etiologies of periodontal diseaes Flashcards by PIPER KING

periodontitis

____, ______ inflammatory disease

____ damage

Types/categories
- ______ PD
- Periodontitis as a ______ of ______ diseases
- Periodontitis Stage ___, Grade ___

what 4 things affect it

Chronic, multifactorial inflammatory disease

Irreversible damage

Types/categories
Necrotizing PD
Periodontitis as a manifestation of systemic diseases
Periodontitis Stage I-IV, Grade A-C

host inflammatory response, microbial shift, environmental factors, genetics

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health microbiological determinants:

host determinants:

environmental determinants:

(biofilm composition)

(tooth anatomic factors and host status)

(smoking/stress)

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what are the 3 steps to properly diagnosing periodontitis

Identify attachment loss in more than TWO NONADJACENT TEETH
- attachment loss must be related to periodontitis
- Other potential etiologies (such as F/L recession, root fracture, impacted wisdom teeth, migrating teeth, and defective restorations) should be excluded
Identification of the form of periodontitis (e.g., necrotizing, manifestation of systemic conditions, or periodontitis)
Description of the presentation, based on the staging and grading system

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Pocket formation/gingival recession __________

Bacterial infection with ____ to ____ destruction
- __ to __% of population severe destruction; ____pts slight to moderate
- when Host response in severely ______ > severe breakdown is more commonly observed

Prevalence increases with ____; remember:
- ___ percent, or ___ million American adults, have mild, moderate or severe periodontitis
- Adults __ and older, prevalence rates increase to ____ percent

Clinical Signs?

Pocket formation/gingival recession interproximally

Bacterial infection with slow to moderate destruction
- 10 to 20% of population severe destruction; most pts slight to moderate
- Host response in severely compromised severe breakdown more commonly observed

Prevalence increases with age; remember:
- 47.2 percent, or 64.7 million American adults, have mild, moderate or severe periodontitis
- Adults 65 and older, prevalence rates increase to 70.1 percent

inflammation, infection, furcations, mobility, IAG, open embrasure spaces for food impaction, drifting teeth due to attachment loss

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what is necrotizing perio*

three typical clinical features: necrosis of the papilla, bleeding; and pain.

This condition is associated with an impairment of the host immune response

*necrotizing forms are considered periodontal emergencies that need immediate attention. Rare to see.

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what is manifestation of systemic disease perio

many diseases and conditions can affect the periodontal tissues by
1) influencing the course of periodontitis
2) affecting the periodontal supporting tissues independently of dental plaque biofilm-induced inflammation.

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what is chronic periodontitis

common, chronic inflammation of the periodontal tissues which is caused by the accumulation of large amounts of dental plaque

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what is aggressive periodontitis

rapid progression and patients often display a different pattern of bone loss compared to those suffering from chronic periodontitis.

Typically affects younger people.

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NECROTIZING PERIODONTAL DISEASE (severely and chronically compromised)

adult predisposing conditions

child predisposing conditions

clinical conditions for adults and children

adult predisposing conditions:
- HIV/AIDS with CD4 counts less than 200 and detectable viral load
- other severe systemic conditions that cause immunosuppresion

child predisposing conditions
- severe malnouishments
- extreme living conditons
- severe viral infections

clinical conditions for adults and children:
- necrotizing gingivitis
- necrotizing periodontitis
- necrotizing stomatitis
- noma
- possible progression

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NECROTIZING PERIODONTAL DISEASE (temporarily or moderately compromised)

gingivitis pt predisposing conditions

gingivitis clinical conditions

periodontitis pt predisposing conditions

periodontitis clinical conditions

local factors predisposing

local factors clinical conditions

gingivitis pt predisposing conditions:
- uncontrolled factors like stress, nutrition, smoking
- previous NPD (residual craters)

gingivitis clinical conditions
- generalized NG
- possible progression to NP

periodontitis pt predisposing conditions
- common predisposing factors

periodontitis clinical conditions
- NG infrequent
- progression
- NP infrequent profession
local factors predisposing

local factors clinical conditions

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NUP > HIV assoc. Necrosis of gingival tissues combined with loss of attachment and bone

___, _____ onset

Spontaneous ____

______, _____ odor, fever, lymphadenopathy

Rapid, ______ bone loss

Painful _______

Extremely rapid ________

Can produce loss of _____ within ___

Characterized by _____of gingival tissues, ___, and _____ bone loss

Associated with severe ______

PAIN, SUDDEN onset

Spontaneous BLEEDING

PSEUDOMEMBRANE, FETID odor, fever, lymphadenopathy

Rapid, IRREGULAR bone loss

Painful INFECTION

Extremely rapid DESTRUCTION

Can produce loss of ATTACHMENT within DAYS

Characterized by necrosis of gingival tissues, PDL, and alveolar bone loss

associated with severe IMMUNODEFICIENCY

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objectives for Nonsurgical Therapy for Periodontitis

