Diagnosis and Classification of Perio Diseases Flashcards
Factors of Diesease
- Microbial plaque
- genetics/host factors
- Aquired/environmental factors
Things we have control over changing
microbial and host factors
reason for loss of… is due to
response due to biofilm
history and physical examination includes
chief complaint risk history, medical and dental history EO/IO Clinical examination Radiographic examination supplemental diagnostic test
order of diagnosis
History/exam -> Diagnosis -> Prognosis -> Treatment -> Non/surgical -> asses outcome -> history/exam or prognosis
Making a diagnosis
- describing the absence or presence of inflammation
- measuring the level of attachment loss
examle of logical inferences
- Raidographs and attachment levels indicate what happened in the past
- signs of inflammation such as erythema, swelling, bleeding etc .. indicate what is happening now
Periodontal probe
- in mm
- used evaluate the health of periodontal tissues
pocket depth
histological depth
probe depth
clinical depth
function of probe is used to determine the
- health of the perio tissues
- extent of damage to the perio tissues
- miniature rulers for making intraoral measurements
bleeding on probing
for 4 consecutive visits 30% chance of clinical attachment loss
Probe position with attachment loss
tip touches the root below CEJ
Usually greater than 3mm
Disease present (bleeding)
Difficult to measure
finding that important for diagnosis perio disease
probing depths recession bleeding on probing furcation involvement mobility Spacing rotation caries anatomy (crowns)
1999 World Workshop Class I
gingival diseases
1999 World Workshop Class II
Chronic Periodontitis
1999 World Workshop Class III
Aggressive Periodontitis
1999 World Workshop Class IV
Periodontitis as a manifestation of Systemic Diseases
1999 World Workshop Class V
Necrotizing Periodontal Diseases
1999 World Workshop Class VI
Abscesses of the Periodontium
1999 World Workshop Class VII
Periodontitis associated with endodontic lesions
1999 World Workshop Class VII
developmental or acquired deformities and conditions
Dental plaque-induced gingival diseases
- associated with dental plaque only
- modified by systemic factors
- modified by medications
- modified by malnutrition
Non-plaque induced gingivallesions
- bacterial orgin
- viral orgin
- fungal origin
- gentic origin
- manifestation of systemic conditions
- traumatic lesions
- foregin body reactions
two main categories of gingivitis are
plaque induced
non-plaque induced
plaque induced gingivities results from
interplay between plaque bacteria and host denfense system
plaque induced inflammation the results is primarily attributable to the
body’s response in the presence of bacteria and or their products
1989 world workshop Class I
adult perio
1989 world workshop Class II
-
-
1989 world workshop Class III
Perio associated with systemic disease
1989 world workshop Class IV
necrotizing Ulcerative Perio
1989 world workshop Class V
Refracting Perio
you can treat gingivitis with a
prophylaxis
slight gingivitis can be
slight areothemia
plaque induced gingivitis can occur in
area where there had been attachment loss previously, but is stable and not progressing
Gingivititis: _____ _____ must be available for proper diagnosis, including ___ ____ ___
longitudinal records, clinical attachment levels
can you make diagnosis of gingivitis from a radiograph?
NO
amlodipine induces
gingival enlargemnet
gingivitits associated with systemic medications
- phenytoin (dilantin)
- Cyclosporin
- Calcium channel blockers (ex. Nifedipine)
Guidelines of extent of disease are
> 30% = Generalized
non-plaque induced gingivitis represents a small percentage of cases and can result from
- virus
- fungi
- allergic reactions
- autoimmune reactions
- Trauma
desquamative means
shloffing off tissue
auto immune reactions such as desquamative gingivitis, caused by?
lichen planus
mucous membrane
pemphyigold and pemphigus vulgaris
lichen planus can lead to
squamous carcinoma
Clinical attachment loss depths for slight, moderate, severe for periodontitis
slight: 1-2 mm CAL
moderate: 3-4 mm CAL
severe: > 5 mm CAL
chronic periodontitis is characterized as a
slowly progressing disease
can patients exhibit short periods of rapid progression?
