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Perio I Supplemental Cards > Diagnosis and Classification of Periodontal Disease > Flashcards

Diagnosis and Classification of Periodontal Disease Flashcards

1
Q

describe how diagnosis, prognosis, and treatment are related

A
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2
Q

describe the basics for making a diagnosis

A
  • Describing the absence or presence of inflammation
  • Measuring the level of attachment loss
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3
Q

describe gathering and analyzing findings

A
  • žLook at your gingival description.
  • žDoes it describe health or disease (signs of inflammation)?
  • žIs it localized to a few surfaces of a few teeth or is it generalized throughout the mouth?
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4
Q

describe analysis of findings

A
  • Use the evidence in your findings to make LOGICAL inferences, i.e. :
    • Radiographs and attachment levels indicate what has happened in the past.
    • Signs of inflammation such as erythema, swelling, bleeding on probing etc. indicate what is happening now.
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5
Q

describe the diagnosis flow chart, starting with the gingival exam

A
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6
Q

draw out the critical pathway of pathogenesis

A
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7
Q

do all probes have the same pattern of millimeter markings?

A

no

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8
Q

describe the function of probes

A
  • used to determine the health of the periodontal tissues
  • used to determine the extent of damage to the periodontal tissues
  • assess for the presence of bleeding (aka inflammation)
  • used like miniature rulers for making intraoral measurements
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9
Q

describe what periodontal probes measure

A
  • sulcus and pocket depths
  • clinical attachment levels
  • width of attached gingiva
  • size of oral lesions
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10
Q

what should the probing depth be in a healthy sulcus?

A
  • 1-3mm
  • will see a slight blanching (whitening from pressure during probing) of the tissue
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11
Q

describe the probe position in healthy tissue

A
  • probe tip should touch the tooth near the CEJ
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12
Q

what is a periodontal pocket? is it determined by probing depth?

A
  • a periodontal pocket is an unhealthy sulcus
  • it is not determined by probing depth alone
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13
Q

describe the probe position with attachment loss

A
  • probe tip touches the root somewhere below the CEJ (attachment loss)
  • disease present, as indicated by bleeding
  • difficult to measure
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14
Q

what is the minimal probing depth in a periodontal pocket with attachment loss?

A

depth greater than 3mm

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15
Q

describe the clinical attachment level vs. probing depth

A
  • CAL is the measurement from the CEJ to the attachment point of the gingiva
    • independent of the probing depth
  • probing depth is the measurement from the gingival margin to the attachment point of the gingiva
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16
Q

what are 10 clinical exam findings that are important in diagnosing periodontal disease

A
  1. probing depths
  2. recession (gingival margin)
  3. bleeding on probing
  4. furcation involvement
  5. mobility
  6. rotation
  7. spacing (open contacts)
  8. restoraitons
  9. caries (class V)
  10. anatomy
  11. miscellaneous
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17
Q

describe dental plaque-induced gingival diseases

A
  • associated with dental plaque only
  • modified by systemic factors, medications, and malnutrition
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18
Q

describe non-plaque induced gingival lesions

A
  • bacterial, viral, fungal, and/or genetic origin
  • manifestations of systemic conditions
  • traumatic lesions
  • foreign body reaction
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19
Q

what are the two categories of gingivitis?

A

plaque induced and non-plaque induced

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20
Q

describe plaque induced gingivitis

A
  • results from interplay between plaque bacteria and the host’s defense system
  • resulting inflammation is primarily attributable to the body’s response to the presense of bacteria and/or their products
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21
Q

where can plaque induced gingivitis occur?

A
  • in areas where there had been attachment loss previously, but is stable and not progressing
  • longitudinal records must be available for proper diagnosis, including clinical attachment levels
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22
Q

what are 3 systemic medications associated with gingivitis?

A
  • phenytoin (dilantin)
  • cyclosporin
  • calcium channel blockers (nifedipine)
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23
Q

what is the extent of gingival and/or periodontal disease determined by?

