diagnosis and classification of perio disease

Question 1

What was the old perio classification?

Answer 1

Armitage 1999

Question 2

What are the three forms of perio?

Answer 2

Necrotising periodontitis
Periodontitis as a manifestation of systemic disease
Periodontitis (previously chronic/aggressive)

Question 3

What are perio health, gingival diseases and conditions divided into?

Answer 3

Perio health and gingival health
Gingivitis- biofilm induced
Gingival diseases- non biofilm induced

Question 4

What are other conditions affecting the periodontium?

Answer 4

Systemic diseases/conditions affecting periodontium
Periodontal abscesses and endo-perio lesions
Mucogingival deformities and conditions
Traumatic occlusal forces (primary, secondary or ortho)
Tooth and prosthesis related factors

Question 5

What are peri-implant diseases and conditions?

Answer 5

Peri-implant health
Peri-implant mucositis
Peri-implantitis
Peri-implant soft and hard tissue deficiencies

Question 6

Why is there a new classification?

Answer 6

Staging and grading system based on attachment and bone loss
4 stages on severity
3 grades- disease susceptibility 
Diagnostic and prognostic statement
Appropriate treatment

Question 7

What is health?

Answer 7

State of complete physical, mental and social well being and not merely an absence of disease and infirmity
WHO 1948

Question 8

What is perio and ginigival health?

Answer 8

Absence of visible inflammation
Could be on intact/reduced periodontium
Physiological bone levels range from 1-3mm apical to CEJ
Can be restored following treatment

Question 9

What is biofilm induced ginigivitis?

Answer 9

An inflammatory lesion resulting from interactions between plaque and the hosts immune inflammatory response
Variety of signs and symptoms 
Local and systemic predisposing factors
Confined to gingiva
Reversible- reduced plaque

Question 10

What is the difference between gingival health and gingivitis?

Answer 10

If 10% or more bleeding sites- gingivitis

Question 11

What is drug induced gingival enlargement?

Answer 11

Eg. Due to amlodipine
Gingiva improves when drugs stopped
~gingival hyperplasia can only be seen through microscope

Question 12

What are non biofilm gingival diseases?

Answer 12

If inflammation- beyond mucogingival junction
Doesn’t resolve following plaque removal
Manifestation of systemic condition or localised to oral cavity

Question 13

What are examples of non biofilm gingival diseases?

Answer 13

Neoplasms
Nutritional disorders
Traumatic lesions (eg thermal)
Gingival pigmentation
And more

Question 14

What is necrotising gingivitis?

Answer 14

No bone loss
Inflamed gingiva
Dental papilla broken down 
Ulceration
Pain 
Halitosis

Question 15

What is necrotising periodontitis?

Answer 15

Involves bone loss 
Inflamed gingiva
Dental papilla broken down 
Ulceration
Pain 
Halitosis

Question 16

What is necrotising stomatitis?

Answer 16

Extensive

Flesh eating disease

Question 17

What is periodontitis as a manifestation of systemic disease?

Answer 17

Rare systemic disorders impacting loss of tissue by influencing inflammation

Question 18

What are examples of genetic disorders causing periodontitis?

Answer 18

Ehlers- Danlos syndrome
~underlying abnormality of collagen 
~hyper flexibility of joints
~increased bleeding and bruising
~hyperextensible skin

Papillon-Lefevre
~palmoplantar hyper keratosis
~affects primary and secondary dentition
~normal teeth until hyperkeratosis of palms/soles

Question 19

How is periodontitis classified?

Answer 19

A. Stages- severity and complexity of treatment 
I- initial
II- moderate
III- severe
IV- very severe

B. Extent and distribution- localised, generalised, molar-incisor distribution

C. Grades- rate of progression and anticipated treatment response
A- slow
B- moderate
C- rapid

Question 20

What are systemic diseases affecting the periodontium?

Answer 20

Genetic disorders
Acquired immunodeficiency diseases
Inflammatory diseases
Diseases influencing pathogenesis of perio
Disorders resulting in loss of tissues independent of perio

Question 21

What are mucogingival deformities and conditions?

Answer 21

Eg. Decreased vestibular depth, lack of gingiva, abnormal colour, gingival excess

New classification- gingival phenotype (thickness, width etc), inter proximal attachment loss, characteristics of exposed root surface

Question 22

What are traumatic occlusal forces?

Answer 22

Any occlusal force that results in injury to teeth eg. Excessive wear or fracture

Question 23

What are prosthesis and tooth related factors?

Answer 23

Replace biological width with supracrestal tissue attachment

Infringement of restorative margins within supracrestal connective tissue attachment associated w inflam/loss of tissue

Eg. Enamel Pearl related to plaque induced inflam and loss of tissue

Question 24

What is peri-implant health?

Answer 24

Absence of erythema, BOP, swelling and suppurations
No increase in probing depth
Absence of bone loss beyond crestal bone level changes due to initial bone remodelling
Normal/reduced bone support
Baseline radiographic measurements recommended

Question 25

What is peri-implant mucositis?

Answer 25

BOP, erythema, swelling and suppurations may be present
Increased pocket depth due to swelling/decrease in probing resistance
Absence of bone loss beyond crestal bone level changes due to initial bone remodelling
Caused by plaque biofilm

Question 26

What is peri-implantitis?

Answer 26

Plaque associated pathological condition occurring in tissues around dental implants characterised by inflammation in mucosa and subsequent progressive loss of supporting bone

Inflammation, BOP, suppuration, increased pocket depths, recession of mucosal margin, radiographic bone loss

Question 27

What are peri-implant soft and hard tissue deficiencies?

Answer 27

Following tooth loss, healing leads to diminished dimensions of the alv process/ridge resulting in tissue deficiencies

Large ridge deficiencies- severe loss of support, extraction trauma, poor tooth position, endo infections, root fracture, thin buccal bone plates

Other factors- medication, systemic diseases reducing bone, tooth agenesis, prostheses pressure

Question 28

What are risk factors associated w the recession of the peri-implant mucosa?

Answer 28

Malpositioning of implants
Lack of buccal bone
Thin soft tissue
Lack of keratinised tissue 
Surgical trauma

Question 29

What is the diagnosis statement?

Answer 29

Disease extent (L/G/M-I)
Periodontitis
Stage (based on bone loss- I, II, III, IV)
Grade (bone loss in relation to age- rate of progression, S/M/R)
Stability (BOP and pocket depth measured, stable, remission, unstable)
Risk factors (should be measurable and have good evidence base)