Perio Classification Flashcards
Give examples of non-plaque induced gingival diseases
- herpetic gingival stomatitis
- genetic
- immune conditions e.g. lichen planus
- vitamin c deficiency
What are the signs and symptoms of necrotising gingivitis?
- pain
- gingival bleeding
- necrosis and ulcer in the interdental papilla
Periodontal health definitions
- patients with an intact peridontium
- patients with a reduced periodontium due to causes other than periodontitis and
- patients with a reduced periodontium due to periodontitis
gingival health definition for an intact periodontium
absence of:
- bleeding on probing
- erythema and edema
- patient symptoms
- attachment and bone loss
physiological bone levels range from 1 to 3mm apical to ACJ
Gingival health definition for reduced and stable periodontium that’s intact
- <10% bleeding sites
- probing depth less than or equal to 3mm
plaque induced gingivitis features
- associated with dental biofilm alone
- mediated by systemic or local risk factors
- drug influenced gingival enlargement
- no radiological bone loss
- no interdental recession
Localised vs generalised gingivitis
localised
<30% BOP
generalised
>30% bleeding on probing
potential modifying factors of plaque induced gingivitis
systemic conditions
- sex steroid hormones e.g. menstrual cycle, puberty, pregnancy, oral contraceptives
- hyperglycaemia
- leukaemia
- smoking
- malnutrition
oral factors enhancing plaque accumulation
- prominent sub gingival restoration margins
- hyposalivation
necrotising gingivitis - features
- necrosis and ulcer in interdental papilla
- gingival bleeding
- pain
- pseudomembrane formation
- halitosis
- regional lymphadenopathy
- fever
necrotising periodontitis features
in addition to signs and symptoms of NG:
- periodontal attachment and bone destruction
- frequent extraoral signs
- bone sequestrum possible in severely immune-compromised patient
necrotising stomatitis symptoms
- bone destruction extended through alveolar mucosa
- larger areas of osteitis and bone sequestrum
Periodontitis as a manifestation of systemic disease
classification based on primary systemic disease
mainly rare diseases affecting course of periodontitis in early presentation of severe periodontitis:
- papillon lefervre syndrome
- leucocyte adhesion deficiency
- Down’s syndrome
systemic diseases or conditions affecting periodontal tissues
mainly rare conditions affecting the periodontal sporting tissues independently of dental plaque biofilm induced inflammations:
- squamous cell carcinoma
- langerhans cell histicytosis
mucogingival deformities and conditions
gingival recession
- lack of keratinised gingiva/abnormal frenal attachment
Recession type 1 characteristics
gingival recession with no loss of inter-proximal attachment
Recession type 2 characteristics
gingival recession associated with loss of inter proximal attachment
- interproximal attachment loss less than or equal to buccal attachment loss
Recession type 3 characteristics
gingival recession associated with loss of inter-proximal attachment
- interporximal attachment loss greater than buccal attachment loss
what bpe code indicates the need for a radiographic assessment
3 or 4
Stage 1 periodontitis severity and bone loss at worst affected site
early/mild
<15% or 2mm
stage 2 periodontitis severity and bone loss at worst affected site
moderate
coronal third of root
stage 3 periodontitis severity and bone loss at worst affected site
severe
- potential for additional tooth loss
mid third of root
stage 4 periodontitis severity and bone loss at worst affected site
very severe
- potential for loss of dentition
apical third of root
Periodontiits - how to describe the distribution/extent of disease
localised
< 30% of teeth
generalised
> 30% of teeth
molar incisal pattern
step 2 - how to determine whether patient is engaging
plaque levels <20% and bleeding levels <30%
OR
>50% improvement in plaque and bleeding scores
as well as no obvious risk factors to control
In step 3 - what pockets would you re-perform sub gingival instrumentation for
4-5mm
step 3 - deep residual pockets still remain (6mm or more) - how would you treat
consider alternative causes
- refer for pocket management or regenerative surgery
what defines successful periodontal treatment?
good oral hygiene
gingival health definition achieved
- <10% BOP
- < OR = 3mm pocket depth
no increasing tooth mobility
a functional and comfortable dentition
reason for trying to eliminate pockets
teeth with pockets greater than 4mm are more likely to be lost in the future
- deeper the pocket, increased likelihood of tooth loss
factors influencing decision for periodontal surgery
smoking
compliance
oral hygiene
systemic disease
suitability of site
prognosis of tooth
availability of specialist treatment
patient preference
when would you proceed to step 4
if stable at 3 month re-evaluation after step 2 or if all sites are stable after step 3
step 4 treatment consists of…
supportive periodontal care
reinforce OH, risk factor control and behaviour change
regular targeted PMPR as required to limit tooth loss
consider evidence based adjunctive to control gingival inflammation
- toothpaste
- mouthwash
