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3rd Year > Perio- Classification > Flashcards

Perio- Classification Flashcards

1
Q

What is periodontal health?

A

Patients with an intact periodontium or reduced periodontium (not caused by peridontitis)

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2
Q

What is characteristic of periodontal health?

A

<10% bleeding sites

Bone levels 1-3mm (no pockets >3mm)

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3
Q

What is plaque induced gingivitis?

A

Patients with

  • Visible plaque around the gingival margins
  • redness and gingival inflammation at the papilla.
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4
Q

What is characteristic of plaque induced periodontitis?

A

No bone loss or interdental recession

Bleeding on probing

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5
Q

What can increase a patient’s susceptibility to plaque induced gingivitis?

A

Puberty- Plaque causes gingivitis but the hormones exagerate it.

Poor restorative margins- enabling greater plaque build up and inflammation.

Drug induced gingivial enlargemement.

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6
Q

What is shown here and what causes it?

A

Drug induced gingival enlargement.

Drugs such as:

Calcium channel blockers

Immunosuppresants.

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7
Q

What has caused the red gingivae in this image?

A

Primary herpetic gingivostomatitis

(infection)

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8
Q

What has caused this gingival appearance?

A

A vitamin C deficiency has caused this skin discoloration.

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9
Q

What do you need to assess to diagnose periodontitis?

A

Stage-Bone loss

Grade-progression of bone loss (D for development)

Extent How much disease there is and where?

  • Current periodontal Status
  • Risk factors.

Some Giants Eat Sour Raspberries.

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10
Q

Compare grading and staging?

A

Staging is how much bone has been lost. (S for severe)

Stage 1/2/3/4

Grading is how quickly the bone loss has progressed is (D for Development)

Grade A/B/C

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11
Q

How do you stage bone loss?

A

Look at the maximum bone loss at the worst site and give it stage 1-4

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12
Q

What is stage 1 bone loss?

A

Early/mild with interproximal bone loss of 2mm at the worst site.

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13
Q

What is stage 2 bone loss?

A

Bone loss to the coronal third of the root.

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14
Q

What is stage 3 bone loss?

A

Interproximal bone loss to the mid third of the root.

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15
Q

What is stage 4 bone loss?

A

Interproximal bone loss to the apical third of the root.

Or if the patient has lost teeth due to periodontal disease.

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16
Q

How do you grade bone loss?

A

You find the worst site of bone loss and assign a percentage of bone that has been lost:

Grade= percentage bone loss/ age.

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17
Q

What is grade A bone loss?

A

When the percentage bone loss/age is <0.5.

The bone is being lost slowly.

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18
Q

What is grade B bone loss?

A

When the percentage bone loss/ age 0.5-1.

The bone loss is moderate.

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19
Q

What is grade C bone loss?

A

When percentage bone loss/age is >1.

The bone is being lost rapidly.

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20
Q

How do you describe the extent of periodontal disease?

A

Can be

  • Localised <30% of teeth
  • Generalised >30% of teeth.
  • Molar incisor pattern (younger patients)
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21
Q

What is characteristic of perio disease that is currently stable?

A

<10% teeth bleed on probing.

Periodontal pocket depth <=4mm

No BOP at 4mm sites.

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22
Q

What do we mean if the periodontal patient is in remission?

A

The patient had periodontitis and now has bleeding gums.

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23
Q

What is characteristic of a perio patient that is currently in remission?

A

Bleeding on Probing >=10%

Periodontal pocket depth <4mm

No BoP at 4mm sites

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24
Q

What is characteristic of a currently unstable periodontal patient?

A

Periodontal pocket depth >5mm

or

Periodontal pocket depth >4mm WITH bleeding on probing.

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25
Q

Why is the periodontal pocket depth cut off 4mm?

A

As these deep pockets are less stable and cannot be cleaned.

26
Q

Why is the patient’s periodontal history vital for clincial examination?

A

A deep pocket without bleeding may be inactive disease. Therefore, you need to know patient history as the pocket may be in the process of, but have not healed yet.

27
Q

What are the symptoms of necrotising gingivitis?

