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BDS3 CLINICAL Periodontology > Classification of Periodontal Diseases > Flashcards

Classification of Periodontal Diseases Flashcards

1
Q

What are the guidelines for treating periodontal disease during pregnancy

A

Treat periodontitis before patients get pregnant although this may not be possible

Provide non-surgical treatment in the second trimester

Avoid ‘traumatic’ procedures during pregnancy e.g RSD or perio surgery

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2
Q

What is the minimum treatment for those who are pregnant

A

supportive periodontal care

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3
Q

Why do we classify

A
  • So we can properly diagnose and treat patients
    • For research purposes so scientists can investigate aetiology, pathogenesis, natural history, treatment of diseases and conditions
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4
Q

What is periodontitis split into

A

localised
generalised
molar incisor pattern

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5
Q

What is localized periodontitis

A

less than 30% of teeth effected

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6
Q

What is generalized periodontitis

A

more than 30% of teeth are effected

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7
Q

What was aggressive periodontitis classification replaced with

A

a staging and grading system was created instead that is based upon bone loss and classifies disease

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8
Q

What are the stages and grades based on

A

○ 4 stages based on severity (I, II, III, or IV)

3 grades based on disease susceptibility (A, B or C)

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9
Q

What is staging based on

A

the severity of disease, complexity of management and the worst site of interproximal bone loss

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10
Q

What is stage 1 periodontitis

A

Early/mild severity

<15% or 2mm bone loss at worst site

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11
Q

What is stage 2 periodontitis

A

Moderate severity

Bone loss at worst site includes the coronal third of the root

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12
Q

What is stage 3 periodontitis

A

Severe (potential for additional tooth loss)

Bone loss at worst site includes mid third of the root

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13
Q

What is stage 4 periodontitis

A 
Very severe (potential for loss of dentition)
Bone loss at worst site includes apical third of root
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14
Q

How do we measure bone loss in staging

A

• Use bitewings to measure bone loss but if they aren’t available then measure from the CEJ

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15
Q

If someone is known to have lost teeth from perio what stage can we assign them to

A

can automatically be assigned to stage 4

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16
Q

When looking at severity in staging what do we look at

A

Inderdental clinical attachment loss at site of greatest loss
Radiographic bone loss
Tooth loss

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17
Q

When looking at complexity in staging what do we look at

A

○ What is the max probing depth? Larger the depth the more complex
○ Horizontal bone loss or vertical bone loss? Vertical is more complex
○ Furcation involvement? What class?
○ Ridge defect?
Bite defect?

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18
Q

What is grade A

A

Slow progression

Maximum bone loss is less than 50% of their age

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19
Q

What is grade B

A

Moderate progression

Maximum bone loss is between 50% and 100% of their age

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20
Q

What is grade C

A

Rapid progression

Maximum bone loss is greater than 100% of their age

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21
Q

When looking at progression what do we look at

A

direct evidence of progression

indirect evidence of progression

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22
Q

What determines staging

A

progression
bone loss in relation to age
risk factors

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23
Q

What is direct evidence of progression

A

§ Longitudinal date (radiographic bone loss or the clinical attachment loss) and over how long the bone loss has occurred

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24
Q

What is indirect evidence of progression

A

§ % bone loss/age

Case phenotype - is the destruction about right for the amount of biofilm?

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25
Q

What risk factors can modify the grade

A

○ Smoking - how many cigarettes?

Diabetes - well controlled?

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26
Q

How is extent of periodontitis determined

A

• Localised (less than 30% of teeth effected)
• Generalised (more than 30% of teeth effected)
Molar incisor pattern (more seen in younger px)

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27
Q

If a patient gets BPE code 0/1/2 what should next be investigated

A

bleeding on probing - the diagnosis is split on:
<10%
10-30%
>30%

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28
Q

What is <10% BOP for codes 0-2

A

clinical gingival health

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29
Q

What is 10-30% BOP for codes 0-2

A

localized gingivitis

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30
Q

What is >30% BOP for codes 0-2

A

generalized gingivitis

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31
Q

If there is a code 3 after BPE what should be done

A

appropriate radiographic assessment

initial periodontal therapy and review in 3 months with localized 6PPC in involved sextants

