Introduction to classification of periodontal disease Flashcards
List the determinants of clinical periodontal health according to the 2017 AAP Periodontal Classification system
- Microbiological determinants
- Host determinants
- Environmental determinants
Identify the microbiological components of the 2017 AAP Periodontal Classification system
• Supragingival plaque composition
* Subgingival biofilm composition
Identify the host determinants of the 2017 AAP Periodontal Classification system
Local predisposing factors ○ Periodontal pockets ○ Dental restorations ○ Root anatomy ○ Tooth position and crowding
Systemic modifying factors
○ Host immune function
○ Systemic health
○ Genetics
Identify the environmental determinants of the 2017 AAP Periodontal Classification system
- Smoking
- Medications
- Stress
- Nutrition
List the general categories included in AAP “Periodontal and Gingival Diseases and Conditions”
- Periodontal and Gingival health
- Biofilm induced gingivitis
- Non- biofilm induced gingival disease
Describe the “Periodontal and Gingival health” component of “Periodontal and Gingival Diseases and Conditions”
• Assesses the gingival health on intact periodontium i.e, no clinical attachment loss or bone loss
• Assesses the gingival health on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable
* Clinical gingival health can be restored following treatment of gingivitis and periodontitis
Describe the “biofilm induced gingivitis” component of “Periodontal and Gingival Diseases and Conditions”
- Associated with dental biofilm alone
- Mediated by local or systemic risk factors
- Drug influenced gingival enlargement
Describe the “non- biofilm induced gingivitis” component of “Periodontal and Gingival Diseases and Conditions”
• Genetic/ developmental; disorders • Specific infections • Immune and inflammatory conditions • Endocrine, nutritional and metabolic diseases Traumatic lesions
List the general categories included in AAP
‘Periodontitis’
- Necrotising Periodontal Diseases
- Periodontitis
- Periodontitis as a Manifestation of Systemic Disease
What are the types of Necrotising Periodontal Diseases?
- Necrotising stomatitis
- Necrotising gingivitis
- Necrotising periodontium
What are the systemic diseases identified in the category of ‘Periodontitis as a Manifestation of Systemic Disease’? (10)
- Genetic diseases
- Diseases associated with immunological disorders; down syndrome, severe neutropenia
- Diseases affecting oral mucosa and gingival tissue; epidermolysis bullosa
- Diseases affecting connective tissues; systemic lupus erythematous
- Metabolic and endocrine disorders; glycogen storage disorders
- Acquired immunodeficiency diseases; HIV, acquired neutropenia
- Inflammatory diseases; inflammatory bowel disease
- Systemic disorders; diabetes, obesity, osteoporosis, arthritis,
- Neoplasms (growths); squamous Cell Carcinoma, secondary metastatic neoplasms of perio tissues
- Other disorders; langerhans cell histiocytosis, hyperparathyroidism
Explain ‘staging’ of periodontitis
Staging is known as classifying the severity and extent of a patients disease based on the measurable amount of destroyed/ damaged tissue
What are elements included in the staging of diseases?
- Complexity
- Severity
- Extent and distribution
Describe the “extent and distribution” staging component
- 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
What does the “complexity” staging component include?
- Probing depth
* Type of bone loss
Describe the “complexity” staging component
Stage 1:
• 4 mm PD
* Horizontal bone loss
Stage 2:
• 5 mm PD
* Horizontal bone loss
Stage 3:
• 6 mm PD
• Vertical bone loss 3 mm
* Furcation of Class II or III
Stage 4: • 6 mm PD • Vertical bone loss • All of stage 3 plus masticatory dysfunction • Tooth mobility * Less than 20 remaining teeth
What does the “severity” staging component include?
- Radiographic bone loss (RBL)
- Tooth loss
- Interdental Clinical Attachment Loss (CAL) or LOA (loss of attachment)
Describe the “CAL or LOA” of the severity staging component
- Measured from CEJ to base of sulcus
- Not the same as probing depth
- To measure when recession is present: probing depth + recession
- No recession but PD of 4mm: probing depth - 3mm (healthy gingiva is 3 mm max)
Stage 1: 1- 2mm
Stage 2: 3- 4 mm
Stage 3: 5mm
Stage 4: 5mm
Describe the “RBL” of the severity staging component
- Stage I: coronal third of root (<15%)
- Stage II: coronal third of root(15 - 33%)
- Stage III and IV: extending to middle third of root and beyond
Describe the “Tooth loss” of the severity staging component
Stage 1: 0
Stage 2: 0
Stage 3: 4
Stage 4: 5+
Discuss the key characteristics of stage 1 periodontitis
• Gingival inflammation
• Microbial dysbiosis
* Early LOA
Discuss the key characteristics of stage 2 periodontitis
• Damage to tooth supporting structures
- Established periodontitis
- Management: simple; professional bacterial removal and monitoring to arrest disease progression
Discuss the key characteristics of stage 3
• Significant LOA
- Deep PD Lesions extending to middle portion of root
- Management: complicated by infraboney defects, and furcation involvement
Discuss the key characteristics of stage 4
• Significant LOA
- Deep PD Lesions extending to middle portion of root
- Management: Complicated by tooth hypermobility
- Requires stabilisation or restoration of masticatory functions
Discuss the ‘primary criteria’ and how it assists in determining the grade of periodontitis
The primary criteria uses DIRECT EVIDENCE of progression SUCH AS radiographic bone loss or CAL, or INDIRECT EVIDENCE SUCH AS %bone loss/age and characteristics, in order to assign a grade
What does the primary criteria in assigning a grade include?
Direct evidence:
* RBL
Indirect evidence:
- % bone loss/ age
- characteristics
List the primary criteria used in classifying a Grade A: Slow rate of progression
- No CAL loss over 5 years
- % bone loss/ age:
< 0.25
CHARACTERISTICS
- Heavy biofilm deposits
- Low levels of destruction
List the primary criteria used in classifying a Grade B: Moderate rate of progression
- < 2mm CAL loss over 5 years
- % bone loss/ age:
0. 25- 1.0
CHARACTERISTICS
* Level of destruction is directly proportional to the amount of biofilm deposits
List the primary criteria used in classifying a Grade C: Moderate rate of progression
- > 2mm CAL loss over 5 years
- % bone loss/ age:
> 1.0
CHARACTERISTICS
* Level of destruction is greater and unrelated to amount of biofilm
