Periodontal classification - periodontitis

Question 1

how do we describe the periodontitis?

Answer 1

loss of attachment
receding gums or gingiva
swollen
wobbly teeth
redness and tenderness
deeper than 3mm pocket
gingiva bleeding
plaque and calculus
modify by other things such as smoking
can be fibrotic

Question 2

describe stages of peridontitis

Answer 2

stage 1: initial periodontitis - represent status between periodontitis and gingivitis, early stages of attachment loss, persistent to gingival inflammation and gingival dysbiosis. management: periodontal probing may not provide all asessment information, may require asessment of salivary biomarkers and imaging technology
stage 2: moderate peridontitis - represents established periodontitis with characteristic damage to tooth support. management: straight forward ad relatively simple, involving personal (patient) and professional bacteria removal and monitoring to arrest disease progression. case grade and patient’s response to standard treatment must be carefully evaluated to determine if more intensive management is required
stage 3: severe periodontitis with potential for tooth loss- significant attachment loss, in absence of treatment (tooth loss may occur), characterised by deep periodontal lesions that extend to middle portion of the root. management; complicated by intraboney defects, furcation involvement and history of periodontal tooth loss, usually treatment does not rehabilitation of masticatory function
stage 4; severe periodontitis with potential for loss of the dentition- characterise by the presence of deep periodontal lesions that extent to apical portion root and history of multiple tooth loss. management; complicated by tooth hyper- mobility due to secondary occlusal trauma and tooth loss. usually requires stabilisation or restoration of masticatory function.

Question 3

describe the extent and distribution of periodontal destruction (determine by loss of periodontal attachment)

Answer 3

localised; <30% teeth effected (have LOA)
generalised; > 30% teeth affected (have LOA)
molar incisor distribution or pattern

Question 4

describe the grades of periodontitis

Answer 4

estimate the future risk of periodontitis progression and responsive treatment, estimate potential health impact of periodontitis on systemic disease and vice versa
Grade A: slow rate progression (no LOA or radiographic bone loss/RBL over 5 years); bone loss/age <0.25; heavy biofilm with low levels of destruction
Grade B; moderate rate of progression (less than 2mm LOA or RBL over 5 years); bone loss/age 0.25 to 1.0 destruction corresponds to biofilm deposits
Grade C: rapid rate of progression (equal to or more than 2.5 mm LOA or RBL over 5 years); bone loss/ age greater than 1.0; destruction exceeds amount expected given biofilm deposits
grade modifiers; smoking and diabetes factors taken into account
smoking: grade A (non - smoker), grade B (<10 cigarette/day). Grade C (>10 cigarettes/day)
diabetes: grade A (normoglycemia/no diagnosis of diabetes), grade B (HbA1c <7.0% in patients with diabetes, Grade C (HbA1c>7.0% in patients with diabetes

Question 5

define and describe ‘loss attachment’(LOA)

Answer 5

measure distance from the base of the pocket/sulcus to the cemento enamel junction (CEJ)
represent the destruction of the tooth supporting structure around a tooth or teeth
characterise by:
- destruction of the fibres of the gingiva
- destruction of the periodontal ligament fibres
- relocation of the junctional epithelium to the root surface
- loss of alveolar bone support

Question 6

demonstrate the ability to calculate LOA and utilise the findings to demonstrate periodontal classification

Answer 6

positive GR; LOA= PPD + GR
minimal GR; no recession, LOA = PPD
natural gingiva; CEJ not visible, LOA =PPD - 3mm = 0

Question 7

staging periodontitis

Answer 7

staging 1:
- CAL- 1-2 mm,
- RBL: coronal third (15%)
- tooth loss; no tooth loss
- local; max probing < 4mm and mostly horizontal bone loss
staging 2:
- CAL; 3-4 mm
- RBL; coronal third (15%-33%)
- tooth loss; no tooth loss
- local: max probing <5mm and horizontal bone loss
staging 3;
- CAL; >5 mm
- RBL: extending to middle root and beyond
- tooth loss; <4 teeth
- local; probing depth >6 mm, vertical bone loss >3mm, furcation involvement class 2 or 3. moderate ridge defects
staging 4;
- CAL; >5mm
- RBL; extending to middle root and beyond
- Tooth loss: >5 teeth
- local: masticatory disfunction, secondary occlusal trauma, severe ridge defects, bite collapse drifting, <20 remaining teeth.