Perio Swep 1.3 Flashcards
Papillary-Marginal-Attachment (PMA)-Index
Background: “The number of units affected correlates with the severity of gingival inflammation”
Facial gingival surface is divided in 3 scoring units P - M - A
Gingival units affected with gingivitis are counted. Presence or absence of inflammation is counted as {1} and {0}, respectively
Severity component can be considered
Score computed for tooth subject population
First published by Schour & Massler (1947)
Gingival Index (GI)
The severity of inflammation is assessed in 4 distinct gingival areas: distofacial papilla, facial margin, mesiofacial papilla, lingual gingival margin.
Scores: 0 to 3; bleeding is considered. Presence of bleeding automatically leads to a score ≥2
Score for tooth subject population
Useful for the calculation of prevalence and severity in population and individual
Frequently used index in clinical trials
First published by Löe (1961) and Löe & Silness (1963)
The bleeding tendency is assessed upon probing a periodontal pocket using
standardized pressure
Periodontal probe is inserted to the bottom of the periodontal pocket. Bleeding is observed 15 seconds following retraction of probe.
Presence or absence of bleeding is scored as {1} and {0}, respectively.
Not to be confused with bleeding as scored in GI
B-o-P is a valid indicator for periodontal stability. However, it is a poor indicator of periodontal breakdown.
The Extent and Severity Index (ESI)
Agreement
Disease is defined as attachment loss >1mm
Extent
Proportion of tooth sites in a patient showing signs of destructive periodontitis
Severity
Amount of attachment loss at the diseased sites, expressed as a mean value
The Periodontal Index System (PI)
Score 0: Negative.
Score 1, 2: Gingivitis
Score 6: Gingivitis with pocket formation
Score 8: Advanced destruction with loss of masticatory function
All teeth are examined. The circumference of each tooth is inspected visually, and given a score.
Index computed for subject, population.
The Periodontal Disease Index System:
This system includes several components:
Gingival status Crevicular measurements Periodontal Disease Index Plaque criteria Calculus Criteria
The Periodontal Disease Index System
Score 1, 2, 3: Severity of gingivitis
Score 4: Initial attachment loss (£3 mm)
Score 5: Moderate attachment loss (>3 mm and
£6 mm)
Score 6: Advanced attachment loss (>6 mm)
4 areas per tooth are examined using a probe. The most severe score is tabulated and used for the calculation of the subject’s PDI
Index computed for subject, population
Community Periodontal Index of Treatment Needs (CPITN)
Primarily designed to assess periodontal treatment needs in under served parts of the world
Uses a specially designed probe
Epidemiology: 10 index teeth are examined and worst finding is recorded per sextant
For individual subjects: worst finding of all teeth in a sextant is recorded, resulting in 6 scores per subject. The worst score determines the treatment needs score
Published and promoted by the World Health Organization (1982).
Community Periodontal Index of Treatment Needs (CPITN)
Perio status
Periodontal Status Score 1: Bleeding on gentle probing Score 2: Calculus felt during probing,crevicular depth £3 mm Score 3: Probing depth 4 mm or 5 mm Score 4: Probing depth ³6 mm
Community Periodontal Index of Treatment Needs (CPITN): treatment status
Treatment Needs Code 0: No treatment Code I: Improved oral hygiene Code II: I + professional scaling Code III: I + II + complex treatment
Periodontal Screening & Recording® (PSR)
Purpose:
Periodontal Screening and Recording® (PSR®) is a rapid and effective way to screen patients for periodontal diseases and summarizes necessary information with minimum documentation.
Periodontal Screening & Recording® (PSR)
Endorsement:
The ADA and the AAP support the use of PSR® by dentists as a part of oral examinations.
PSR - Benefits: Early detection:
PSR® includes evaluation of all sites. For this reason, it is a highly sensitive technique for detecting deviations from periodontal health and a uniquely appropriate screening tool for periodontal diseases that are, by nature, site specific and episodic.
PSR - Benefits:
Speed:
Once learned, PSR® takes only a few minutes to conduct for each patient. It can be readily incorporated into routine oral examinations.
PSR - Benefits
Simplicity:
PSR® is easy to administer and comprehend. The simplicity of the scoring system aids in monitoring a patient’s periodontal status.
PSR - Benefits
Cost-effectiveness:
PSR® utilizes a simple periodontal probe designed specifically for use with this screening system. It does not require the use of expensive equipment.
