Perio- ABGD Flashcards
what are the peiodontal disease and condition classification categories
perio health, gingival disease and conditions
periodontitis
Other conditions affecting the peridontium
What are the two categories of perio health?
- health on an intact periodontium
- health on a reduced periodontium - 2a: stable perio, 2b: non-perio
What are the 4 levels of perio health
- pristine
- well maintained clinical perio health with a structurally sound/intact perio
- perio disease stability with a reduced periodontium
- perio disease remission /control with reduced periodontium
What indicates perio health?
minimal to no BOP
Shallow pockets or deep “healthy” pockets
Minimal to no radiographic bone loss
Physiologic tooth mobility <0.2mm (unless associated with occlusal trauma with widened PDL)
Which drugs can cause Drug-Induced gingival enlargement.
- Anti-epileptic drugs (phenytoin, sodium valproate)
- Calcium channel blockers (nifedipine, amlodipine, verapamil, diltiazem, felodipine)
- Immunoregulating drugs (cyclosporine, high dose oral contraceptives)
What is a genetic/developmental gingival disease that is non-biofilm induced?
hereditary gingival fibromatosis
What type of non-biofilm gingival disease are bacterial?
necrotizing perio disease, acute streptococcal gingivitis, Neisseria gonorrhoeae , orofacial TB
What type of non-biofilm gingival disease are viral?
coxsackie, HSC/herpetic gingivostomatitis, HPV, VZV, molluscum contagiosum
What type of non-biofilm gingival disease are fungal?
candidiasis, histoplamosis, aspergillosis
What type of non-biofilm gingival disease are hypersensitivity reactions??
contact allergy
plasma cell gingivitis
erythema multiforme
What type of non-biofilm gingival disease are autoimmune disease?
pemphigus vulgaris
pemphigoid
lichen planus
lupus erythematosis
What type of non-biofilm gingival disease are granulomatous inflammatory conditions?
orofacial granulomatosis, Crohn’s disease, sarcoidosis
What are the 3 sub categories of peiodontitis?
Necrotizing perio disease
periodontitis
perio as a manifestation of systemic diseases
What are the three subcategories of necrotizing periodontal disease and how do you tlel them apart?
- Necrotizing gingivitis: necrosis/ulcer of papilla, bleeding, pain, halitosis, pseudo membranes, lymphadenopathy, fever, sialorrhea
- Necrotizing perio: same but with rapid bone loss
- Necrotizing Stomatitis: soft tissue necrosis beyond the gingiva, bone denudation, osteitis, severely compromised.
What are the primary flora involved in necrotizing periodontal diseases?
Treponema, Selenomona, Fusobacterium, Prevotella intermedia (TSFPi)
How do you define a periodontitis patient?
Interdental CAL at >/= 2 non-adjacent teeth
B/L CAL >/= 3mm with PD >3mm detectable at >2 teeth
What are the 3 broad diagnostic categories for perio?
Stage, Grade, Extent and Distribution
What are the stages of perio?
severity and complexity of management
I: initial
II: moderate
III: severe with potential for addtl tooth loss
IV: severe with potential for loss of dentition
What are the extent and distribution categories?
Localized <30% of teeth
Generalized
Molar-Incisor distribution
What are the grades of perio
evidence or risk of progression and anticipated response
A: slow
B Moderate
C Rapid
What are the steps to determine perio dx?
- initial overview- screen the xray PD tooth loss and put them into 1-2 or 3-4 stage
- Fine tune the state: look closly at the max CAL/BL determine if BL is H or V, perio tooth loss, complexity including furcation grade, PDs, occlusion, need for extensive multidisiplinary tx. Start at B then judge from there.
- Determine grade: hx of perio, risk factors and the ability to control them, response to tx, compliance with recs, and their systemic health factors
- diagnose- stage, extended/disp, and grade
In the category of periodontitis as a manifestation of systemic disease(under perio), what diseases are associated with immunologic disorders?
down syndrome
leukocyte adhesion deficiency
papillon-Lefevre syndrome
Haim-Munk syndrome
severe neutropenia
primary immunodeficiency diseases such as agammaglobulinemia, hyperimmunoglobulin E G,
Cohen syndrome
In the category of periodontitis as a manifestation of systemic disease, what diseases are associated with those that effet the oral mucosa and gingival tissue?
epidermolysis bullosa, plaminohen deficieny
What diseases affect CT (and contribute to perio)
Ehler-danlos syndrome, angioedema, and systemic lupus erythematosis
What metabolic diseases and endocrine disorders have manifestations as periodontal disease
glycogen storage disease,
gaucher disease,
hypophosphatasia,
hypophospatemic rickets,
Hajdu-cheney syndrome
DM
obesity
Osteoporosis
Under the section of periodontal disease and conditions, what 5 things fall under “other conditions affecting the periodontium?”
