Classifications Flashcards
how is periodontitis staged
Staged based on worst site of interproximal bone loss
1 - mild - less than 15% or 2mm bone loss
2 - moderate - bone loss is in coronal 1/3 of root
3 - severe - bone loss is in mid 1/3 of root
4 - very severe - bone loss is in apical 1/3 of root
how is periodontitis graded
Graded based on percentage bone loss in comparison to age of patient
Calculation = % bone loss / age
grade A - less than 0.5 (mild)
grade B - 0.5-1 (moderate)
grade C - > 1 (severe)
e.g 50 year old patient with 35% bone loss - 35/50 = 0.7 = grade B
how is the extent of periodontitis classified
localised - affecting less than 30% of the mouth
generalised - affecting more than 30% of the mouth
molar incisor pattern
name 3 risk factors for periodontitis
smoking
poorly controlled diabetes
plaque retentive factors
stable periodontitis
- BOP at less than 10% of sites
- Pocket depth less than /equal to 4mm
- no BOP at 4mm sites
unstable periodontitis
- pocket depth more than/ equal to 5mm OR pocket depth more than/ equal to 4mm with BOP
periodontitis in remission
BOP more than 10% of sites
pockets less than or equal to 4mm
No BOP at 4mm sites
what 5 things should be included in a diagnostic periodontitis statement
status, grade, stage, risk factors and extent
e.g generalised periodontitis, stage 3 Grade B, currently unstable, risk factor = smoking
gingival health criteria
BOP less than 10% , probing depths less than or equal to 3mm
what should be included when describing clinical pictures
Soft Tissues - inflammation , recession , papilla loss
Hard Tissues - alignment , occlusion, restorations
Other - where and how much
recession type 1
gingival recession that does not affect interproximal aread, only buccal
recession type 2
both buccal and interproximal recession present but buccal more so
recession type 3
both buccal and interproximal recession present and affected equally
Step One of Periodontal Disease Treatment
- Aim
-Steps (5)
Aim: build foundations for optimal treatment outcomes
Steps
I - Educate and Explain to patient what perio is and treatment options
II - OHI advice
III - reduce risk factors e.g smoking cessation, removal of plaque retentive factors
IV - PMPR of all accessible plaque and calculus
V - arrange review appt
Step 2 of Periodontal Disease Treatment
Reinforce and Repeat step one
AND subgingival instrumentation for pockets >4mm (either hand and/or powered)
Some cases may also require systemic antibiotics in addition to this
What should be done after Step 2 of Periodontal Disease Treatment
Re evaluate the patient after 3 months
If their periodontitis is stable move to step 4
If it is unstable progress to step 3
Step 3 of Periodontal Disease Treatment
Repeat steps 1 and 2
In residual pockets re-perform subgingival instrumentation (4-5mm)
Consider referral for pocket management and/or periodontal surgery e.g access flap (6mm+)
Step 4 of Periodontal Disease Treatment
Maintenance / supportive periodontal care
- continuous monitoring of local and systemic risk factors
- PMPR
- continuously re inforce OH
when should interdental brushes be used instead of floss
if no intact interdental papilla
what test should be used to assess diabetic control
HbA1c test (glycated haemoglobin)
normal should be less than 5.7%
diabetes should be less than 6.5%
Define a patient engaging with periodontal treatment
- improvement in OH indicted by >_50% improvement in marginal plaque and bleeding scores
OR - plaque levels >_20% and bleeding levels >_30%
OR - patient met targets outlined in their personal care plan
Define a non engaging patient in regards to periodontal disease treatment
insufficient improvement in marginal plaque and bleeding scores indicated by <50% improvement
OR
plaque levels >20% and bleeding levels >30%
OR
patient believes in a palliative approach to periodontal care (relieving symptoms without addressing cause of disease)
