Diagnosis, Prognostication, Treating Planning and Outcomes Flashcards
What is periodontitis
An infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss; characterised by pocket formation and/or recession of the gingiva
What are some of the clinical features of periodontitis
- Gingival inflammation
- Bleeding on probing
- Gingival recession/enlargement
- Periodontal pockets
- Loss of clinical attachment
- Loss of alveolar bone
- Tooth mobility, drifting of teeth
- Tooth loss
What is important to ask in the Social history of a period patient
- Job?
- Stress?
- Smoking? (none, started?, how long?/many)
- Likely attendance/compliance
What is important to ask in the Family history of a period patient
- Periodontitis in family
- Diabetes?
What is important to ask in the medical history of a period patient
- Systemic diseases
- Medication/treatments
- Allergies
What is important to ask in the dental history of a period patient
- Oral hygiene practice
- Compliance
- Previous therapy
What parameters are checked in order to classify severity of periodontal disease
- Probing pocket depth
- Probing attachment level
- Furcation involvement
- Tooth mobility
- Plaque
- Bleeding/suppuration
What are the different classes of furcation involvement
Class 1 (A) - less than 1/3 loss (3mm ish) Class 2 (B) - more than 1/3 loss (3mm ish) but not through and through Class 3 (C) - Through and through with probe
What is horizontal bone loss
When there is alveolar bone resorption where the height of the bone in relation to the teeth has been uniformly decreased
What is vertical bone loss
This is an abnormal decrease in alveolar bone on one proximal surface of a tooth compared to the tooth on the adjacent side
What do we use to classify periodontitis (not just clinical tings)
- Age of onset/presentation
- Medical history - contributory or not?
- Family history
- Presumed etiological factor
- Clinical presentation (extent and severity)
- Speed of disease progression
What is the more prevalent form of periodontitis in adults
chronic periodontitis
What is the difference between localised and generalised periodontitis
Localised = less than or equal to 30% of sites Generalised = greater than 30% of sites
What is the probing depth of slight, moderate and severe chronic periodontitis
Slight = 3-5mm Moderate = 5-7mm Severe = >7mm
What is the CAL of slight, moderate and severe chronic periodontitis
Slight = 1-2mm Moderate = 3-4mm Severe = >5mm
What is the clinical definition of periodontitis (where these things must be present clinically or it doesnt count)
- Interdental CAL (attributed to periodontal causes) is detectable at 2 or more adjacent teeth
- Buccal or oral CAL of 3 or more mm. with pocketing greater than 3mm detectable at 2 or more teeth
What indicates stage 1 severity periodontitis
Interdental CAL (at greatest site) = 1-2mm Bone loss = coronal third (<15%) Tooth loss = none
What indicates stage 2 severity periodontitis
Interdental CAL (at greatest site) = 3-4mm Bone loss = coronal third (15-33%) Tooth loss = none
What indicates stage 3 severity periodontitis
Interdental CAL (at greatest site) = 5 or more mm Bone loss = extending to middle third of root and beyond Tooth loss = 4 or less teeth
What indicates stage 4 (final stage) severity periodontitis
Interdental CAL (at greatest site) = 5 or more mm Bone loss = extending to middle third of root and beyond Tooth loss = 5 or more teeth
What indicates stage 1 complexity periodontitis
- Max probing depth of 4 or less mm
- Mostly horizontal bone loss
What indicates stage 2 complexity periodontitis
- Max probing depth of 5 or less mm
- Mostly horizontal bone loss
What indicates stage 3 complexity periodontitis
In addition to Stage 2 complexity:
- Probing depths of 6 or more mm.
- Vertical bone loss of 3 or more mm.
- Furcation involvement class 2 or 3
- Moderate ridge defects
What indicates stage 4 complexity periodontitis
In addition to Stage 3 complexity: Need for complex rehabilitation due to: - Masticatory dysfunction - Secondary occlusal trauma - severe ridge defects - Bite collapse, drifting, flaring - less than 20 remaining teeth
What is the grading of periodontitis used for
To indicate the rate of progression of periodontal disease
What grade modifiers can there be
- smoking and diabetes
Describe the smoking risk factor that can put a patient in each of the periodontitis grades
Grade A = non-smoker
Grade B = less than 10 cigs a day
Grade C = 10 or more cigs a day
Describe the diabetes risk factor that can put a patient in each of the periodontitis grades
Grade A = normoglycemic/no diagnosis of diabetes
Grade B = HbA1c < 7% in patients with diabetes
Grade C = HbA1c ≥ 7% in patients with diabetes
What rate of progression of radiographic bone loss or CAL puts a patient in each of there periodontitis gradings
Grade A = no loss over 5 years
Grade B = <2mm over 5 years
Grade C = ≥2mm over 5 years
What %bone loss/age score is used for each periodontitis grading
Grade A = <0.25
Grade B = 0.25 - 1.0
Grade C = >1.0
What is the main distinction between stage 3 and 4 periodontitis
It should be based on the complexity of managing the case that is influenced by tooth loss
Definition of prognosis
The likely cause of a medical condition
What are some of the criteria for a patient to have “periodontal stability”
- <10% BOP
- No sites with PPD>5mm.
- No degree 2/3 furcations
- No mobility > 1
- No sensitivity, caries, aesthetic concerns
When Initial PPD is < 3mm. what PPD reduction can be predicted after non-surgical treatment
0.5mm
When Initial PPD is 3-6mm. what PPD reduction can be predicted after non-surgical treatment
1.0-1.5mm
When Initial PPD is 7-10mm. what PPD reduction can be predicted after non-surgical treatment
2.5-5.0mm
