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Termeie > Diagnosis > Flashcards

Diagnosis Flashcards

1
Q

What is the definition of gingivitis

A

nonspecific gingival inflammation resulting from interactions between dental plaque and the hosts immune response without loss of periodontal attachment. It is reversable.

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2
Q

Describe the clinical and biologic signs of gingivitis

A

erythema, swelling, BOP, Edemarednes and/or bleeding gingiva, Halitosis, Pain or soreness

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3
Q

What are the histopathologic changes of gingivitis? Clinical signs?

A

histopathologic changes
- elongation of rete ridges into the gingival connective tissue
- vasculitis of blood vessels adjacent to the junctional epithelium,
- progressive destruction of the collagen fiber network (alterations in fibroblasts and collagen types)
- progressive inflammatory and immune cellular infiltrate

Clinical signs
- Erythema, bleeding, tenderness, edema, and enlargement

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4
Q

What is periodontitis?

A

Periodontitis is gingival inflammation at sites where there has been loss of collagen fibers from cementum and the junctional epithelium has migrated apically. IT is a complex disease involving interactions between subgingival bacteria, inflammatory responses, and host immune system, and the environmental modifying factors
Primary features
loss of periodontal tissue support
Radiographically assessed alveolar bone loss
Periodontal pocketing and gingival bleeding

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5
Q

How do you diagnose a patient as having periodontitis?

A
  1. Interdental clinical attachment loss is detectable at 2 or more nonadjacent teeth
  2. buccal or lingual/palatal CAL 3+mm with pocketing 3+mm is detectable at 2 or more teeth
  3. The observed CAL cannot be ascribed to non-periodontal causes
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6
Q

What is clinical attachment level

A

Clinical attachment level is the distance from the CEJ to the tip of the periodontal probe during normal probing.

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7
Q

What is probing depth?

A

the distance from the soft tissue margin to the tip of the periodontal probe

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8
Q

What can affect probing depth?

A

insertion force, size of the tip, inflammatory status of the tissues
In health the probe should stop within the junctional epithelium, in periodontitis it will stop within the connective tissue or bone

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9
Q

On a site level how is clinical gingival health classified?

A

Clinical health on an intact periodontium is BOP <10% without attachment loss, erythema, edema, and radiographic bone loss, no PD of 4mm or greater with BOP
Clinical health on a reduced periodontum is stable periodontitis patient (no BOP, erythema, and edema in the presence of reduced bone and clinical attachment levels, no PD of 4+mm with BOP), or a non-periodontitis patient with BOP <10%

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10
Q

Gingival diseases/conditions: Biofilm induced Gingivitis

A

localized - BOP 10-30%
Generalized - BOP 30+%
gingivitis on a reduced periodontum requires no history of periodontitis, possible radiographic bone loss, and all probing depths 3mm or less

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11
Q

Gingival diseases/conditions: gingivitis mediated by systemic or local risk factors

A

systemic risk factors
- Smoking
- Hyperglycemia
- Nutritional factors
- Pharmacologic agents
- Sex Hormones (puberty, Menstrual cycle, pregnancy, contraceptives)
- Hematologic conditions
Oral factors enhancing plaque accumulation
- Prominant subgingivl restoration margins
- Hyposalivation

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12
Q

Gingival diseases/conditions: drug induced

A

Causes gingival enlargement that can mechanically obstruct plaque control, and be painful

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13
Q

Gingival diseases/conditions: non-biofilm induced

A

Genetic disorders (hereditary gingival fibromatosis)
Specific infections (necrotizing, gonorrhea, syphilis, tuburculosis), Viral infection (Coxsackie, HSV, Varicella, PHV), Fungal infection (Candidosis)
Inflammatory and immune conditions. Hypersensitivity reactions (contcact allergy, plasma cell gingivitis, erythema multiforme), Autoimmune diseases (pemphigus vulgaris, pemphigoid, Lichen Planus, Lupus), Granulomatous inflammatory condition (Crohn disease, Sarcoidosis)
Reactive processes. Epulides,
Neoplasms (leukoplakia/erythroplakia, SSC, Leukemia, Lymphoma)
Endocrine/metabolic (Vitamin C)
Traumatic lesions (frictional keratosis, mechanical ulceration, chemical insult, thermal insult
Gingival pigmentation (melanoplakia, smokers melanosis, drug induced pigmentation, amalgam tattoo)