A

the number of sites (not teeth) that have experienced inflammation/destruction:

  • >/= 30% = generalized
  • <30% = localized
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24
Q

describe what can cause non-plaque induced gingivitis

A
  • represents a small percentage of the cases and can result from the following causes:
    • viruses
    • fungi
    • allergic reactions
    • autoimmune reactions
    • trauma
25
Q

what are 5 examples of autoimmune reactions that result in non-plaque induced gingivitis?

A
  • desquamative gingivitis
  • lichen planus
  • mucous membrane
  • pemphyigoid
  • pemphigus vulgaris
  • other causes include hypersensitivity reactions to oral hygiene products and dental materials
26
Q

what findings or combination of findings do you use when diagnosing chronic periodontitis?

A
  • bleeding
  • abscess
  • bone loss
  • attachment loss
  • furcation involvement
  • probing depth
  • plaque
  • calculus
  • smoking
  • mobility
  • systemic conditions
27
Q

according to the 1999 world workshop, what are the 8 categories of periodontal conditions?

A
  1. gingival disease
  2. chronic periodontitis
  3. aggressive periodontitis
  4. periodontitis as a manifestation of systemic diseases
  5. necrotizing periodontal diseases
  6. abscesses of the periodontium
  7. periodontitis associated with endodontic lesions
  8. developmental or acquired deformities and conditions
28
Q

according to the 1999 world workshop, adult periodontitis is now known as ____

A

chronic periodontitis

29
Q

according to the 1999 world workshop, early-onset periodontitis (prepubertal, juvenile, and rapidly progressive periodontitis) is now known as ___

A

aggressive periodontitis

30
Q

according to the 1999 world workshop, periodontitis associated with systemic desease is now known as ____

A

periodontitis as a manifestation of systemic diseases

31
Q

according to the 1999 world workshop, necrotizing ulcerative periodontitis is now known as ____

A

necrotizing periodontal disease

32
Q

describe how the severity of periodontal disease is determined

A
  • clinical attachment loss:
    • slight: 1-2mm CAL
    • moderate: 3-4 mm CAL
    • severe: >/= 5mm CAL
33
Q

describe the 3 classes of periodontitis

A
  • class A: mild or moderate
    • can be treated by a general dentist
  • class B: moderate
    • can be treated by a general dentist or specialist
  • class C: advanced
    • should be treated by a specialist
34
Q

chronic periodontitis is traditionally characterized as a ____ disease. however, some patients may exhibit short periods of ___

A
  • slowly progressing disease (0.1mm/yr)
  • rapid progression
35
Q

describe chronic periodontitis

A
  • most common form of periodontitis
  • slow progression
  • plaque induced
  • can be modified by systemic diseases
  • leads to inflammation of the periodontal tissues that can result in other problems
36
Q

chronic periodontitis leads to inflammation of the periodontal tissues that result in what 3 things?

A
  • inflammation of the periodontal tissues
  • destruction of the connective tissue of the periodontal ligament
  • destruction of the supporting alveolar bone
37
Q

in the diagnosis of periodontitis, what 2 things must be present at the same time and same location?

A
  • loss of periodontal attachment from the cemento-enamel junction
  • presence of gingival inflammation that extends beyond the marginal gingiva into the connective tissue
38
Q

describe generalized aggressive periodontitis

A
  • relatively rare form of periodontitis
  • rapid attachment and bone loss
  • poor serum antibody response to infecting bacteria
  • familial aggregation
  • episodic occurrence of bone and attachment loss over time
39
Q

generalized aggressive periodontitis is usually seen in what age patients and of what health status?

A

clinically healthy patients <30 years old

40
Q

how is generalized aggressive periodontitis defined based on affected teeth?

A

attachment loss affecting >/= 3 permanent teeth other than permanent 1st molars/incisors

41
Q

what are common features of localized (LAP) and generalized (GAP) aggressive periodontitis?