A

Necrosis and ulcers in the interdental papilla and gingvial margins

Ulcers covered in sloughing

Deep pocket formation at the ulcers.

Pain

Readily provoked bleeding.

First lesions are seen inter-proximally at the mandibular anterior region

No fever.

28
Q

Whatis the sloughing formation

A

A layer of yellowish/ white/ grey debris that is made of necrotic tissue,bacteria and cells on the tissue.

29
Q

What are the symptoms of necrotising periodontitis?

A

Necrotising gingivitis symptoms +
* Ulcers covered in sloughing
* Deep pocket formation at the ulcers
* Pain
* Readily provoked bleeding.
* First lesions are seen inter-proximally at the mandibular anterior region
* No fever.

+Destruction of the periodontal attachment and bone

Bone sequestrum (in severely immunocompromised patients)

30
Q

What is a bone sequestrum?

A

The seperation of dead bone .

31
Q

What is this clinical image showing?

A

Necrotising stomatitis

Infection of the oral mucosa that can cause loss of chunks of bone from the alveolar bone.

32
Q

Describe this clinical image.

A

Necrotising gingivitis

The infection is restricted to the soft tissues. (usually papilla)

There is:

Ulceration around the gingival margin.

Sloughing- the white/grey fibrous coating that peels.

33
Q

Describe this clinical image

A

Necrotising periodontitis.

The infection causes attachment loss.

The interdental papilla and bone are destroyed (greater defect)

34
Q

What is this clinical image?

A

Herpetic gingivostomatitis.

This involves the Herpes simplex virus and affects the gingival mucosa.

We see multiple vesicles and the patient has a fever.

This does not permanently destruct tissue.

35
Q

How does peridontitis manifest as systemic disease?

A

Some rare diseases don’t affect the periodontitis proccess, they just cause it to present earlier (as a result of their affected immune system)

e.g. down’s syndrome

Papillion lefevre syndrome.

36
Q

What is Papillion lefevre syndrome?

A

When the patient loses 80-90% of the bone around their deciduous teeth.

& they have premature loss of their permanent dentition at a young age.

37
Q

How does uncontrolled diabetes mellitus affect the periodontal tissues?

A

The uncontrolled diabetes causes the breakdown of periodontal conditions. This mimics periodontitis.

38
Q

What type of gingival recession is shown in the clinical image?

A

Type 1-

There is no loss of interproximal attachment

The recession is narrow and localised.

39
Q

Name and describe the type of gingival recession is shown in the clinical image?

A

Type 2-

There is loss of interproximal attachment

The apical attachment loss is greater than the interproximal attachment loss. (still something left interproximally)

40
Q

Name and describe the type of gingival recession is shown in the clinical image?

A

Type 3-

The papilla is completely lost.

interproximal attachment loss is greater than apical attachment loss.

(there is nothing interproximal left)

41
Q

Name and describe the abscesses of the periodontium

A

gingival abscess- localised to the gingiva

Periodontal abscess- related to a pre-exisiting deep pocket due to food packing or margin tightening after HPT.

Peri-coronal abscess- inflammation around the crown of a partially erupted tooth (like a partially erupted wisdom tooth)

42
Q

What is an abscess?

A

A swelling in the tissue which is filled with pus and caused by an infection.

43
Q

What are the signs and symptoms of a periodontal abscess?

A
  • Swelling
  • Pain
  • TTP laterally.
  • Deep periodontal pocket
  • Suppuration
  • Enlarged regional lymph nodes
  • Fever
  • Commonly pre-existing periodontal disease.
  • Tooth still vital.
44
Q

How do we treat a periodontal abscess?

A
  1. subgingival instrumentation (short of the pocket base)
  2. If pus is present- drain by incision or through the periodontal pocket.
  3. 0.2% Chlorohexidine mouthwash- until acute symptoms subside.
  4. analgesia
  5. ONLY ANTIBIOTICS IN CERTAIN SITUATIONS.
45
Q

Why do we instrument short of the pocket base for a periodontal abscess ?

A

Because the attachment is friable and easily damaged.

Aggresive curetting down to the bone would cause recession rather than healing.

46
Q

Discuss the use of antibiotics for a periodontal abscess

A

Only use them when:

There is spreading infection

The pocket is not responding to instrumentation.