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14
Q

What determines clinical periodontal health

A

Microbial determinants (supragingival plaque and subgingival biofilm composition
Host determinants (local predisposing factors (PPD, restorations, crown anatomy, tooth position and crowding), and systemic modifying factors (host immune function, systemic health, genetics)
Environmental determinants (Smoking, Medications, Stress, Genetics)
From Lang and Bartold, Determinants of periodontal health

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15
Q

Describe the difference between health and gingivitis in an intact periodontium and reduced periodontium (non-periodontitis and successfully treated stable periodontitis patient)

A

Difference is BOP and <10% vs >10%
periodontal helath - no probing attachment loss, PPD 3mm or less, no radiographic bone loss
Reduced periodontium in a non-periodontitis patient - Probing attachment loss present, but PPD 3mm or less, might have radiographic bone loss.
Successfully treated stable periodontitis patient - probing attachment loss and radiographic attachment loss present. Gingivitis can not have 4mmPD, but health can have 4mmPD with no BOP

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16
Q

Describe the characteristics of drug indiced gingiva enlargement

A

occurs mostly in the anterior
higher prevalence in younger age groups
symptoms within 3 months of use
No tooth mortality or tooth loss
first observed in the papilla

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17
Q

What forms of periodontitis are recognised in the revised classification?

A

necrotizing periodontitis
Periodontitis as a manifestation of systemic disease
Periodontitis

18
Q

Periodontitis Stage 1

A

Interdental CAL 1-2mm at site of greatest loss
Radiographic bone loss <15%
PD 3-4mm

19
Q

Periodontitis Stage II

A

Interdental CAL 3-4mm at site of greatest loss
Radiographic bone loss 15-33%
PD 4-5mm

20
Q

Periodontitis Stage III

A

Interdental CAL 5mm+
Radiographic bone loss into the middle third
vertical defects 3mm+
probing depths 6mm+
furcation involvement II or III
masticatory function is preserved
Moderate ridge defect
periodontal tooth loss 4 or less

21
Q

Periodontitis Stage IV

A

Criteria for Stage III must be met, plus
Masticatory disfunction - need for complex rehabilitation
Secondary occlusal trauma, mobility 2+
bite collapse
less than 20 remaining teeth
Severe reidge defect
5+ teeth lost to periodontitis

22
Q

Grading periodontitis

A

A - no bone loss over 5 years, or <0.25 bone loss/age, nonsmoker, no diabetes. Heavy biofilm with no destruction
B - <2mm bone loss over 5 years, 0.25-1 bone loss/age, <10 cigarettes/day, HBA1c <7% in patients with diabetes, Biofilm matches destruction
C - >2mm bone loss over 5 years, >1 bone loss/age, >10 cigarettes/day, HbA1c >7, Destruction exceeds destruction

23
Q

Describe Papillon-Lefevre Syndrome

A

autosomal recessive syndrome characterized by hyperkeratosis of the soles of the feet, palms, knees, and elbows. Most patients have severe periodontitis that leads to early loss of primary and permanent teeth. Neutrophil dysfunction is believed to he the cause of disease.

24
Q

What is the classification of necrotizing periodontal diseases?