- systemic diseases/conditions affecting the periodontal supporting tissues
- endo perio lesions and abscesses
- mucogingival deformities and conditions
- traumatic occlusal forces
- Tooth and prosthesis related factors
Which pathogens are most associated with a periodontal abscess?
Porphyromonas gingivalis,
Prevotella intermedia,
Prevotella melaninogenica, Fusobacterium nucleatum,
Tannerella forsythia,
Treponema spp.,
Campylobacter spp.,
Capnocytophaga spp., Aggregatibacter actinomycetemcomitans
Common pathogens in an endo perio lesion?
P. gingivalis, T. forsythia, Parvimonas micra, Fusobacteriumspp., Prevotellaspp., and Treponemaspp.
How to grade EPL?
Grade 1: narrow deep PF in one surface
2: wide and deep in one surface
3. deep >1 surface
What are the three gingival phenotype?
Thin scalloped: Slender triangular crown, subtle cervical convexity, interproximal contacts close to incisal edge, narrow zone of KT, clear thin delicate gingiva, thin alveolar bone
Thick Flat: Square shaped crowns, pronounced cervical convexity, large interproximal contact located more apically, broad zone of KT, thick fibrotic gingiva, thick alveolar bone
Thick Scalloped: Thick fibrotic gingiva, slender teeth, narrow zone of KT, pronounced gingival scalloping
What are some pre-disposing factors for recession?
Thin phenotype
absence of attached gingiva
reduced thickness of alveolar bone
incorrect toothbrushing? maybe?
intracrevicular restorations
Ortho
What are the Cairo Recession classifications
Recession Type 1 (RT1): no loss of interprox attachement, interprox CEJ not detectable clinically
RT2: Recession with loss of interprox attachement </= buccal CAL
RT3: loss of interprox attachement >buccal CAL
For Cairo RT1, what is the anticipated/predicable root coverage
100%
For Cairo RT2, what is the anticipated/predicable root coverage
100% CAN be achieved but not always
For Cairo RT3, what is the anticipated/predicable root coverage
100% root coverage cannot be achieved
What are the Pini-Parato NCCL Classifications?
Clasa A or B=CEJ, Step = + or -
CEJ detectible = A
CEJ not detecable = B
Step with or without: +/-
What are some indicators of occlusal trauma?
Fremitus
Mobility
Occlusal discrepancies
Wear facets
Tooth migration
Fractured tooth
Thermal sensitivity
Discomfort/pain on chewing
Widened PDL space
Root resorption
Cemental tear
What is? Occlusal force exceeds reparative capacity of periodontal attachment apparatusocclusal trauma, excessive tooth wear or loss
Excessive O Force
What is?Injury resulting in tissue changes to PDL, supporting alveolar bone and cementum
Occurs in an intact periodontium or in a reduced periodontium
Occlusal Trauma
What is Injury resulting in tissue changes on a tooth/teeth with a normal, healthy periodontium
Normal CAL, normal bone levels and excessive occlusal force
Primary Occlusal Trauma
What is? Injury resulting in tissue changes on a tooth/teeth with a reduced periodontium
CAL, bone loss and normal/excessive occlusal force
Secondary O trauma
Do excessive O forces initate plaque induced peio disease or loss of attachement?
NO
At what roughness threshold is there greated plaque accumulation and increased inflammation?
0.2 micrometer
What metals in prosthesis are associated with hypersensitivity reactions that appear similar to gingivitis?
Ni and Pd
Overhangs at what size increase crestal bone loss, increased BOP and PDs?
> 0.2mm
What are some examples of peri implant soft tissue deficiencies?
Tooth loss
Lack of buccal bone
Periodontitis
Papilla height
Systemic diseases
Keratinized tissue
Migration of teeth and life-long skeletal changes
What are some explained of implant hard tissue deficiencies?
Tooth loss
Defects in healthy situations
Trauma from tooth extraction
Malpositioning of implants
Periodontitis
Peri-implantitis
Endodontic infections
Mechanical overload
Root fractures
Soft-tissue thickness
General trauma
Systemic diseases
Bone height in posterior maxilla
Systemic diseases
Describe the Seibert Classifications
Class 1: B-L Loss
Class 2: A-C loss
Class 3: combo of 1 and 2.
What are the categories in Peri implant disease and conditions?
Peri-Implant Health
Peri-Implant mucositis
Peri-implant Implantitis
Peri- Implant Soft and Hard tissue deficiencies
Describe the glickman grades
Grade I: pocket into flute, bone intact
II: into furcation
III: through and through but with soft tissue coverage
IV: no soft tissue, through and through
Is the absence of BOP a sign of stability? What about suppuration?
Yes- to BOP
No- to Suppuration
What cells are in suppuration?
