introduction to classification of periodontal disease - semester 1

Question 1

Discuss the key characteristics of each Stage of periodontitis

Answer 1

›Stage I: Initial Periodontitis
- Represents status between periodontitis and gingivitis
- Early stages of attachment loss (LOA)
- Periodontitis in response to persistent gingival inflammation and microbial
dysbiosis (disease due to decrease in the number of beneficial symbionts and
increase in the number of pathogens)
- Management: Periodontal probing may not provide all assessment
information ‐ may require assessment of salivary biomarkers and/or imaging
technology
›Stage II: Moderate Periodontitis
- Represents established periodontitis with characteristic damage to tooth
support
- Management: Straight‐forward and relatively simple, involving personal
(patient) and professional bacterial removal and monitoring to arrest disease
progression
- Case grade and patient’s response to standard treatment must be carefully
evaluated to determine if more intensive management is required
Stage III: Severe Periodontitis with potential for tooth loss
- Significant attachment loss (LOA)
- In absence of treatment, tooth loss may occur
- Characterised by deep periodontal lesions that extend to middle portion of the
root
- Management: Complicated by intraboney defects, furcation involvement and
history of periodontal tooth loss
- Usually treatment does not involve rehabilitation of masticatory function
›Stage IV: Severe Periodontitis with potential for loss of the dentition
- Characterised by presence of deep periodontal lesions that extend to apical
portion of root and/or history of multiple tooth loss
- Management: Complicated by tooth hyper‐mobility due to secondary occlusal
trauma and tooth loss
- Usually requires stabilization or restoration of masticatory function

Question 2

• Discuss the ‘primary criteria’ and how it assists in determining the grade of
  periodontitis

Answer 2

› Estimates future risk of periodontitis progression and responsiveness to treatment
› Estimates potential health impact of periodontitis on systemic disease and vice‐versa
- Grade A
 slow rate of progression (no LOA or radiographic bone loss (RBL) over 5 years); bone
loss/age <0.25; heavy biofilm with low levels of destruction
- Grade B
 moderate rate of progression (less than 2mm LOA or RBL over 5 years); bone loss/age 0.25
to 1.0 destruction corresponds to biofilm deposits
- Grade C
 Rapid rate of progression (equal to or more than 2.5mm LOA or RBL over 5 years); bone
loss/age greater than 1.0; destruction exceeds amount expected given biofilm deposits
- Grade Modifiers: Smoking and Diabetic factors taken into account

Question 3

Guidelines for Determining Stage of
Disease

Answer 3

Localised or Generalised
– Disease is localised when less than 30% of teeth have loss of attachment (LOA)
– Disease is generalised when greater than or equal to 30% of teeth have LOA
– To calculate severity, determine the site with greatest LOA
› Incisor-Molar distribution
› Radiographic Bone Loss (RBL)
– Stage I
* coronal third (<15%)
– Stage II
* coronal third (15 ‐ 33%)
– Stage III and IV
* extending to middle third and beyond

Question 4

Staging Periodontitis

Answer 4

› Largely depends on severity of disease at presentation and
complexity of disease management
› Stage categories determined based on several variables:
– clinical attachment loss
– amount and percentage of bone loss
– probing depth
– presence and extent of angular bony defects
– furcation involvement
– tooth mobility
– tooth loss due to periodontitis

Question 5

periodontitis

Answer 5

› Stages: Based on Severity and Complexity of Management
- Stage I: Initial Periodontitis
- Stage II: Moderate Periodontitis
- Stage III: Severe Periodontitis with potential for additional tooth loss
- Stage IV: Severe Periodontitis with potential for loss of the dentition
› Extent and distribution
- Localized (< 30% teeth have LOA)
- Generalized (> 30% teeth have LOA)
- Molar-incisor distribution
› Grades
– Grade A: slow rate of progression
– Grade B: Moderate rate of progression
– Grade C: Severe rate of progression

Question 6

Periodontitis as Manifestation of Systemic
Disease

Answer 6

Systemic disorders that have a major impact on the loss of
periodontal tissues by influencing periodontal inflammation
- Genetic disorders
- Diseases associated with immunologic disorders Eg. Down Syndrome,
Severe Neutropenia, Papillon-Lefèvre Syndrome, Congenital and Cyclic
Neutropenia
- Diseases affecting the oral mucosa and gingival tissue Eg. Epidermolysis
bullosa
- Diseases affecting the connective tissues Eg. systemic lupus erythematous
- Metabolic and endocrine disorders Eg. Glycogen storage disease
- Acquired immunodeficiency diseases Eg. acquired neutropenia, HIV infection

Question 7

Health and Gingival Involvement

Answer 7

› Gingival diseases – non-dental biofilm-
induced
- Genetic/developmental disorders
- Specific infections
- Inflammatory and immune conditions
- Reactive processes
- Neoplasms
- Endocrine, nutritional and metabolic diseases
- Traumatic lesions
- Gingival pigmentation

Periodontitis
›Necrotizing Periodontal
Diseases

Question 8

Determinants of Clinical Periodontal Health

Answer 8

• Microbiological Determinants
• Supragingival biofilm composition
• Subgingival biofilm composition
• Environmental Determinants
• Smoking
• Medications
• Stress
• Nutrition
• Host Determinants
• Local predisposing factors
• Periodontal pockets
• Dental restorations
• Tooth morphology, root anatomy
• Tooth position, crowding, etc
• Systemic modifying factors
• Host immune function
• Systemic health
• Genetics

Question 9

Overview of 2017 Periodontal Classification
Scheme

Answer 9

• periodontal health, gingival disease and conditions
• periodontitis
• other conditions affecting the periodontium
• peri implants disease and conditions