Classification Scheme for Periodontal & Peri-Implant Diseases Flashcards
The periodontitis Armitage 1999 states that the severity of disease is based upon:
clinical attachment level (gold standard)
The periodontitis Armitage 1999 states that the severity of disease is based upon clinical attachment level (gold standard)
Slight:
Moderate:
Severe:
Slight: 1-2 mm
Moderate: 3-4mm
Severe: >= 5mm
The periodontitis Armitage 1999 states that the severity of disease is based upon clinical attachment level (gold standard)
________: 1-2mm
________: 3-4mm
________: greater than or equal to 5mm
Slight: 1-2mm
Moderate: 3-4mm
Severe: greater than or equal to 5mm
What is the PRIMARY cause of tooth loss in the US population over the age of 30?
Periodontitis
With the 1999 classification of periodontal diseases and conditions, why was there concern with the categories chronic periodontitis and aggressive periodontitis?
there was not enough evidence that they were two different entities
In simple terms what’s it mean if you have periodontitis?
attachment loss
What can cause pseudo pockets?
gingival hyperplasia due to medications, genetic diseases etc.
Attachment loss can be measured via:
radiographic bone loss & probing depths
If there is no attachment loss there is no _____ because its not ____
staging & grading; periodontitis
Few practitioners use _____ routinely
clinical attachment level (CAL)
AAP formed a task force in 2015 to identify alternative criteria including:
- radiographic bone loss (RBL)
- probing depth (PD)
T/F: A 6mm probing depth with 20% bone loss is significantly different that 6 mm with 75% bone loss
True
Probing depth is not considered:
diagnostic
Probing depth is not considered diagnostic because: (2)
- Inflammation has effect on penetration of probe into tissue
- Inflammation (swelling) may move gingival margin coronally (pseudo pocket)
When inflammation moves the gingival margin coronally:
pseudopocket
In regard to the 2015 task force guidelines, the 2017 workshop recommended: (2)
- use interproximal attachment loss (2 or more non-adjacent teeth)
- use probing depth as a “complexity” factor (difficulty of treatment)
How do you use attachment loss?
Use two sites that are not next to each other
The 2017 classification of periodontal and peri-implant diseases and conditions new classification is based on strongest:
current evidence
The 2017 classification of periodontal and peri-implant diseases and conditions developed a ______ system that is:
adaptive system; 3 dimensional
The 2017 classification of periodontal and peri-implant diseases and conditions adaptive system (3 dimensional) takes into account: (3)
- severity/extent (number of teeth affected rather than sites)
- prognosis (affects no teeth, up to 4 teeth, 5 or more teeth)
- progression (grading)
answer to something: Plaque in a susceptible host
basically was discussing about if he gave each of us a spoonful of plaque (ew) why we would all not have the same response
Periodontal disease is an _____ disease
inflammatory
Approximately _____ % of adults over the age of 30 years old have periodontitis and this is the primary cause of tooth loss in adults
47%
What is the primary cause of tooth loss in adults?
periodontitis
What categories of people show a greater percentage of periodontitis?
- Men
- Mexican Americans
- Adults below the 100% federal poverty level
- current smokers
- self reported diabetics
Three steps to staging and grading a patient
Step 1:
Initial case overview to assess disease
Three steps to staging and grading a patient
Step 1: Initial case overview to assess disease
Screening involves:
- full mouth probing depths
- full mouth radiographs
- missing teeth
Mild to moderate periodontitis will typically be either:
stage I or stage II
Clinical attachment loss of 1-2mm is stage:
Stage I
Clinically attachment loss of 3-4mm is stage:
Stage II
Three steps to staging and grading a patient
Step 2:
Establish stage
When establishing a stage (step 2) for mild to moderate periodontitis (typically stage I or stage II), what else are you determining during this step?
- confirm clinical attachment loss (CAL)
- rule out non-periodontitis causes of CAL (e.g. cervical restorations or caries, root fractures, CAL due to traumatic causes)
- Determine maximum CAL or radiographic bone loss
- Confirm RBL patterns
For moderate to severe periodontitis these guys are typically:
Stage III or IV
When establishing a stage (step 2) for moderate to severe periodontitis (typically stage III or stage IV), what else are you determining during this step?
- determine maximum CAL or RBL
- confirm RBL patterns
- assess tooth loss due to periodontitis
- evaluate case complexity factors (e.g. severe CAL frequency, surgical challenges)
Three steps to staging and grading a patient
Step 3:
Establish grade
What should be done in step 3- establishing the grade of the patient?
- calculate RBL (% of root length x 100) divided by age
- assess risk factors (such as smoking or diabetes)
- measure response to scaling and root planing and plaque control
- assess expected rate of bone loss
- conduct detailed risk assessment
- account for medical and systemic inflammatory considerations
According to the AAP 2017 classification, in regards to staging and grading:
Every patient categorized based on the _______ periodontal site and specific factors that may impact long term management
WORST
According the the AAP 2017 classification, staging is divided into:
- severity
- complexity
- extend and distribution
Classify the following stages-
Stage 1:
Stage 2:
Stage 3:
Stage 4:
Stage 1: Initial
Stage 2: Moderate
Stage 3: Severe with potential for additional tooth loss
Stage 4: Severe with potential for loss of dentition
Staging 1-4 is based upon:
severity of disease and complexity of case management
What should be taken into consideration when staging?
- Clinical attachment loss (CAL) - USING WORST SITE
- Amount and % of bone loss
- Probing depth
- Presence/extend of ridge defects and furcation involvement
- Tooth mobility
- Tooth loss (due to periodontitis if known)
Criteria for Defining Periodontitis:
- Interdental clinical attachment loss at 2 or more NON-ADJACENT teeth
OR
- Buccal or oral clinical attachment loss of > or = 3mm with
a) pocketing of greater than 3 mm
b) on 2 or more teeth
According to the New staging guidelines using interproximal CAL; a CAL of 1-2 mm would classify someone as:
Stage I
According to the New staging guidelines using interproximal CAL; a CAL of 3-4 mm would classify someone as:
Stage II
According to the New staging guidelines using interproximal CAL; a CAL of greater than equal to 5mm would classify someone as:
Stage III or IV
CAUTION: Ensure the problem cannot be attributed to non-periodontal causes such as:
- Gingival recession- due to trauma (toothbrush trauma/toothpaste abrasion)
- Dental caries- extending to or below the gingival margin
- Defect on distal of 2nd molars caused by malposition or extraction of a 3rd molar
- Endodontic lesion-draining through marginal periodontium (deep probing depth)
- Vertical root fracture (usually isolated deep probing depth)
Complexity:
1. Takes into account ____
2. Evaluates ____
3. Evaluates ____
- overall probing depths
- radiographic bone loss, horizontal and vertical
- furcation involvements, number of missing teeth, function
When considering staging and grading for periodontitis, factors to consider include all EXCEPT:
- smoking
- diabetes
- attachment level
- bleeding on probing
- bleeding on probing because this is just a sign of inflammation
Prognosis based upon staging and tooth loss
Stage I or II =
No tooth loss likely
