ICP L27: Epidemiology and classification of periodontal disease Flashcards
Define prevalence
The percentage/proportion of the population affected by the disease at a single point in time
Define incidence
The number of new cases of a disease occurring in the population over a defined period of time
How can periodontal disease be measured
- Look at current disease - pocket/probe depth (PPD) reflecting current levels of inflammation
- Historic disease - look at bone loss and clinical attachment loss (CAL)
- Look at treated disease - where PPDs have reduced to <4mm, bone loss is irreversible so will still be present even if the pockets have healed
What differences are there in measuring periodontal disease for epidemiology and for clinical practice
Epidemiology studies the population and uses a partial mouth examination to give a quick summary which is cheaper and faster
Clinical practice looks at individuals’ health using BPE (whole mouth screening) and 6PPC
Outline measures of plaque levels
- Detection: visually, disclosing, using probe
- Presence/quality: dichotomous scoring (present/absent), indices (scores levels)
- Full mouth assessment: 4/6 points per tooth
- Partial assessments: Epidemiology = plaque index (PI)
Outline measures of bleeding
- Detect using a probe
- Look at time: immediate - marginal gingival health shows inflammation; delayed - when marginal health is good but there is deep pocketing
- Identify/quantify: dichotomous scoring/incicies
- Full mouth assessment: 4/6 points per tooth
- Partial assessment: Epidemiology = gingival bleeding index
How is full periodontal charting done
- Probing pocket depth (PPD) = distance from gingival margin to base of pocket in mm
- Recession = distance from gingival margin to CEJ in mm
- Clinical attachment levels = distance from CEJ to base of pocket in mm; use William’s or UNC probe (6PPC)
- Mobility = horizontal/vertical
- Furcation involvement = use Naber’s probe
What is the difference between PPD and CAL
Periodontal pocket depth = free gingival margin till the base of pocket
Clinical attachment loss = from CEJ to base of pocket
What is the adult dental health survey and what is assessed
UK national survey of dental health conducted each 10 years on a random sample of the population and it assesses
- demographics of population
- levels of disease in population
- experience of dental services and treatment
What did the adult health survey of 2009 show
- Gingival bleeding is associated with plaque
- More common in less regular attendants
- Less common in the east
- Reduction in mild disease is associated with an increase in dental hygiene
- Slight increase in prevalence of more severe disease
- Severe disease is concentrated in a relatively small proportion of the population
What are the local risk factors of periodontal disease
- Anatomical
- Enamel pearls/ root grooves/ furcations/ recession
- Tooth positioning
- Malalignment/ crowding/ tipping
- Iatrogenic
- Restorative margins/ partial dentures/ orthodontic appliances
What are the modifiable systemic risk factors of periodontal disease
- Specific bacteria
- Smoking, Diabetes mellitus, Obesity, Diet, Stress
- Oral hygiene and medications
- Immunodeficiency (e.g. with systemic disease)
What are the non-modifiable systemic risk factors of periodontal disease
- Age
- Genetics
- Hormonal influences (e.g. pregnancy related)
What factors are considered in periodontal diagnosis
- Health/disease?
- Gingivitis/periodontitis?
- All/few teeth?
- How much disease previously?
- How quickly has it occurred?
- Active/stable?
- What are the contributing risk factors?
What are the main periodontal diseases
- Periodontal health = PPD <4mm, no/low bleeding levels
- Gingivitis = gingival bleeding with no bone/attachment loss
- Periodontitis = bone/attachment loss
- Periodontitis is most common (aggressive/chronic)
- Necrotising periodontitis (necrotised papillae, halitosis, pain, stress)
- Periodontitis as a manifestation of systemic disease
- Genetic = Papillon Lefevre syndrome, Leukocyte adhesion deficiencies, Chediak-higashi syndrome
- Metabolic = Hypophosphatasia
- Immunodeficiency = HIV, neutropenia
What is pristine periodontal health
Rare - no bleeding/attachment loss, no bleeding on probing
What is clinical gingival health with intact periodontium
<10% bleeding on probing, no bone/attachment loss
What is clinical gingival health with a reduced peridontium (stable periodontitis)
Bone/attachment loss present due to periodontitis and the PPD has resolved to 4mm without bleeding/less
What is clinical gingival health with a reduced periodontium (crown lengthening)
Bone/attachment loss due to surgical procedure and PPDs are 4mm without bleeding or less
What is the difference between localised and generalised gingivitis
Bleeding without bone/attachment loss
Localised = 10-30% BoP
Generalised = >30% BoP
What are the 4 factors to consider in periodontitis
- Distribution/extent - molar incisor, localised, generalised
- Type - periodontitis (chronic/aggressive), necrotising, manifestation of systemic disease
- Stage (I-IV)
- I = 2-1mm CAL coronal third
- II = 3-4mm CAL coronal third
- III = >5mm middle/apical third
- IV =>5mm middle/apical third - Grade (A-C)
- A = slow, no loss over 5 yrs, non-smoker, non-DM
- B = moderate, <2mm over 5yrs, smokes <10 a day, HcA1c <7%
- C = rapid, smokes >=10 a day, HbA1c >=7%
What is the staging of periodontitis based on (I-IV)
- amount of inter proximal radiographic bone loss
- the single worst site in the mouth (NOT average)
- divide tooth into thirds starting 2mm apical to CEJ
- not necessary to have full mouth PAs/DPT to see tooth length of all teeth
What are the six factors for a complete BSP approved periodontal diagnosis and give an example
Distribution + Periodontitis + Stage + Grade + Current activity + Risk factor list
Generalised Periodontitis Stage IV Grade C (currently unstable) with risk factors of Diabetes and Smoking
