess
- Need to find out if there is root damage or not
- If there is then need to work out what is wrong
- If no root damage then need to find out if it is a periodontal patient or not
What is the most common mucogingival deformity/condition?
- Gingival recession
What is type 1 gingival recession?
Gingival recession with no loss of inter-proximal attachment. Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth
What is type 2 gingival recession?
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)
What is type 3 gingival recession?
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)
Look at lecture for examples
:)
