Classifications

Question 1

how is periodontitis staged

Answer 1

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

Question 2

how is periodontitis graded

Answer 2

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

Question 3

how is the extent of periodontitis classified

Answer 3

localised - affecting less than 30% of the mouth
generalised - affecting more than 30% of the mouth
molar incisor pattern

Question 4

name 3 risk factors for periodontitis

Answer 4

smoking
poorly controlled diabetes
plaque retentive factors

Question 5

stable periodontitis

Answer 5

• BOP at less than 10% of sites
• Pocket depth less than /equal to 4mm
• no BOP at 4mm sites

Question 6

unstable periodontitis

Answer 6

• pocket depth more than/ equal to 5mm OR pocket depth more than/ equal to 4mm with BOP

Question 7

periodontitis in remission

Answer 7

BOP more than 10% of sites
pockets less than or equal to 4mm
No BOP at 4mm sites

Question 8

what 5 things should be included in a diagnostic periodontitis statement

Answer 8

status, grade, stage, risk factors and extent
e.g generalised periodontitis, stage 3 Grade B, currently unstable, risk factor = smoking

Question 9

gingival health criteria

Answer 9

BOP less than 10% , probing depths less than or equal to 3mm

Question 10

what should be included when describing clinical pictures

Answer 10

Soft Tissues - inflammation , recession , papilla loss
Hard Tissues - alignment , occlusion, restorations
Other - where and how much

Question 11

recession type 1

Answer 11

gingival recession that does not affect interproximal aread, only buccal

Question 12

recession type 2

Answer 12

both buccal and interproximal recession present but buccal more so

Question 13

recession type 3

Answer 13

both buccal and interproximal recession present and affected equally

Question 14

Step One of Periodontal Disease Treatment
- Aim
-Steps (5)

Answer 14

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

Question 15

Step 2 of Periodontal Disease Treatment

Answer 15

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

Question 16

What should be done after Step 2 of Periodontal Disease Treatment

Answer 16

Re evaluate the patient after 3 months
If their periodontitis is stable move to step 4
If it is unstable progress to step 3

Question 17

Step 3 of Periodontal Disease Treatment

Answer 17

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+)

Question 18

Step 4 of Periodontal Disease Treatment

Answer 18

Maintenance / supportive periodontal care
- continuous monitoring of local and systemic risk factors
- PMPR
- continuously re inforce OH

Question 19

when should interdental brushes be used instead of floss

Answer 19

if no intact interdental papilla

Question 20

what test should be used to assess diabetic control

Answer 20

HbA1c test (glycated haemoglobin)
normal should be less than 5.7%
diabetes should be less than 6.5%

Question 21

Define a patient engaging with periodontal treatment

Answer 21

• 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

Question 22

Define a non engaging patient in regards to periodontal disease treatment

Answer 22

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)