diagnosis and classification of perio disease Flashcards
What was the old perio classification?
Armitage 1999
What are the three forms of perio?
Necrotising periodontitis
Periodontitis as a manifestation of systemic disease
Periodontitis (previously chronic/aggressive)
What are perio health, gingival diseases and conditions divided into?
Perio health and gingival health
Gingivitis- biofilm induced
Gingival diseases- non biofilm induced
What are other conditions affecting the periodontium?
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
What are peri-implant diseases and conditions?
Peri-implant health
Peri-implant mucositis
Peri-implantitis
Peri-implant soft and hard tissue deficiencies
Why is there a new classification?
Staging and grading system based on attachment and bone loss 4 stages on severity 3 grades- disease susceptibility Diagnostic and prognostic statement Appropriate treatment
What is health?
State of complete physical, mental and social well being and not merely an absence of disease and infirmity
WHO 1948
What is perio and ginigival health?
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
What is biofilm induced ginigivitis?
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
What is the difference between gingival health and gingivitis?
If 10% or more bleeding sites- gingivitis
What is drug induced gingival enlargement?
Eg. Due to amlodipine
Gingiva improves when drugs stopped
~gingival hyperplasia can only be seen through microscope
What are non biofilm gingival diseases?
If inflammation- beyond mucogingival junction
Doesn’t resolve following plaque removal
Manifestation of systemic condition or localised to oral cavity
What are examples of non biofilm gingival diseases?
Neoplasms Nutritional disorders Traumatic lesions (eg thermal) Gingival pigmentation And more
What is necrotising gingivitis?
No bone loss Inflamed gingiva Dental papilla broken down Ulceration Pain Halitosis
What is necrotising periodontitis?
Involves bone loss Inflamed gingiva Dental papilla broken down Ulceration Pain Halitosis
What is necrotising stomatitis?
Extensive
Flesh eating disease
What is periodontitis as a manifestation of systemic disease?
Rare systemic disorders impacting loss of tissue by influencing inflammation
What are examples of genetic disorders causing periodontitis?
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
How is periodontitis classified?
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
What are systemic diseases affecting the periodontium?
Genetic disorders
Acquired immunodeficiency diseases
Inflammatory diseases
Diseases influencing pathogenesis of perio
Disorders resulting in loss of tissues independent of perio
What are mucogingival deformities and conditions?
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
What are traumatic occlusal forces?
Any occlusal force that results in injury to teeth eg. Excessive wear or fracture
What are prosthesis and tooth related factors?
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
What is peri-implant health?
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
What is peri-implant mucositis?
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
What is peri-implantitis?
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
What are peri-implant soft and hard tissue deficiencies?
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
What are risk factors associated w the recession of the peri-implant mucosa?
Malpositioning of implants Lack of buccal bone Thin soft tissue Lack of keratinised tissue Surgical trauma
What is the diagnosis statement?
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)