PMNs
Describe the Hamp, Nyman Lindhe Furcation classification?
Degree I: Horizontal loss <3mm
Degree II: >3mm loss but not the entire widt
Degree III: through and through
What are the four broad approaches to the management of diseased sites?
Reflective
Resective
Additive
Combination
What medication is Arestin?
Minocycline
What are the 2007 prognosis categories?
favorable, quesitonable, unfavorable, and hopeless
With osseous resection, what side would you approach from and why?
P and L: avoids B furcation exposure
avoid shallow vestibule
more thicker bone
more keratinized tissue (max)
increased embrasure size
natural cleansing of from the tongue
What are 5 causes of a gummy smile and how to tell them apart?
Altered Passive eruption: CEJs
Dental Alveolar extrusion: Wear
Vertical Maxillary Excess: disproporitionate face height: look at Glabella to base of nose, BON to chin.
Short Upper lip: <20mm
Hyperactive upper lip: lip mobility is 6-8mm (botox)
What options do you have for furcation management?
Increase access, elimination of furcation, and non-surgical scrp
What procedures increase access for furcation?
Tunneling, Odontoplasty/barreling, gingivectomy/flap, osteoplasty/ostectomy,
What procedures help to eliminate the furcation?
coronally positioned flap,
obilteration
guided tissue regeneration
osseous graft
Root resection and bicuspidization
Are autographs osteogenic, osteoinductive, or osteoconductive?
all three
Are allografts osteogenic, osteoinductive, or osteoconductive?
Freeze dried Bone Allograft- OC
Demind FDBA - OC and OI
Are xenografts osteogenic, osteoinductive, or osteoconductive?
What are some examples?
Osteoconductive
Osteograft N300,700, - HA
BioOss
BioOss Collagen (bovine bone, + porcine collagen)
describe the miller classifications of recession
1: normal periodontium, recession does not extend past MGJ
2. normal periodontium, recession pas MGJ
3. moderate interprox attachment loss and recession past MGJ
4. advanced/severe interprox loss with recession past MGJ
What are some reasons to graft a mucogingiva defect?
progressive recession
esthetics,
sensitivity
deepen the vestibule
relieve the fremum,
pre-prosth
pre-ortho
what is the amount of attached gingival tissue that is considered adequate?
2+mm
Miller 1-2: is it predicable for grafting? What about 3-4?
1-2: yes 100% root coverage
3-4: not predicable
What kind of mucosal grafting techniques are there?
Free soft tissue autografts
Pedicle grafts
CT grafts
combination grafts
GTR
What are some techniques for CT grafting?
Raetzke Pouch
Langer-Langer
Coronally Advanced Flap
Lateral Pedicle Graft
Tunnel Technique
Alloderm
What are the 4 bone types?
1-4
At what temp will bone necrose?
47C, (116 F). for 1 min.
What is peri-mucositis?
an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss.
caused by
plaque accumulation
smoking
lack of compliance with maintenance
implant prosthesis design is over contoured and submarginal restorative margins
radiation
more evidence is needed for potential risk factors like diabetes, lack of KM, and excess cement.
Describe Peri-implant Implantitis
Clinical signs of inflammation (may include erythema, edema, BOP, suppuration) with loss of supporting bone and/or progressive bone loss
How can it present itself?
-bone loss pattern is circumferential or as a facial dehiscence with semicircular bony defect
What are risk factors?
-history of periodontitis, smoking, diabetes, poor OH/lack of maintenance
How can periapical peri implantitis occur?
direct correlation between periapical peri implantitis and adjacent endo related infection
What are the three red complex bacteria associated with perio disease and describe them
TANNERALLA FORSYTHIA- bacillus, gram neg, non-motile, anaerobic
TREPONEMA DENTICOLA- spirochete, gram neg, motile, anaerobic
PORPHYROMONAS GINGIVALIS- bacillus, gram neg, non-motile, anaerobic
ALL anaerobic, gram neg. BSB, NMN
What is the new term for biological width? Why is it important for periodontal health? What does it consist of and its average measurements?
Supracrestal attached tissues
It is vital in the preservation of periodontal health by acting as a natural barrier around the teeth to protect the alveolar bone from disease and infection.
2.04mm: total
0.97: JE
1.07”:CT
Explain the concepts of repair and regeneration?
Repair:
Healing of a wound tissue that does not fully restore the architecture or the function of part of the long junctional epithelium
Regeneration:
Reproduction or reconstitution of a lost or injured part- Bone, cementum, PDL, CT, are reformed in a region that has been deprived of its attachment apparatus.
In term of regeneration, what does “new attachment” and “reattachment” mean and what is the difference?
new attachment: union of ET and/or CT with a previously disease rt surface
Reattachement: reunion of ET and/or CT with rt surfaces and bone after incision or injury
One is diseased and other is not
Think flap reflection for healthy teeth for gingivectomy= reattachment.