Yes
what is the most commonform of periodontitis?
chronic perio.
what induces chronic perio.?
plaque
chronic periodontitis leads to inflammation of the periodontal tissue that results in:
- inflammation of the periodontal tissues
- destruction of connective tissue of PDL
- destruction of supporting alveolar bone
diagnosis of perio. must have both what at the same time and location?
- loss of periodontal attachment from the cemento-enamel junction
- Presence of gingival inflammation that extends beyond the marginal gingiva into the connective tissue
what did aggressive periodontitis replaced?
early onset periodontitis
Generalized Aggressive
Periodontitis
-usually seen in clinically healthy
common feautres of localized (LAP)and generalized aggressive periodontitis (GAP)
Clinically healthy subjects Rapid onset of attachment loss and bone loss Familial aggregation Phagocyte abnormalities Hyperresponsive macrophage phenotype
????protein associated with aggressive periodontitis?
PMN trianlge
protein GP 120?
Amounts of microbial deposits are ______ with the severity of periodontal destruction
inconsistent
bugs associated with aggressive periontitis
A.a. and P.g.
most import part of treatment?
re evaluation
Aggressive Perio facts for localized
- circumpubertal onset
- First molar or incisor w/ attachment loss atleast 2 permanent teeth, one of which a first molar
- sig. serum antibody response to infecting agents
aggressivePerio facts for generalized
- usually under age 30,but may be older
- gen attachment loss aff. least 3 teeth other than first molar and incisors
- poorserum response to infecting agents
- epdisoic nature of destruction
necrotizing periodontal diseases two basic forms:
- Necrotizing Ulcerative gingivitis (NUG)
2. Necrotizing Ulcerative periodontitis (NUP)
Common feautures of NUG and NUP include:
- Rapid onset of pain
- Ulceration and necrosis of marginal gingiva (papillais the classis location)
- predisposition to decreased systemic resistance to certain bacterial infections
NUG is/has
- interproximal necrosis and ulceration of gingival papilla or margin(black triangle)
- Rapid onset of pain
- Fetid breath
- may have pseudomembrane on the surface
- may have lymphadenopathy, fever, malais, anorexia
smell is coming from
valital fatty acid spirochetes and dead tissue
NUG factors associated with disease
- emotional stress
- heavy cigarette use
- lack of sleep
- poor diet
- immunosuppression
Nup is/has
- sim. to clinical apprearance of NUG
- often involves sign loss of connective tissue and alveolar bone
- sometimes bone exposure and sequestration is seen
- associated with severe immuno-suppression is seen in small proportion of HIV- infected patients or those protein -energy malnutrition
periodontal abscess is
- circumscribed collection of neutrophil-laden pus in the sift tissue wall of the periodontal pocket
- usually has a swelling
- can have a fistula
fistula is
An abnormal connection between organs
causes of perio abscess
- deep periodontal pockets
- incomplete calculus removal
- occlusion of the pocket by foreign bodies
- use of antibiotics without scaling and root planing to remove plaque and calculus
Periodontal Abscess is classified into what categories:
Gingival Ascess
Periodontal Abscess
Pericoronal Abscess
gingival abscess
localized to the gingiva only
periodontal abscess
localized to the tissues adjacent to the periodontal pocket that may lead to the periodontal ligament and bone
Pericoronal abscess
associated with the crown of a partially erupted tooth
developmental or acquired deformities / conditions
- cervical enamel projections
- enamel pearls
- furcation anatomy
- root proximity
- tooth position
- root surface grooves
what are mucogingival deformities
lack or absence of keratinized marginal gingival tissue
what can cause mucogingival deformities
- trama
- hist of periodontitis
- ortho (moving teeth)
occlusal tramuma results from
loads on a tooth that exceeds the ability of the periodontium to withstand them
primary occlusal tramuma is
highly moblie
second occlusal tramuma is
most common , loss attachment and is now normal but has movment
the two recognized forms of occlusal trauma
primary and secondary occlusal tramuma
Periodontitis as a manifestation of systemic diseases is
asscoiated with hematologic disorders ( neutropenias, leukemias)
associated genetic disorders with Periodontitis as a manifestation of systemic diseases are
- familial and cyclic neutropenia
- down syndrome
- leukocyte adhesion deficiency syndrome
- papillon-leferve syndrome
- chediak-higashi syndrom