PSR - Benefits:
Recording ease:
Documentation for PSR® requires the recording of six numerical scores, one for each sextant of the mouth. It does not require extensive charting or lengthy narrative explanation.
PSR - Benefits:
Risk management:
Proper, consistent, and documented use of PSR® shows that the dentist is evaluating a patient’s periodontal status.
PSR - Limitations
PSR® is a screening system designed to detect periodontal diseases. It is not intended to replace a comprehensive periodontal examination when indicated.
Patients who have been treated for periodontal diseases and are in a maintenance phase of therapy require periodic comprehensive periodontal examinations.
In addition, PSR® is designed primarily for use with adult patients and has limited utility in screening children and adolescents.
Peri-implant Tissues and Indices
Modified PlI
Modified GI
Reliability of gingival indices
(Reliability of an index to measure a condition in the same subject repeatedly and obtain the same score results each time)
Validity of a diagnostic test
(Sensitivity and specificity of various diagnostic tools used to create an index)
Halo Effect (Thorndike 1920):
The examiner’s general impression of target distorts his/her perception of the target on specific dimensions
Leniency/Severity Error (Saal & Landy 1977):
The examiner’s tendency to be lenient or severe
Central Tendency Error (Korman 1971):
The examiner’s reluctance to rate at either the positive or negative extreme, so all scores cluster in the middle
Calibration involves:
- Several examiners at different experience levels
- Subjects with various disease extend and severity
- Follow-up appointments
Main goal is to determine inter/intra-examiner variations.
Sensitivity
=
The probability that a test result will be positive when the test is administered to people who actually have the disease in question
Sensitivity = Pr(T+/D+)
Specificity
The probability that a test will be negative when administered to people who are free of the disease in question
Specificity = Pr(T-/D-)
Predictive Value Positive (PVP)
The probability of disease in a subject with a positive test result
PVP = Pr(D+/T+)
Predictive Value Negative (PVN)
The probability of not having the disease when the test is negative
PVN = Pr(D-/T-)
Bone loss % =
CEJ-Crest - 2 mm divided by
CEJ-Apex - 2 mm
Hemiseptal defect:
a vertical defect in the presence
of adjacent roots; thus half of a septum remains on
one tooth, AKA one-walled defect
Bone Loss in Furcation AreasPathologic resorption of bone within a furcation.
Shows up in radiograph as
radiolucency
Furcation radiolucency
When radiographs of maxillary molars are observed, a small, triangular radiographic shadow is sometimes noted over either the mesial or distal roots in the proximal furcation area. However,
absence of the furcation arrow image does not necessarily mean absence of a bony furcation involvement because the arrow was not seen in a large number of furcations with Degree 2 or 3 involvement.
PDL appears as the periodontal space of
0.4 to 1.5 mm on radiographs, a radiolucent area between the radiopaque lamina dura of the alveolar bone proper and the radio opaque cementum.
Vessels within Interdental Bone appear as
They appear as radiolucent lines bordered by thin radiopaque lines
IF the maxillary sinus is close to or has invaginated among the roots of the maxillary teeth, there may be difficulties with
surgical treatment of the periodontal problems.
Mandibular Tori
A bony exostosis on the lingual aspect of the mandible, generally in the premolar-molar region; commonly bilateral
If the roots are less than 2.5 mm apart
Periodontal bone loss will affect the entire interproximal
Internal Resorption:
Tooth resorption beginning from within the pulp.
External Resorption:
Resorption of tooth structure beginning on the external surface.
To standardize the projection and to ensure the reproducibility of serial radiographs,
customized bite blocks was fabricated using XCP film holder (Dentsply) with impression material of hydrophilic addition reaction silicone (Dentsply) and direct conventional radiographic images (Figure 3).
Gingival lesions of specific bacterial origin
Infective gingivitis and stomatitis.
The lesions may be due to bacteria. The lesions may or may not be accompanied by lesions elsewhere in the body. Bacteria involved: Neisseria gonorrhea, Treponema pallidum, Streptococci, Mycobacterium chelonae or other org.s
Clinical presentation … Variations
Fiery red edematous painful ulcerations Asymptomatic chancres Mucous patches Atypical non-ulcerated, highly inflamed gingivitis. Diagnosis: Biopsy Microbiologic examination
Herpes virus infections-
Herpes simplex viruses type 1 and 2
Varicella-zoster virus
Herpes simplex 1 usually causes oral manifestations.
