Perio - Classification Flashcards
How do we classify/provide a diagnostic statement for periodontal disease?
Type and extent, stage, grade, stable/unstable and the risk factors
T- generalised/localised E - local, general, MIP S - 1-4 G - A-C Stable/unstable = related to bleeding RF - smoking, uncontrolled diabetes
List the classifications of periodontal disease? (10)
- Health
- Plaque induced gingivitis
- Non plaque induced gingival diseases and conditions
- Periodontitis
- Necrotising periodontal diseases
- Periodontitis as a manifestation of systemic disease
- Systemic disorders affecting the periodontal tissues
- Periodontal abscesses
- Periodontal- endodontic lesions
- Mucogingival deformities and conditions.
how do we stage periodontal disease? (4)
use the worst affected site in the whole mouth
Stage 1 = Early/mild
< 15% of inter proximal bone loss at the worst site
Stage 2 = Moderate
Bone loss at coronal third of root
Stage 3 = Severe (potential for tooth loss)
Bone loss to the mid third of the root
Stage 4 = Very severe (potential for tooth loss)
Bone loss to the apical third of the root
what staging does a patient who has lost teeth before to peridontal disease get?
stage 4
how do we grade periodontal disease? (3)
Measured using the patients age and the percentage bone loss at the worst affected site.
Slow
if % bone loss / age = < 0.5
Moderate
if % bone loss / age = between 0.5 to 1.0
Rapid
if % bone loss / age = > 1
what percentage is generalised periodontal disease?
> 30%
what percentage is localised periodontal disease?
< 30%
what indicates that the disease is uncontrolled?
bleeding
what are the bleeding percentage in a healthy periodontium?
< 10%
what are cause of non-plaque induced gingival disease?
genetic/developmental disorders
e.g. Hereditary gingival fibromatosis
Specific infections
e.g. herpetic gingival stomatitis
Inflammatory and immune conditions
e.g. Lichen planus
Endocrine, nutritional and metabolic diseases
e.g. Vitamin C deficiency
what are predisposing factors to necrotising gingivitis/periodontitis In adults? (6)
HIV/Aids Immunosuppression Uncontrolled stress poor nutrition/malnourished smoking
all paired with gingivitis from poor oral hygiene
what are predisposing factors to necrotising gingivitis/periodontitis in children? (3)
Severe malnourishment
Extreme living conditions
Severe viral infections
what conditions are associated with Periodontitis as a manifestation of systemic diseases? (5)
Papillion Lefevre Syndrome Leukocyte adhesion deficiency Hypophosphatasia Down syndrome Ehlers- Danlos
describe recession type 1.
Gingival recession with no loss of inter-proximal attachment.
describe recession type 2.
Gingival recession associated with loss of inter proximal attachment.
The inter proximal attachment loss is LESS than/equal to the buccal attachment loss.
describe recession type 3.
Gingival recession associated with loss of inter proximal attachment.
The amount of interproximal attachment loss is GREATER than the buccal attachment loss.
how do we measure successful outcomes in periodontitis patients?
reduced bleeding sites = < 10%
reduce pocket depths
plaque index = < 15%
we cannot be too strict with these however as large improvements can be seen even if the score is > those above.
what are the symptoms of necrotising periodontal disease? (4)
crater like ulcerations
slough - necrotic tissue, bacteria and cells
loss of the papillae
halitosis
what medications are used in treating necrotising periodontal disease (drug, dose, frequency?
When are these used?
Metronidazole
400mg 3x per day for 3 days
when? - accompanied by systemic symptoms such as fever and lymphadenopathy
what are the indications for carrying out HPT before surgical methods (3)
allows you to assess patient motivation
stabilise the gingiva before surgery
HPT can can help to reduce need for surgery?? by reducing probing depths and reducing bleeding on probing.
what is the review period and the indications for surgical intervention? (3)
4-6 weeks after non-surgical methods
persisting pockets > 5mm
alongside
Excellent oral hygiene
what is the GDP’s role after the completion of surgical intervention? (3)
Reinforce OH instruction and motivate
Review - examine to see if there have been any positive changes or relapse
Carry out the appropriate treatment according to findings I.e more HPT
what is the guidance when prescribing metronidazole for necrotising gingivitis? (3)
Avoid consumption of alcohol
Avoid if pregnant
Avoid if using warfarin
When reviewing a patient with necrotising gingivitis what should we do? (3)
upon review - (after chlorhexidine and metronidazole have been used) and after the acute symptoms have subsided, we should;
- Carry out more thorough supra and subgingival scaling
- If there is no resolution and persistent symptoms consider referral
List the modifying factors of plaque induced gingivitis.
puberty - hormones exaggerates response to plaque
poor restorative margins/overhangs
drugs e.g. Ca channel blockers and immunosuppressants
Describe a currently stable periodontal status.
< 10% Bleeding sites
pockets of ≤ 4mm with no bleeding
Describe a currently in remission periodontal status.
≥ 10% bleeding sites
Pocket depths ≤ 4mm
no bleeding at 4mm sites
Describe a currently unstable periodontal status.
pocket depths of ≥ 5mm
or
PPD ≥ 4mm & BoP.
How do we treat necrotising periodontitis? (5)
Ultrasonic debridement of the necrotic tissue to facilitate healing
0.2% Chlorhexidine mouthwash twice daily (pain makes it unbearable to brush)
Antibiotics for acute form
Smoking cessation, vitamin supplementation and dietary advice
Hygiene phase therapy (to treat the perio disease)
