Perio Midterm Flashcards
How many stages and grades are assigned to each perio pt?
1 stage + 1 grade
What is the severity of perio diagnosis based on?
Most severe tooth
Your assessment of expected outcomes of suggested tx modalities
Prognosis
What are the different prognoses?
Favorable
Questionable
Unfavorable
Hopeless
Which prognosis?
Perio status of the tooth can be stabilized with comprehensive periodontal tx and maintenance.
Favorable
Which prognosis?
Future loss of the periodontal supporting tissues is unlikely if these conditions are met
Favorable
Which prognosis?
Perio status of the tooth is influenced by local and/or systemic factors that may or may not be able to be controlled.
Questionable
Which prognosis?
The periodontium can be stabilized with comprehensive treatment and periodontal maintenance if these factors are controlled; otherwise, future periodontal
breakdown may occur
Questionable
Which prognosis?
Periodo status of the tooth is influenced by local and/or systemic factors that cannot be controlled
Unfavorable
Which prognosis?
Periodontal breakdown is likely to occur even with comprehensive periodontal tx and maintenance
Unfavorable
Which prognosis?
Tooth must be extracted
Hopeless
What is the only evidence based prognosis scheme for molars with furcations?
Miller prognosis
What is the goal for Miller prognosis?
Score of < 5
What are the 4 categories of perio health?
Pristine perio health
Clinical perio health
Perio disease stability
Perio disease remission/control
Which category of perio health?
Absence of pocket depth > 3mm
(exception = most distal molar)
Pristine perio health
Which category of perio health?
Absence of attachment loss
Pristine perio health
Which category of perio health?
BOP < 10%
Pristine perio health
Clinical perio health
Which category of perio health?
Absence of clinical erythema, edema, pus
Pristine perio health
Clinical perio health
Which catgeory of perio health?
Can contain attachment loss due to recession
Clinical perio health
Which category of perio health?
No pocket depths of clinical importance (pseudopockets)
Clinical perio health
Which category of perio health?
Absence of minimal levels of clinical inflammation
Clinical perio health
Which category of perio health?
Normal osseous support
Clinical perio health
Which category of perio health?
Absence of inflammation and infection, but reduced periodontium
Perio disease stability
Which category of perio health?
Goal of perio patients
Perio disease stability
Which category of perio health?
Reducing predisposing factors and controlling modifying factors
Perio disease stability
Which category of perio health?
Cannot fully control modifying and predisposing factors
Perio disease remission/control
Which category of perio health?
Decreased inflammation and improvement in clinical parameters
Perio disease remission/control
Which category of perio health?
Stabilization of disease progression to low disease activity
Perio disease remission/control
Which category of perio health?
May be an acceptable alternative therapeutic goal in long-standing disease
Perio disease remission/control
Minimal recession without pre-existing active perio disease (ex: brushing too hard, ortho, etc)
Health
Denotes a healthy state in a patient with a previously diagnosed perio disease (attachment loss)
Stability
For patients with reduced periodontium
for any reason (recession, crown
lengthening procedure, or history of
periodontal therapy), as long as PDs
are ≤3 mm, the diagnosis is _____________
Gingivitis/inflammation on a reduced periodontium
For patients with a history of periodontitis, PDs ≥4 mm with BOP (at the same sites) indicate _______________
Recurrence of disease
Describe Step 1: initial case overview to assess disease
Full mouth PDs
Full mouth X-Rays
Missing teeth
Mild-moderate perio is usually Stage I or II
Severe-very severe perio is usually Stage III or IV
Describe Step 2: establish stage (for mild-moderate perio)
Confirm CAL
Rule out non-perio causes of CAL
Determine max CAL or radiographic bone loss (RBL)
Confirm RBL patterns
Describe Step 2: establish stage (for moderate-severe perio)
Determine max CAL or RBL
Confirm RBL patterns
Assess tooth loss due to perio
Evaluate case complexity factors
Describe Step 3: establish grade
Calculate RBL (% of root length x 100) divided by age
Assess risk factors
Measure response to SRP & plaque control
Assess expected rate of bone loss
Conduct detailed risk assessment
Account for medical/systemic inflammatory considerations
Root length, CAL, and CP for Stage I chronic perio
Root length = 15%
CAL = 1-2
CP = slight
Root length, CAL, and CP for Stage III or IV chronic perio
Root length = >30%
CAL = >5mm
CP = severe
PDs and gingival margin enteries are required for ____ sites and _____ teeth present at time of evaluation
all; all
If you have a PD of 3mm or less, what do you put in the GM?
Negative reciprocal, or blank
If you have a PD of 4mm or greater with CAL, what do you put in the GM?
-2 or blank
What do you enter when you see recession?
Positive numbers
What do you enter when you see pseudo-pockets?
Negative numbers
What do you enter when gingival margin is at the CEJ?
0
Go through the diagnosis sequence for chronic perio
Start with generalized or localized
Enter stage and grade
Enter chronic perio at end
(Ex: Generalized Stage I Grade B chronic perio)
Probing is considered what type of procedure?
Invasive
(premed, other consults may be necessary)
How often must a dental exam be updated (D0180)?
Anually
What code is used for a dental exam?
D0180
What must you use during a dental exam?
Disclosure stain for plaque index
What are the 3 major components of a perio exam?
Diagnosis, treatment plan, prognosis
What code is used for OHI?
D1330
Chronic perio is most prevalent in what age group?
Adults
(can occur in children too tho)
Patients diagnosed with chronic perio under 25 years old must be evaluated for a differential diagnosis of what?
Molar/incisor pattern perio
What should you assess in a patient with chronic perio?
Localized bone loss of 1st molar and incisors
Assess OH
The amount of destruction present in chronic perio is consistent with the presence of what?
Local factors (ex: primary and secondary etiologic factors)
What is a frequent finding in chronic perio?
Subgingival calc
What is chronic perio associated with?
Variable microbial pattern
Predisposing factors
Systemic diseases (diabetes, HIV)
Describe the rate of progression of chronic perio
Slow/moderate
(but can have periods of rapid destruction)
How can chronic perio be further classified?
Extent and severity
What can chronic perio be modified by (other than systemic diseases)?
Cig smoking
Emotional stress
Localized vs generalized chronic perio is based on what?
% of sites affected
30% or greater = generalized
30% or less = localized
Describe severity CAL and Armitage system of diagnosis (outdated but seen in chart notes)
Slight chronic perio = 1-2mm CAL
Moderate chronic perio = 3-4mm CAL
Severe chronic perio = 5+mm CAL
What is “CAL”?
Clinical/calculated attachment loss
What should you do for a patient with > than 3mm pockets without loss in CAL?
Enter appropriate negative number OR leave blank
What must be entered into the appropriate charting for ID?
Pseudopockets
T/F: Pts with subgingival calculus on enamel w/o CAL are not appropriate for SRP codes
True
What is the code for scaling with inflammation?
D4346
What is the code for scaling/root planing?
D4341, D4342
Which types of patients are likely to have pseudo pockets?
Young pts with edema and subgingival calc
Pts with associated pharmacologic effects
Exposure of root surface by apical shift in position of gingiva
Recession
Apical migration of JE; apical shift of gingiva
Root exposure
CEJ to the attachment
Actual recession
Visible on clinical exam; gingiva margin to CEJ
Apparent recession
Level of attached perio tissue; not directly visible, but determined by probing
Actual position
Level of gingival margin or crest of free gingiva that is seen by direct vision
Apparent position
What are the 2 causes of recession?
Pt self-care
Anatomical