Non-surgical periodontal therapy (NSPT) is your ________

_____ periodontal pathogens

Remove ______ biofilm

Resolve _______

Eliminate ______ and other _____ risk factors

________ disease progression

Non-surgical periodontal therapy (NSPT) is your scaling and root debridement

Reduce periodontal pathogens

Remove subgingival biofilm

Resolve inflammation

Eliminate calculus and other local risk factors

Arrest disease progression

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principles of NSPT

Assess ____ factors

Self-care pt ______

Create a ______ biologically acceptable ____ surface

Instrumentation

Appropriate ______

_______ at regular intervals

Eliminate/suppress infectious microorganisms

Eliminate or control the source of the infection to prevent ________

Establish an environment which promotes resolution of _______

Consideration of ___ factors

Reduce ____, reduce _____, stabilize ______ levels

Assess risk factors

Self care pt education

Create a smooth biologically acceptable root surface

Instrumentation

Appropriate referral

Re-evaluation at regular intervals

Eliminate/suppress infectious microorganisms

Eliminate or control the source of the infection to prevent re-infection

Establish an environment which promotes resolution of inflammation

Consideration of host factors
Reduce biofilm, reduce pockets, stabilize attachment levels

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what can our outcomes be impacted by? (6)

Depth of pockets (we can only reach up to 7mm)

Accessibility/location

Furcation involvement

Sensitivity

Active infection

Patient motivation/understanding

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ASSESSMENT PHASE

Have patient _______

They will not “buy in” without feeling ______ in the process

Have them identify ____ sites versus ____ sites: SHOW the _____ chart

Have them identify where ______ accumulates (with your two-tone, new versus old plaque too!)

Help patient acknowledge disease ______

Develop ______ and _____ plans with the patient

Designed to: (3)

Have patient participate

They will not “buy in” without feeling included in the process

Have them identify healthy sites versus disease sites-SHOW the perio chart

Have them identify where plaque accumulates (with your two tone, new versus old plaque too!)

Help patient acknowledge disease status

Develop goals and education plans with the patient

Designed to: Inform, Motivate, Elicit Cooperation

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bleeding on probing

Check at ____ appt
Sign of ______/______ infection
Measure of _____ success

Check at every appt
Sign of re-infection/active site
Measure of long-term success

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limitations of BOP

Medication impacts
- ______
- ______
- ______

Menstruation

Dietary supplements
- _______
- ______

_______ force

Local trauma
- _____ impacting
- _______ habits

Smoking

Medication impacts
- Aspirin
- Anti-coagulant therapy
- Hypertensive medications

Menstruation

Dietary supplements
- Ginkgo
- St. John’s Wart

Probing force

Local trauma
- Food impacting
- Flossing habits

Smoking

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bleeding assessment - opportunity to design and evaluate effective _______ self-care therapies

______/______ options
Irrigation
_______ therapy
_______ aids

bleeding assessment - opportunity to design and evaluate effective adjunctive self-care therapies

Brushing options
Flossing options
Irrigation
Antimicrobial therapy
Adjunctive aids

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the pt should be informed of (4)

Areas resistant to therapy
Changes in therapy outcomes
Need for re-treatment
Other health problems

severe cases

____% of the population with perio

_______ infection results in _____ within supporting structures of teeth

Characterized by _____ destruction of PDL, bone, high risk for ____ loss and ___ response to therapy

Disease severity inconsistent with ______ of plaque biofilm

Commonly ______ (___ marker test is for this gene specifically)

Elevated ___ and ___

PMN’s ________ defect

8-20% of the population with perio

Bacterial infection results in inflammation within supporting structures of teeth

Characterized by rapid destruction of PDL, bone, high risk for tooth loss and poor response to therapy

Disease severity inconsistent with amount of plaque biofilm

Commonly familial (PST marker test is for this gene specifically)

Elevated PGE and IL

PMN’s chemotaxis defect

molar/incisor distribution

*Specific _____ associated with _______ periodontitis forms

___ to ___ % familial, siblings

Onset: _____

Permanent ____ molars and ____ incisors = major rapid ___ loss

Rads = _______ bone loss, rapid

______, ____ and ______

__ x faster

__ to __ % in __ weeks in one study!

*Specific pattern associated with aggressive periodontitis forms

25 to 50 % familial, siblings

Onset: puberty (YOUNG) (chronic is associated with molars)

