How to Recognize Periodontal Disease

Question 1

Healthy gingiva

Answer 1

Coral pink
May have racial pigmentation
Knife edge, scalloped margins
Firm, resilient
Complete papilla fill, gingival margins above CEJ
Keratinized gingiva with stippling

Question 2

Gingivitis gingiva

Answer 2

Gingival redness, erythematosus
Edematous, spongy consistency
Enlarged, swollen, hyperplastic rolled margins
Shiny, loss of stippling, possible ulcerations

Question 3

Periodontitis gingiva

Answer 3

Gingival redness, erythematosus with increased intensity (cyanotic) and extent towards MGJ
Edematous, spongy consistency
Enlarged, swollen, hyperplastic rolled margins
Shiny, loss of stippling, possible ulcerations

Pain
Spontaneous bleeding
Suppuration
Loss of function
Gingival recession
Drifting of teeth
Shaky teeth

Question 4

PPD

Answer 4

Vertical distance from FGM to base of sulcus

Typically 1-4mm

If deep, it is an anaerobic environment perfect for periopathogens and therefore increases breakdown of periodontal tissues

Question 5

Recession

Answer 5

Vertical distance between CEJ (fixed reference point) and FGM

Measure from same 6 sites as probing depths

Question 6

CAL

Answer 6

Measure of tissue damage around a tooth

Can be used to monitor patients over time

BUT is a measure of accumulated past disease at a site rather than a current disease activity level

Question 7

BOP

Answer 7

Primary parameter to monitor health/inflammation

Absence denotes health

Question 8

Suppuration

Answer 8

PMN leukocytic exudate

Only 3-5% of periodontitis sites, but highly specific

Question 9

Mobility

Answer 9

Subjective indication of loss of periodontal attachment

BUT could be caused by orthodontic forces, heavy functional loads, endo lesions

1- At most 1mm horizontally
2- More than 1mm horizontally, can visualize
3- Severe mobility horizontally and vertically impinging on function

Question 10

Furcation involvement

Answer 10

Measures degree of periodontal support destruction in furcations

I- horizontal loss <1/3 tooth width
II- horizontal loss >1/3 tooth width but not through and through
III- horizontal through and through

Question 11

Radiographs

Answer 11

Confirmatory - defect is truly present if correlated with clinical findings

Clinical bone loss precedes radiographic bone loss by 6-8 months, only after 30-50% of minerals are loss

Bone loss = periodontitis