We use penicillin V (500mg 4 times daily for 5 days)

(400mg 3 times daily metrondiazole if allergic)

in combination with mechanical therapy.

47
Q

How can endodontic disease affect periodontal health?

A

The inflammatory factors spread from the pulp via the apical foramen ,adversely affecting periodontitis progression.

48
Q

Compare acute and chronic endo-periodontal lesions?

A

Acute- caused by perforation (iatrogenic damage during periodontal treatment)

Chronic- Due to pre-existing periodontitis- this tends to be slow and chronic progression

49
Q

What are the signs and symptoms of endo-periodontal lesions.

A
  • Deep periodontal pockets reaching (or close to) the apex.
  • Negative or altered response to pulp vitality tests
  • Bone resorption in the apical or furcation regions.
  • Spontaneous pain.
  • Pain on palpitation and percussion
  • Pus
  • Tooth mobility
  • A sinus tract draining buccal or palatally
  • Crown or gingival colour alterations.
50
Q

What are the potential routes of infection for an endoperiodontal lesion ?

A
  • The contamination of dentinal tubules with bacteria to affect the pulp.
  • Perforation
  • Apical foramen
  • Lateral and accessory canals .
  • Furcal canals
  • Vertical development of the radicular grove (an anomaly found in upper incisors that is exposed due to loa)
51
Q

How is the apical foramen a potential route of infection?

A

It is the main route of communication between the pulp and periodontium.

Entrance for inflammatory byproducts to affect the pulp.

Exit from the pulp of microbial and inflammatory by-products to cause peri-radicular pathology.

52
Q

What questions do we ask to classify an endo-periodontal lesion.

A
  1. Is the root damaged.
  2. Did the patient have previous periodontal disease .
  3. What is the lesion affecting
53
Q

How do we treat an endo- perio lesion?

A
  1. Incise abscess if present.
  2. Endodontic treatment of the affected tooth.
  3. Analgesia.
  4. 0.2% chlorohexidine mouthwash- until the acute symptoms subside.
  5. Carry out supra and subgingival instrumentation 10 days later if root surface is still contaminated.
54
Q

How do we treat necrotising periodontal disease?

A

First line-

Ultrasonic debridement and 0.2% chlorohexidine mouthwash twice daily.

or 3% hydrogen peroxide mouthwash.

If acute form or initial treatment doesn’t work.

400mg Metrondiazole 3 times daily for 3 days.

*if allergic use 500mg Amoxicillin 3 times daily for 3 days*

55
Q

How can we further classify a periodontal abscess?

A

A periodontal abscess can be further classified by wether the patient has periodontal disease.

If it is a Periodontal abscess in a periodontitis patient. This abscess is caused by :
-Untreated periodontitis
-After treatment (e.g., post scaling/surgery/medications)
If there is a Periodontal abscess in a non-periodontitis patient- this can be due to:
-Impaction
-Gingival overgrowth
-Harmful habits

56
Q

Give some causes of a periodontal abscess in a patient with periodontitis ?

A

Untreated periodontitis.

Leftover plaque in the pocket after treatment.

57
Q

Give some causes of a periodontal abscess in a non-periodontitis patient

A

Impaction.

Gingival overgrowth

Harmful habits e.g. nail biting.

58
Q

How can we further classify a necrotising disease?

A

By the compromisation:

-Necrotising disease in chronically, severely compromised patients e.g. HIV +-AIDS/ immunosuppression.

-Necrotising disease patients compromised due to gingivitis or periodontitis.

59
Q

What has caused this presentation?

A

A chemical burn e.g. from acid etch.

60
Q

What has caused this presentation?

A

A thermal burn.

61
Q

How can we treat any traumatic presentations to the gums?

A

0.2% Chlorohexidine mouthwash and pain killers- we don’t want the patient to brush off the fibrin & healing tissues.

62
Q

How does 3% hydrogen peroxide mouthwash treat Necrotising diseases?

A

The bacteria involved is spirochete and fusiform (these are anerobic bacteria)
The hydrogen peroxide mouthwash froths up to produce oxygen

3rd Year (63 decks)

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