Permanent first molars and central incisors = major bone loss, and rapid

Rads = vertical bone loss, rapid

Diastema, Migration and Mobility

4 x faster

25 to 60 % in 9 weeks in one study!

molar/incisor: formerly known as __________

Onset of disease around ______; African American _____ most affected

Involving NO more than ____ teeth other than the ______ and ______

molar/incisor: formerly known as localized aggressive

Onset of disease around puberty; African American females most affected

Involving NO more than two teeth other than first molars and incisors

molar/incisor distribution

Lack of tissue _______ and minimal amounts of ______ that seem _______ with amount of periodontal destruction

Frequently associated with _________

_____ bone loss around _____ and _______: beginning around _____.

______ destruction despite ______ plaque and no _____ calculus deposits

Neutrophil ________ defect with this gene

_____ appearing gingiva – no clinical ________ ; Deep on ____ and in _____

Lack of tissue inflammation and minimal amounts of plaque that seem inconsistent with amount of periodontal destruction

Frequently associated with Aggregatibacter actinomycetemcomitans (Aa)

Vertical bone loss around first molars and incisors—beginning around puberty

Localized destruction despite sparse plaque and no supragingival calculus deposits

Neutrophil chemotaxis defect with this gene

Healthy appearing gingiva – no clinical inflammation; Deep on root and in epithelium

treatment

______ 1 gram _/day, __ to ___ days

_______, _______

___ after surgery

__-__ month recare

__ VBWX series each recare until resolved

____ Care

Microbiological monitoring

Perio surgery: may be indicated depending on amount of ______ and ________

tetracycline 1 gram 4/day, 7-21 days

amoxicillin, metronidazole

CHX after surgery

2-3 month recare

7 VBWX series each recare until resolved

self Care

Microbiological monitoring

Perio surgery: may be indicated depending on amount of attachment loss and dentition dysfunction

periodontitis associated with systemic conditions Likely a condition associated with ________ issues (6)

immunological issues: Down Syndrome Leukocyte adhesion deficiency syndromes Papillon‐Lefevre syndrome Haim‐Munk syndrome Chediak‐Higashi syndrome Severe neutropenia

hematologic disorders: abnormalities in the structure or function of the _____ and blood forming tissues such as: (4) acquired ________, _______, ____/____, other rare blood disorders

Hematologic Disorders Abnormalities in the structure or function of the blood and blood-forming tissues such as: Red blood cells White blood cells Platelets Clotting factors Acquired neutropenia, leukemia, AIDS/HIV, other rare blood disorders

CAN GENETIC DISORDERS CAUSE PD: yes! still being studied Genetic disorder: disease caused by the _____ of a gene or by the products of a ______ Passed down in _______, but not always in each _______ (2)

Genetic disorder: disease caused by the absence of a gene or by the products of a defective gene Passed down in families, but not always in each generation Down syndrome, autoimmune disorders

mucogingival deformities and conditions Mucogingival deformity: a significant alteration of the _____, size, and ______ between the gingiva and _______ most common example?

Mucogingival deformity—a significant alteration of the morphology, size, and interrelationships between the gingiva and alveolar mucosa Recession of the gingival margin is the most common example

occlusal trauma with periodontal patients what is secondary occlusal trauma Rapid ____ and ______ may result Widened ___, root ______, bone loss, ______, fremitus, _______, fracture, ______ sensitivity

Occlusal forces applied to a tooth or teeth that previously had attachment loss or bone loss, called secondary occlusal trauma. Rapid bone loss and pocket formation may result Widened PDL, root resorption, bone loss, mobility, fremitus, migration, fracture, thermal sensitivity

tooth abnormalities Can be considered _____ contributing factors ______ enamel projections Enamel ______ ______ grooves Malalignment ______-related issues

Can be considered local contributing factors Cervical enamel projections Enamel pearls Palatolingual grooves Malalignment Prosthesis-related issues

Staging levels = _____ status - Indicate the ______of the disease - Complexity of disease _________ Grading = a ______ prediction - Considers _______ biologic characteristics of the patient - Estimating the ___ and likelihood of periodontitis _______ - _______

Staging levels = current status - Indicate the severity of the disease - Complexity of disease management Grading = a future prediction - Considers supplemental biologic characteristics of the patient - Estimating the rate and likelihood of periodontitis progression - Prognosis

step 1 staging/grading Step 1: ____ Case Overview to Assess Disease Mild to moderate periodontitis = Severe to very severe periodontitis = what do you use to determine

Step 1: Initial Case Overview to Assess Disease Mild to moderate periodontitis Typically, either Stage I or Stage II Severe to very severe periodontitis Typically, either Stage III or Stage IV full mouth xrays, full mouth probing depths, missing teeth from perio

complexity score Based on the __________ assuming the need to eliminate local factors Considers the presence of: (7) Besides the local complexity, individual case management may be complicated by ______ factors or _______.

