Perio - Classification Flashcards

1
Q

How do we classify/provide a diagnostic statement for periodontal disease?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the classifications of periodontal disease? (10)

A
  • 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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how do we stage periodontal disease? (4)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what staging does a patient who has lost teeth before to peridontal disease get?

A

stage 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do we grade periodontal disease? (3)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what percentage is generalised periodontal disease?

A

> 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what percentage is localised periodontal disease?

A

< 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what indicates that the disease is uncontrolled?

A

bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the bleeding percentage in a healthy periodontium?

A

< 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are cause of non-plaque induced gingival disease?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are predisposing factors to necrotising gingivitis/periodontitis In adults? (6)

A
HIV/Aids 
Immunosuppression 
Uncontrolled stress
poor nutrition/malnourished
smoking 

all paired with gingivitis from poor oral hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are predisposing factors to necrotising gingivitis/periodontitis in children? (3)

A

Severe malnourishment
Extreme living conditions
Severe viral infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what conditions are associated with Periodontitis as a manifestation of systemic diseases? (5)

A
Papillion Lefevre Syndrome
Leukocyte adhesion deficiency 
Hypophosphatasia
Down syndrome 
Ehlers- Danlos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe recession type 1.

A

Gingival recession with no loss of inter-proximal attachment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

describe recession type 2.

A

Gingival recession associated with loss of inter proximal attachment.
The inter proximal attachment loss is LESS than/equal to the buccal attachment loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe recession type 3.

A

Gingival recession associated with loss of inter proximal attachment.
The amount of interproximal attachment loss is GREATER than the buccal attachment loss.

17
Q

how do we measure successful outcomes in periodontitis patients?

A

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.

18
Q

what are the symptoms of necrotising periodontal disease? (4)

A

crater like ulcerations
slough - necrotic tissue, bacteria and cells
loss of the papillae
halitosis

19
Q

what medications are used in treating necrotising periodontal disease (drug, dose, frequency?

When are these used?

A

Metronidazole
400mg 3x per day for 3 days

when? - accompanied by systemic symptoms such as fever and lymphadenopathy

20
Q

what are the indications for carrying out HPT before surgical methods (3)

A

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.

21
Q

what is the review period and the indications for surgical intervention? (3)

A

4-6 weeks after non-surgical methods

persisting pockets > 5mm
alongside
Excellent oral hygiene

22
Q

what is the GDP’s role after the completion of surgical intervention? (3)

A

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

23
Q

what is the guidance when prescribing metronidazole for necrotising gingivitis? (3)

A

Avoid consumption of alcohol

Avoid if pregnant

Avoid if using warfarin

24
Q

When reviewing a patient with necrotising gingivitis what should we do? (3)

A

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
25
Q

List the modifying factors of plaque induced gingivitis.

A

puberty - hormones exaggerates response to plaque

poor restorative margins/overhangs

drugs e.g. Ca channel blockers and immunosuppressants

26
Q

Describe a currently stable periodontal status.

A

< 10% Bleeding sites

pockets of ≤ 4mm with no bleeding

27
Q

Describe a currently in remission periodontal status.

A

≥ 10% bleeding sites

Pocket depths ≤ 4mm

no bleeding at 4mm sites

28
Q

Describe a currently unstable periodontal status.

A

pocket depths of ≥ 5mm
or
PPD ≥ 4mm & BoP.

29
Q

How do we treat necrotising periodontitis? (5)

A

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)