ICS2/1: Classification of Periodontal Diseases

Question 1

name the 2 types of gingival diseases (category I). these diseases are associated with?

Answer 1

1 - dental plaque induced gingival diseases
- associated with dental plaque or systemic factors such as pregnancy/puberty, leukemia, diabetes

2 - non-plaque induced gingival diseases

• infective origins (bacteria, virus, fungal)
• genetic disorders
• systemic diseases
• allergy
• trauma: chemical, physical, thermal

Question 2

chronic periodontitis (II): describe its characteristics in terms of progression, LOA, bone loss, proportion of destruction with risk factors

Answer 2

• plaque induced inflammatory disease
• slow to moderate progression over years
• irreversible LOA and bone loss
• destruction is proportional to local and systemic risk factors

Question 3

chronic periodontitis (II): how to classify?

Answer 3

by distribution (30% rule); either localized or generalized

and severity: slight/moderate/severe

Question 4

describe severe chronic periodontitis

Answer 4

LOA =/> 5mm

Bone loss > half root length and/or furcation involvement

Question 5

describe moderate chronic periodontitis

Answer 5

LOA 3-4mm

Bone loss between 1/3rd and 1/2 root length

Question 6

describe slight chronic periodontitis

Answer 6

LOA 1-2mm

Bone loss =/

Question 7

according to the old classification, what would a 18 year old with chronic periodontitis be diagnosed to have?

Answer 7

Early onset periodontitis

Question 8

according to the old classification, what would a 50 year old with chronic periodontitis be diagnosed to have?

Answer 8

chronic adult periodontitis

Question 9

aggressive periodontitis (III): characterized by? proportion of destruction with risk factors? rate of progression? possible aetiological agents?

Answer 9

deep pockets & advanced alveolar bone loss typically in children, adolescents and young adults without any associated systemic diseases

• amount of destruction disproportionate to level of plaque/calculus. strong family history
• rapid rate of progression
• genetics & virulent bacteria (A. a)

Question 10

aggressive periodontitis (III): how to classifiy?

Answer 10

distribution (30% rule)

severity (slight, moderate, severe)

Question 11

aggressive periodontitis (III): replaces which category from the old classification?

Answer 11

the 3 diseases of early onset periodontitis (prepubertal/juvenile/rapidly progressive periodontitis)

Question 12

periodontitis as a manifestation of systemic diseases (IV): what are the 3 categories of systemic diseases?

Answer 12

1 - haematological disorders
2 - genetic disorders
3 - those not specified

Question 13

periodontitis as a manifestation of systemic diseases (IV): name 2 haematological diseases

Answer 13

acquired neutropenia

leukemias

Question 14

periodontitis as a manifestation of systemic diseases (IV): name 5 genetic disorders

Answer 14

• familial & cyclic neutropenia
• down syndrome
• papillon leferve syndrome
• chediak-higashi syndrome
• ehlers-danlos syndrome

Question 15

necrotising periodontal diseases (V): what are the 2 categories?

Answer 15

1 - necrotising ulcerative gingivitis

2 - necrotising ulcerative periodontitis

Question 16

abscesses of the periodontium (IV): 3 types?

Answer 16

1. gingival abscess: infection of marginal gingva or papilla
2. periodontal abscess: infection within periodontal tissues leading to destruction of PDL and bone
3. pericoronal abscess: infection in tissues surrounding a partially erupted tooth

Question 17

periodontitis associated with endodontic lesions (VII): what is it and how does it occur?

Answer 17

a combined periodontic-endodontic lesion

- caused by infection of pulp that spreads in pulpal tissues and to periodontal tissues

Question 18

developmental or acquired deformities and conditions (VIII) - 4 categories?

Answer 18

1 - localized tooth factors that modify or predispose to plaque induced gingival disease/periodontitis
2 - mucogingival deformities (teeth)
3 - mucogingival deformities (edentulous)
4 - occlusal trauma

Question 19

developmental or acquired deformities and conditions (VIII): what are examples of local factors that modify or predispose to plaque induced gingival disease/periodontitis? (5)

Answer 19

1 - tooth anatomy issues: enamel pearls, root anomalies
2 - tooth malposition/inclination
3 - dental restorations/appliances
4 - root fractures
5 - cervical root resorption/cemental tears

Question 20

developmental or acquired deformities and conditions (VIII): what are the mucogingival deformities (teeth)?

Answer 20

1 - gingival/soft tissue recession
2 - lack of keratinized gingiva
3 - decreased vestibular depth 
4 - aberrant frenulum/muscle position
5 - gingival excess
6 - abnormal color

Question 21

developmental or acquired deformities and conditions (VIII): occlusal trauma - what are the 2 different types? what does occlusal trauma lead to?

Answer 21

primary and secondary occlusal trauma

- leads to tooth mobility and tooth migration

Question 22

what were the 7 changes made from the old to new classification?

Answer 22

• inclusion of gingival diseases
• change to chronic periodontitis: removal of “adult” and 35 year age factor
• changes to aggressive periodontitis: replacement of the 3 categories of EOP
• increased emphasis on periodontitis caused by systemic factors
• inclusion of abscesses
• inclusion of perio-endo lesions
• inclusion of developmental/acquired deformities and conditions
• removal of “refractory periodontitis”: more of a descriptive than diagnostic term now