Based on the local treatment complexity assuming the need to eliminate local factors Considers presence of: vertical defects, furcation involvement, tooth hypermobility, drifting and/or flaring of teeth, tooth loss, ridge deficiency and loss of masticatory function. Besides the local complexity, individual case management may be complicated by medical factors or comorbidities.

what are the 3 options for extent and distribution

localized: under 30 percent generalized: over 30 percent molar/incisor pattern

stage 1 severity: 3 stage 1 complexity: 2

severity: - 1-2mm CAL - less than 15% RBL - no perio tooth loss complexity - max probing depths 4mm or less - mostly horizontal bone loss

stage 2 severity: 3 stage 2 complexity: 3

severity: - 3-4mm CAL - 15-33% RBL - no tooth loss due to perio complexity: - 5mm max PD - horizontal bone loss - furcation's 2 or 3 would shift to a stage 3 or 4

stage 3 severity: 3 stage 3 complexity in addition to stage 2: 4

severity: - 5mm CAL or more - RBL middle third or above - 1-4 teeth loss complexity: - takes ONE complexity factor to shift to a higher stage - probing depth 6mm or higher - class 2/3 furcations - moderate ridge defects

stage 4 severity: 3 stage 4 complexity: 6

severity: - 5mm or more CAL - RBL mid or apical third - 5 or more teeth lost complexity; Need for complex rehabilitation due to: - Masticatory dysfunction loss of teeth - Secondary occlusal trauma - (tooth mobility degree ≥2) - Severe ridge defects (implant issues) - Bite collapse, drifting, flaring - <20 remaining teeth (10 opposing pairs

GRADING Estimate ____Risk of periodontitis _______ and responsiveness to standard therapeutic principles, to guide intensity of therapy and monitoring Estimate Potential _______ Periodontitis on systemic disease and the reverse, to guide systemic _____ and co‐therapy with medical colleagues

Estimate Future Risk of periodontitis progression and responsiveness to standard therapeutic principles, to guide intensity of therapy and monitoring Estimate Potential Health Impact of Periodontitis on systemic disease and the reverse, to guide systemic monitoring and co‐therapy with medical colleagues

GRADING ________ to standard therapy Potential impact on ________ A = _____ B = _______ C = ______ Clinicians should initially assume grade __ disease and seek specific evidence to shift to grade ___ or ___ risk/________

Responsiveness to standard therapy Potential impact on systemic health A slow B moderate C rapid Clinicians should initially assume grade B disease and seek specific evidence to shift to grade A or C. Risk/prognosis

GRADE A characteristics (2) modifiers (2)

characteristics: - no additional bone loss or attachmetn loss over past 5 years - low levels of destruction modifiers: - nonsmoker - no history of diabete

GRADE B characteristics 2 modifiers 2

characteristics - less than 2mm additional bone loss or attachment loss over past 5 years - destruction is in line with amount of plaque modifiers - smokes less than 10 cigs a day - hba1c 7% or less

GRADE C characteristics 2 modifiers 2

characteristics - 2mm or more of bone/attachment loss over past 5 years - tissue destruction exceeds expectations modifiers - smokes 10 or more cigs a day - 7% or greater hba1c

grade A = slow rate Primary criteria (direct or indirect- try to use direct most often) example of direct evidence of progression (1) examples of Indirect evidence of progression (2)

Primary criteria (whenever possible, direct evidence should be used) Direct evidence of progression No loss over 5 years on radiographic eval Indirect evidence of progression - <0.25 % bone loss/age - Heavy biofilm deposits with low levels of destruction

how to calculate bone loss

Length of root from CEJ to apex; measure CEJ to height of bone (crest) (CEJ to crest/CEJ to apex) x 100 = % then divide by age EXAMPLE: 4mm (CEJ to crest)/ 13mm(CEJ to apex)= 30.7% divided by age 50 =.6 (grade B)

grade B = moderate example of direct evidence examples of indirect evidence

Direct evidence of progression - <2 mm over 5 years (compare x-rays over time) Indirect evidence of progression - 0.25 to 1.0 % bone loss/age - Destruction commensurate with biofilm deposits

grade C = rapid example of direct evidence examples of indirect evidence

Direct evidence of progression - ≥2 mm over 5 years Indirect evidence of progression - >1.0 % bone loss/age - Destruction exceeds expectations given biofilm deposits; specific clinical patterns suggestive of periods of rapid progression and/or early onset disease