What is guided tissue regeneration?
What is used to achieve regeneration?
Attempt to regenerate lost perio structure through differential tissue responses
Bone graft and barrier are used to facilitate GTR
Why is a barrier used in GTR?
retard apical migration of ET and exclude CT from the root or existing bone surface in the belief that the interfere with regeneration.
Whta are examples of a reduced periodontium situation?
stable perio patient or non-perio with bone loss/ recession from abrasion
Broadly, what are the Perio 2017 classifications?
Major Categories:
1. Periodontal Health, Gingival Diseases, and Conditions (3)
2. Periodontitis (3)
*Significant changes in labeling of Periodontitis with Staging, grading, and extent/distribution
3. Peri-implant diseases and conditions (4)
4. Other Conditions affecting the Periodontium (5)
What are the categories wihtin perio health, gingival diseases and conditions?
periodontal health and gingival health
gingivitis: dental biofilm induced
gingival disease: non-dental biofilm induced.
Name the categories within periodontitis
necrotizing perio disease
periodontitis
perio as a manifestation of systemic disease
name the categories under peri implant diseases and conditions?
perio implant health
peri implant mucosistis
peri implantitis
peri implant soft and hard tissue deficiencies
Name the categories within other conditions affecting the periodontium
systemic diseases or conditions affecting the perio tissues
periodontal abscesses and endo/perio lesions
mucogingival deformities and conditions
traumatic occlusal forces
tooth and protheses related factors
According to the new perio classification- describe a state of health
pristine periodontium
well maintained and intact
stable (even if reduced)
excellent OH
lack of palque and calc
no CAL
shallow PDs (<3mm) with no BOP <— best predicotr of health
How would you describe the etiology of perio disease
multifactorial- bacterial plaque in a susceptible host
subgingival microorganisms
host immune-inflammatory response
local factors ( pockets, restorations, anatomy, crowding)
systemic factors (immune, disease, genetics)
Environmental (smoking, meds, stress, nutrition)
What are some meds that cause gingival enlargement?
cyclosporin- immunoregulating drugs
Calcium Channel Blockers- Nifedipine, verapamil, dilitazem, amlodipine
Anti-epiletics—-Phenytoin, sodium valproate
Name some system factors that can lead to gingival disease
Sex steriod hormones
hyperglycemia
leukemia
smoking
malnutrition
large subg restors
hyposalivation
What are the features of a bioflim induced gingival disease?
Inflammation confined to the free and attached gingiva
BOP and gingival erythemia/edema
high bac load
stable attachement levels
tenderness with probing
halitosis
prereq to perio, reversible
Name examples of non-biofim induced disease
gingival fibromatosis
bacterial, viral, fungal- necrotizing, acute strep gingiva etc
hypersensitivity rxns
autoimmune disease
granulomatosus inflammatory conditions
reactive- epulides
- fibrous epulis, pyogenic granuloma, Perf GCG
Neoplasm (leukoplakia, SCC)
endocrine (vitamin)
Traumatic lesion
ging pigmentation- smokers melanosis, amalgam tattoo
What are the 3 types of necrotizing periodontal diseases?
necro ging- ulcer of papillae, ging bleeding, pain, fever, pseudomembranes, lymphadenopathy,
necro perio- + rapid bone loss
Necro stomatitis - necrosis beyond the ging, bone denudation through mucosa, osteitis, boney sequestrum, severely compromised
What is the difference between necro perio and necro gingi?
rapid bone loss with perio
What are the pathogens in necrotizing perio?
Treponema
selenomonas
fusobacterium
prevotella intermedia
PTSF like PTSD(but F)
Name some systemic risk factors for necrotizing perio disease?
compromised host
HIV/AIDs <200 with a viral laod
Malnutrition
Physiologic stress
lack of sleep
inadquete OH, hx of NPD, ging
tobacco/etoh use
young, white,
winter
What dies the statement mean “ a perio pt is a perio pt for life”?
never leave the risk level of perio. always at a higher risk than someone who never had
With the 2017 guidelines, what is the definition of someone with perio
Interdental CAL at >2 non-adjacent teeth
B or L CAL >3mm with pocketing >3mm detectable at >2 teeth
Name an example of CAL that would not be considered for CAL periodontitis?
TB abrasion
trauma loss
dental caries on cercial aspect of tooth
presence of CAL on distal 2nd molars due to 3rd molars
endo lesion draining through marginal gingiva
VRF
DOes staging and grading help you come to a dx?
No. dx is determined first. THEN stage and grade to clarify extent, severity and complexity inaddition to rate of disease progression and predicted response to therapy and impact to systemic health
Can you stage/grade by quad?
No. Whole mouth only