A
  • clinically healthy subjects
  • rapid onset of attachment loss and bone loss
  • familial aggregation
  • phagocyte abnormalities
  • hyperresponsive macrophage phenotype
42
Q

localized aggressive periodontitis is localized to what teeth?

A
  • 1st molars/incisors
  • involves 2+ permanent teeth including one 1st molar and = 2 other tooth types
43
Q

describe localized aggressive periodontitis (LAP)

A
  • rapid onset in clinically healthy circumpubertal adolescents
  • relatively rare form of periodontitis
  • associated with a robust antibody response to infecting bacteria
  • familial aggregation
  • generally amount of plaque is not commensurate with the amount of destruction
44
Q

T or F:

in aggressive periodontitis, the amounts of microbial deposits are consistent with the severity of periodontal destruction (A.a., P.g.)

A

false

amounts of microbial deposits are inconsistent with the severity of periodontal destruction

45
Q

what are the 2 basic forms of necrotizing periodontal disease?

A
  • necrotizing ulcerative gingivitis (NUG)
  • necrotizing ulcerative periodontitis (NUP)
46
Q

describe the features common to both NUP and NUG

A
  • rapid onset of pain
  • ulcerative and necrosis of marginal gingiva (papilla is the classic location)
  • predisposition to decreased systemic resistance to certain bacterial infections
47
Q

describe necrotizing ulcerative gingivitis

A
  • interproximal necrosis and ulceration of gingival papilla or margin (classic presentation is the “punched-out papilla”)
  • rapid onset of pain
  • fetid breath
  • may have a pseudomembrane on the surface (made of fibrin, bacteria, sloughed epithelial cells, and debris)
  • may have lymphadenopathy, fever, malaise, anorexia
48
Q

what are 5 factors associated with NUG?

A
  • emotional stress
  • heavy cigarette use
  • lack of sleep
  • poor diet
  • immunosuppression
49
Q

describe necrotizing ulcerative periodontitis

A
  • similar to the clinical appearance of NUG
  • often involves significant loss of connective tissue and alveolar bone
  • sometimes bone exposure and sequestration is seen
  • associated with severe immuno-suppression such as that seen in a small proportion of HIV-infected patients or those with protein-energy malnutrition
50
Q

describe periodontal abscesses

A
  • circumscribed collection of neutrophil-laden pus in the soft tissue wall of the periodontal pocket
  • localized to the tissues adjacent to the periodontal pocket that may lead to the periodontal ligament and bone
  • usually has swelling
  • can have a fistula
51
Q

what are 4 causes of periodontal abscesses?

A
  • 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
52
Q

what are the 3 categories of periodontal abscess classification?

A
  • gingival abscess
  • periodontal abscess
  • pericoronal abscess
53
Q

what is a gingival abscess

A

localized to the gingiva only

54
Q

what is a pericoronal abscess?

A

associated with the crown of a partially erupted tooth

55
Q

name 6 developmental or acquired deformities/conditions sometimes associated with periodontal disease

A
  • cervical enamel projections
  • enamel pearls
  • furcation anatomy
  • root proximity
  • tooth position
  • root surface grooves
56
Q

what is a mucogingival deformity associated with periodontal disease?

A

lack or absence of keratinized marginal gingival tissue

57
Q

describe occlusal trauma and its 2 recognized forms

A
  • results from loads on a tooth that exceeds the ability of the periodontium to withstand them
  • two recognized forms are:
    • primary occlusal trauma
    • secondary occlusal trauma
58
Q

what are 2 generalized disorders that periodontitis is associated with?

A
  • hematologic disorders
    • neutropenias, leukemias
  • genetic disorders
59
Q

name 5 genetic disorders associated with periodontitis

A
  • familial and cyclic neutropenia
  • down syndrome
  • leukocyte adhesion deficiency syndrome
  • papillon-lefevre syndrome
  • chediak-higashi syndrome

Perio I Supplemental Cards (7 decks)

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