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32
Q

If there is a code 4 what should be done

A

appropriate radiographic assessment

full periodontal assessment

33
Q

After staging and grading what should be assessed

A

current perio status

risk factor assessment

34
Q

What determines currently stable periodontitis

A

BOP <10%
PPD <=4mm
No BOP at 4mm sites

35
Q

What determines currently in remission periodontitis

A

BOP >=10%
PPD <=4mm
No BOP at 4mm sites

36
Q

What determines currently unstable periodontitis

A

PPD >= 5mm or PPD>=4mm and BOP

37
Q

What is the diagnosis statement

A

extent, periodontitis, stage, grade, stability, risk factors

38
Q

What are the two options for BPE 3

A

○ Option 1 = if a sextant scores a 3 then this sextant should be reviewed after initial treatment and a 6 point pocket chart completed for that sextant only
○ Option 2 = if a sextant scores 3, a 6 point pocket chart should be completed for that sextant before and after treatment (full perio examination of all teeth and RSD)
When a code 3 is only observed in one sextant, carry out full periodontal exam and RSD in that sextant only

39
Q

What is required to come to a diagnosis

A 
To come to a diagnosis the following is required
	• Medical 
	• Dental history
	• Oral examination
Further investigations
40
Q

What questions do we ask in diagnostic pathway

A 
what disease does the px have
how extensive is the disease
is the disease active or controlled
how severe is the disease
what is the patients risk profile
what is the rate and risk of disease progression
41
Q

What are limitations of BPE

A

• It is a screening tool employed to rapidly guide clinicians to arriving at a provisional diagnosis of periodontal health, gingivitis or periodontitis irrespective of historical attachment loss and bone loss (irrespective of staging and grading)
Therefore the BPE guides the need for further diagnostic measures prior to establishing a definitive periodontal diagnosis and appropriate treatment planning

42
Q

What may a perio patient represent a case of following therapy

A

○ Health in a successfully treated patient (stable)
○ Recurrent gingival inflammation (BOP equal to or greater than 10%) at sites with PPD < 3mm and no PPD > 4mm (disease remission)
○ Recurrent periodontitis, bleeding sites >= 4mm or any PPD >= 5mm (unstable)

43
Q

Does 4mm mean active disease

A
  • The 4mm threshold is critical as it determines periodontal disease stability at non-bleeding sites following successful periodontal therapy
    • A higher probing depth of 5mm or 6mm in the absence of bleeding may not always represent active disease - in particular soon after periodontal treatment.
    • Therefore clinicians need to exercise clinical judgements when considering the need or lack of need for additional treatment such as re-instrumentation or surgery for such sites
44
Q

Why may there be a reduced periodontium other than periodontitis

A

○ An example of other things that cause loss of attachment are crown lengthening surgery or wisdom tooth extraction that leaves a defect on the distal of the 7

45
Q

What is clinical gingival health on an intact periodontium characterized by

A

○ The absence of bleeding on probing
○ Erythema and oedema
○ Patient symptoms
○ Attachment and bone loss

46
Q

What do physiological bone levels range from

A

1.0 to 3.0mm apical to the CEJ

47
Q

For an intact periodontium and a reduced stable periodontium, what is gingival health defined as

A

○ <10% bleeding sites

No pockets exceeding 3mm depth

48
Q

Can gingivitis only be on an intact periodontium

A

• You can have gingivitis on an intact or reduced periodontium (not periodontitis cause)

49
Q

What is gingivitis associated with

A

dental biofilm alone

50
Q

What is gingivitis mediated by

A

systemic or local risk factors (e.g medical conditions or overhanging restorations)

51
Q

What is the difference between health and gingivits for an intact periodontium

A

only difference is gingivitis, BOP >10%

52
Q

What is the difference between health and gingivitis for a reduced periodontium (non perio px)

A

only difference is gingivitis, BOP >10%

bone loss may be seen in both healthy and gingivitis patients

53
Q

What are modifying factors

A

systemic conditions

oral factors enhancing plaque accumulations

54
Q

What are systemic conditions that can make perio disease worse

A 
sex steroid hormones
hyperglycaemia
leukemia
smoking
malnutrition
55
Q

What are the sex steroid hormones that can impact perio

A

□ Puberty
□ Menstrual cycle
□ Pregnancy - can get pregnancy epulis (considered a mucogingival deformity)
□ Oral contraceptives

56
Q

What are oral factors that enhance plaque accumulated,ation

A

§ Prominent subgingival restoration margins

§ Hyposalivation

57
Q

What can non plaque induced gingival disease be due to

A 
genetic developmental disorders
specific infections
inflammatory and immune conditions
reactive processes
nutritional deficiency
neoplasms
endocrine nutritional and metabolic disease
traumatic lesions
gingival pigmentation
58
Q