Primary herpetic gingivostomatitis-
Symptoms:
- painful severe gingivitis with redness - ulcerations with serofibrinous exudate - edema accompanied by stomatitis
Characteristics: - Incubation period is one week. - Formation of vesicles, which rupture, coalesce and leave fibrin-coated ulcers. - Healing within 10 to 14 days.
Herpes virus can stay latent in trigeminal ganglion for years.
Found in
gingivitis, Necrotizing Ulcerative Diseases (NUG/NUP) and periodontitis.
More primary infections occur at older ages in industrialized society.
Primary herpetic gingivostomatitis may be asymptomatic in childhood, but may also give rise
severe gingivostomatitis (painful severe gingivitis with redness, ulcerations with serofibrinous exudate and edema. The incubation period is 1 week A characteristic feature is formation of vesicles, which rupture, coalesce, and leave fibrin coated ulcers. Fever and lymphadenopathy are other classic features.
Recurrent herpetic infections
herpes labialis
Vermilion border and/or the skin adjacent to it. 20-40% of individuals with primary infection. Trauma, UV light exposure, fever, menstruation
Diagnosis:
- generally considered an aphtous ulceration. - ulcers in attached gingiva and hard palate.
Recurrent infections occur in general more than once a
year, usually at the same location on the vermillion border and/or skin adjacent to it, where neural endings are known to be clustering.
Factors that trigger recurrent infections are listed as trauma, UV light exposure, fever, menstruation and others.
Herpes zoster-
- Virocella-zoster virus causes varicella (chicken pox).
- Small ulcers usually on the tongue, palatal and gingiva.
- Latent in the dorsal root ganglion.
- Unilateral lesions.
- 2nd and 3rd branch of the trigeminal ganglion.
Gingival lesions of fungal origin
Candidosis
Linear gingival erythema
Histoplasmosis
Candidosis-
Candida species isolated from the mouth:
C.albicans, C.glabrata, C.krusei, C.tropicalis, C. parapsilosis and C. guillermondii.
Oral carriage of C.albicans in healthy adults: 3-48%.
Reduced host defense posture
C.albicans is frequently isolated from the subgingival flora of patients with severe periodontitis.
Linear gingival erythema-
- Distinct linear erythematous band limited to the free gingiva.
- Lack of bleeding.
Positive for C.albicans by culture:
50% of HIV associated gingivitis sites,
26% of unaffected sites of HIV seropositive patients, 3% of healthy sites of HIV negative patients.
Histoplasmosis-
- Granulomatous disease caused by Histoplasma capsulatum *
- Acute and chronic pulmonary histoplasmosis and a disseminated form… Immunocompromised patients.
- Any area of the oral mucosa.
- Nodular or papillary and later may become ulcerative type of lesions with pain.
Hereditary gingival fibromatosis-
- Diffuse gingival enlargement.
- Disease entity or a part of a syndrome.
(example: hypertrichosis, mental retardation, epilepsy, hearing loss, growth retardation, abnormalities of extremities) - May interfere with or prevent tooth eruption.
- Possible mechanism(s):
TGF-1 favor the accumulation of ECM.
May be located on chromosome 2 in human.
- Disease entity or a part of a syndrome.
Gingival lesions of systemic origin
Allergic and traumatic reactions
Other gingival manifestations
Mucocutaneous disorders
Type I reactions (immediate Type),mediated by
IgE,
or
Type IV reactions (delayed type) mediated by
T-cells.
Allergies to:
Dental restorative materials (type IV, contact allergy)
Oral hygiene products, chewing gum and food [generally flavor additives or preservatives]
A diffuse fiery red edematous gingivitis sometimes with ulcerations or whitening.
Chemical traumatic lesions-
Surface etching by various chemical products with toxic properties.
Examples: chlorhexidine-induced mucosal desquamation, acetylsalicylic acid burn, cocaine burn. Incorrect use of caustics by the dentist.
Physical traumatic lesions-
Hyperkeratosis, a white leukoplakia-like, frictional keratosis.
Gingival laceration resulting in gingival recession. Traumatic ulcerative gingival lesion. (brushing and flossing techniques)
Thermal injury-
Minor burns from hot beverages.
Mostly seen on palatal and labial mucosa.
Painful, erythematous lesions.
Vesicles may develop.
Foreign body reactions-
Epithelial ulceration that allows entry of foreign material into gingival connective tissue.
Foreign body can be generally detected via X-rays.
(Examples: amalgam tattoo, abrasives, toothpick etc.)