A

Necrotizing gingivitis (necrosis/ulcer of the interdental papillae, gingival bleeding)
Necrotizing periodontitis (necrosis/ulcer of the interdental papilla, gingival bleeding, halitosis and rapid bone loss)
Necrotizing Stomatitis (severe inflammatory condition with soft tissue necrosis extending beyond the gingiva and bone denudation with bone sequestrum)
Noma (usually in severely immunocompromised patients, eg AIDS, malnutrition)

25
Q

Describe the classification for periodontal abscesses

A

In a periodontitis patient there is acute exacerbation, or post treatment
In a non-periodontitis patient there is impaction, harmful habits, orthodontic factors, gingival overgrowth, alteration of the root surface

26
Q

What is the differential diagnosis for a periodontal abscess?

A

Tumor lesion (lymphoma, myxoma, SSC
Sickle Cell Anemia
Surgical procedures causing abscesses
Other oral lesions (osteomyelitis, pyogenic granuloma, eosinophilic granuloma)
Odontogenic abscesses (dentoalveolar abscesses, pericoronitis, lateral periapical cyst, endo-periodontal abscess)

27
Q

Classification of endo-perio lesions

A

with root damage (root fracture, canal perforation, external root resorption)
without root damage: either in a periodontitis site (chronic without symptoms) or a non-periodontitis site Grade 1(narrow deep PPD on one tooth surface, Grade II wide deep PPD on one tooth surface, Grade III deep PPD on more than one surface)

28
Q

Describe the prognosis of a tooth with endo-perio lesion

A

usually hopeless tooth, however it ranges depending on the severity of the periodontal destruction

29
Q

Recession classification

A

RT1 - gingival recession with No loss of interproximal attachment, CEJ is not clinically detectable at both mesial and distal aspects of the tooth
RT2 - Gingival recession associated with LOA, with interproximal LOA less than or equal to the buccal attachment loss
RT3 - Gingival recession associated with LOA, with interproximal LOA is greater than buccal LOA

30
Q

Peri-implant health

A

no erythema, no BOP, no inflammation, PD 5mm or less, with no changes 2mm or greater after the first year, and mucosa forms a tight seal around the implant

31
Q

Peri-implant mucositis

A

inflammation of the soft tissues without additional bone loss after the initial remodeling period that may occur during healing following implant placement

32
Q

Peri-implantitis

A

an inflammatory process affecting the tissue around an implant in function that has resulted in loss of supporting bone

33
Q

Peri-implant soft and hard tissue deficiencies

A

soft tissue deficiencies
- thin peri-implant mucosa
- Lack of KT
- reduced papilla height
- Peri-implant frenum attachments
Hard Tissue deficiencies
- horizontal ridge deficiency
- Vertical ridge deficiency
- Pneumatization of maxillary sinus
- Thin/absent buccal and/or lingual bone plates

34
Q

Is BOP a reliable predictor of periodontal disease progression

A

Lang et al found 6% positive predictive value and 98% negative predictive value, indicating that lack of BOP is a reliable indicator of health

35
Q

How much pressure should be applied to a probe when measuring BOP

A

25N around teeth and 15N around implants, Gerber et al

36
Q

Is suppuration a predictor of periodontal disease?

A

suppuration found in 3-5% of sites with periodontal disease

37
Q

Are CAL measurements a good predictor of periodontal disease?

A

They give a good measure of previous damage compared to PPD
CAL measurements are the most valid method of assessing treatment outcomes

38
Q

Is probing depth a good predictor of periodontal disease?

A

Isidor et al found low positive predictive value for deep PPD, but a high negative predictive value for absence of PPD

39
Q

Is tooth mobility a sign of disease?

A

it is a sign of occlusal trauma, indicating that it should not be used as a sign of disease

40
Q

What are important factors when determining a diagnosis?

A

CC
History of CC
medical history
drug history
family history
Extraoral and intraoral examination

41
Q

In which situations are biopsies required?

A

a cancerous lesion is suspected
A positive histologic diagnosis has implications for other body systems
The lesion being diagnosed has variable clinical histologic features

42
Q

Is Rheumatoid Arthritis a predictor of periodontal disease?

A

Pischon et al found RA had significantly increased odds of AL and 8X increase in periodontitis compared with controls

Termeie (9 decks)

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