What are genetic/developmental disorders that cause non plaque induced gingival disease and conditions

A

hereditary gingival fibromatosis

59
Q

What are specific infections that can result in gingival disease

A

Herpetic gingival stomatitis
□ Common in children
□ Presents with red inflammation of the gingivae
□ Child is usually taken to the GP who gives antibiotics but doesn’t do anything

60
Q

What are immune and inflammatory conditions that can cause gingival disease

A

§ E.g lichen planus

§ E.g benign mucous membrane pemphigoid

61
Q

What are the 3 types of necroticising periodontal disease

A

necrotising gingivits
necrotising periodontitis
necrotising stomatitis

62
Q

What is necrotising gingivitis

A

○ It is necrosis and ulcers in the interdental papilla
○ There is gingival bleeding
○ Pain
○ Pseudo membrane formation
○ Bad breath (halitosis)
○ Extra oral symptoms too - regional lymphadenopathy (44-61%)/fever (20-39%)
○ In children, pain and halitosis is less frequent whereas fever, lymphadenopathy and sialorrhea were more frequent

63
Q

What is necrotising periodontitis

A

○ In addition to the signs and symptoms of NG the following is seen
§ Periodontal attachment and bone destruction
§ Frequent extra-oral signs
§ In severely immune compromised patients, bone sequestrum may occur

64
Q

What is necrotising stomatitis

A

○ Bone denudation extended through alveolar mucosa

Larger areas of osteitis and bone sequestrum

65
Q

What results in periodontitis as a manifestation of systemic disease

A 
• It is mainly rare diseases that affect the course of periodontitis resulting in the early presentation of severe periodontitis 
		○ Papillion lefevre syndrome
		○ Leucocyte adhesion deficiency 
		○ Hypophosphatasia 
		○ Down's syndrome
		○ Ehlers danlos
66
Q

What are systemic diseases or conditions that affect periodontal tissues

A

• Mainly rare conditions affecting the periodontal supporting tissues independently of dental plaque biofilm-induced inflammation
• 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
Examples include squamous cell carcinoma and Langerhans cell histiocytosis

67
Q

What is the effect of diabetes on perio

A

• Common systemic diseases such as uncontrolled diabetes mellitus have variable effects on the course of periodontitis which appear to be part of the multifactorial nature of complex diseases such as periodontitis and are included in the new clinical classification of periodontitis as a descriptor in the staging and grading process

68
Q

Which patients get perio abscesses

A

• The majority of patients with periodontal abscesses already have periodontal diseases

69
Q

What can the causes of a periodontal abscess be split into

A

periodontal abscess in periodontitis patients (in a pre-exisitng periodontal pocket)

periodontal abscess in non-periodontitis pocket (not mandatory to have a pre-exisitng periodontal pocket)

70
Q

What can result in a periodontal abscess in a perio patient

A 
§ Acute exacerbation 
			§ After treatment 
				□ Post surgery 
				□ Post scaling
Post medication
71
Q

What can result in a periodontal abscess in a non perio patient

A 
§ Impaction
			§ Harmful habits (wire or nail biting)
			§ Orthodontic factors/forces 
			§ Gingival overgrowth 
			§ Alteration of root surface
72
Q

Classify periodontal-endodontic lesions

A

Can be with or without root damage

73
Q

What can periodontal-endodontic lesions with root damage be due to

A

○ Root canal fracture or cracking
○ Root canal or pulp chamber perforation
○ External root resorption

74
Q

What can periodontal-endodontic lesions without root damage be due to

A

○ Endo-periodontal lesion in periodontitis patients

○ Endo-periodontal lesion in non-periodontitis patients

75
Q

What are mucgongival deformities and conditions

A

• Mucogingival deformities and conditions around teeth lack of keratinised gingiva/aberrant frenal attachment

76
Q

What is gingival recession split into

A

RT1
RT2
RT3

77
Q

What is RT1 gingival recession

A

gingival recession with no loss of interproximal attachment. Interproximal CEJ is clinically not detectable at both the mesial and distal aspects of the tooth

78
Q

What is RT2 gingival recession

A

gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss is less than or equal to the buccal attachment loss

79
Q

What is RC3 gingival session

A

gingival recession associated with loss of interproximal attachment. Amount of attachment loss is greater than the buccal attachment loss

BDS3 CLINICAL Periodontology (7 decks)

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