Periodontal Disease Classification Flashcards
What was the first Perio Classification recognized by the AAP
Orban 1942
When/where was the first world workshop of periodontitis?
1966 in Ann Arbor
What are some updates that are included in the newest classification?
Multi-dimensional staging and grading
Re-categorization of various forms of perio
Classification of peri-implant diseases/conditions
What type of perio was discussed in the 1966 classification?
Chronic Marginal Periodontitis
What type of perio was discussed in the 1977 classification?
Juvenile Periodontitis
What kind of perio was discussed in the 1986 classification?
Classified by age/distribution:
Prepubertal periodontitis (children)
Localized juvenile (adolescents)
Generalized Juvenile
Adult Perio
Necrotizing ulcerative perio
Refractory perio
What kind of perio was discussed in the 1989 classification?
Condensed PreP/LocJuv/GenJuv and added Perio associated with systemic diseasezzzx
Refractory Perio
Adult Perio
Perio associated with systemic disease
Early onset periodontitis (children, adolescents, young adults)
Necrotizing Ulcerative Perio
What kinds of perio were included in the European Workshop on Periodontics? What year?
1993
Early-onset perio
Adult perio
Necrotizing Ulcerative Periodontitis
What kinds of perio were included in the 1999 International Workshop on Periodontal Classification?
- Gingival diseases
- Dental plaque-induced gingival diseases
- Non-plaque-induced gingival lesions
- Chronic Periodontitis
- Localized
- Generalized
- Aggressive Periodontitis
- Localized
- Generalized
- Periodontitis as a Manifestation of Systemic Diseases
- Necrotizing Periodontal Diseases
- Abscesses of the Periodontium
What is the Case Definition for Periodontal Health? (citation)
Absence of clinically detectable inflammation
Less than 10% BOP with PD < 3mm
Chapple et al. 2018
What are the subgroups of Periodontal Health?
- Periodontal Health
- Intact Periodontium (no CAL/BL)
- Reduced Periodontium
- Periodontitis Patient (Stable)
- Non-Periodontitis Patient (CL or GR)
- Periodontitis Patient (Stable)
What is the case definition for Stable Periodontitis? (Citation)
Control of local/systemic risk factors with minimal (<10%) BOP, PD _<_4mm, and no progressive periodontal destruction. (Chapple et al. 2018)
What are the main groups of the new classification?
Periodontal health, Gingival Diseases and Conditions
Forms of Periodontitis
Periodontal Manifestations of Systemic Diseases and Developmental and Acquired Conditions
Peri-implant Diseases and Conditions
What are the subgroups of the first Main Group?
Periodontal and Gingival Health
Dental Biofilm Induced (Gingivitis)
Non-Dental Biofilm Induced (Gingival diseases)
What are the subgroups of the second Main Group?
Periodontitis
Necrotizing Periodontal Diseases
Periodontitis as a Manifestation of Systemic Diseases
What are the subgroups of the 3rd Main Group?
Systemic Diseases or Conditions Affecting the Periodontal Supporting Tissues
Periodontal abscesses and Endo-Perio lesions
Muco-gingival Deformities and Conditions
Traumatic Occlusal Forces
Tooth and Prostheses Related Factors
What are the subgroups of the 4th Main Group?
Peri-implant Health
Peri-implant Mucositis
Peri-implantitis
Peri-implant Soft and Hard Tissue Deficiencies
What conditions are included in Non-Dental Biofilm-Induced Gingival Diseases?
GREAT BIG F’VN PeN
Genetic/Developmental Disorders
Reactive processes
Endocrine
Autoimmune
Traumatic lesions
Bacterial
Inflammatory/Immune conditions
Granulomatous Inflammatory Lesions
Fungal
Viral
Neoplasms
(gingival) Pigmentation
Nutritional/Metabolic diseases
Who published on Non-Plaque-Induced Gingival Diseases?
Holmstrup et al. 2018
What characterizes non-dental biofilm-induced gingival diseases?
Not cause by plaque
Does not resolve after plaque removal
May be a manifestation of systemic condition or localized to the oral cavity
Biofilm frequently increases clinical inflammation
What are signs and symptoms of Gingivitis?
inflammation
swelling
BOP
redness
discomfort on probing
pain
halitosis
difficulty eating
What Case Definitions are under the umbrella of Gingival Disease (biofilm induced)? (Citation)
Trombelli et al. 2018
Gingivitis in a patient without a reduced periodontium
Gingivitis in a patient with reduced periodontium (who has not been treated for periodontitis)
Gingivitis in a patient with reduced periodontium (who has been treated for periodontitis)
Case Definition for Gingivitis
Trombelli et al. 2018
PD _<_3mm, BOP >10%, no RBL/CAL
(Generalized = >30%)
Case Definition for Gingivitis in a Reduced Periodontium (no hx of perio)
Trombelli et al. 2018
CAL (recession)
>10% BOP
RBL Possible (CL)
Case Definition for Gingivitis in a patient who has been successfully treated for perio
Trombelli et al. 2018
CAL
RBL
BOP >20%
NO BOP IN SITES WITH PD _>_4mm (unstable)
How do you diagnose Necrotising Periodontal Diseases?
Hx of Pain
Presence of ulceration on gingival margin
Characteristically decapitated gingival papillae
Possible exposure of the marginal alveolar bone
What categories are there for Periodontitis as a Manifestation of Systemic Disease?
Systemic disorders that:
- Impact periodontal inflammation
- Influence the pathogenesis of perio
- Cause periodontal-tissue loss independent of perio
What is the case definition for periodontitis?
- Interproximal* CAL at 2 or more non-adjacent teeth
- Buccal/Facial* CAL _>_3mm with PD >3mm at 2 or more teeth
Tonetti et al. 2018
What are some examples of CAL that are not used to classify a patient as having Periodontitis?
Recession of traumatic origin
Caries extending in the cervical area
CAL from malposition or 3rd molar extraction
Endo-Perio lesion
Vertical Root Fracture
What is the definition of Periodontitis?
Tonetti et al. 2018
Microbially-associated, Host-mediate inflammation that results in loss of periodontal attachment
What Categories of Necrotizing Periodontal Diseases are there?
Herrera et al. 2018
NUG and NUP are considered different stages of the same disease
Categories:
- Necrotizing periodontal disease in a chronic or severely compromised patient
- Necrotizing periodontal diseases in a temporarily or moderately compromised patient
What is Staging periodontitis based on?
Severity
Complexity
Extent
What is Severity based on?
Interdental CAL at site of greatest loss
RBL
Tooth loss due to Periodontitis
What is Complexity based on?
Level of Competence/Experience required for optimal care
PD, BL Pattern (vertical/horizontal), Furcation, Ridge defects
Bite collapse, Complex rehab
What is Grading based on?
Variability and Rate of Progression
Risk of further progression (RBL)
Analysis of possible poor outcomes of tx (Grade Modifiers)
Assessment of the risk that the disease or its treatment may negatively effect the general health of the patient (Risk of Systemic Impact of Perio | Biomarkers)
What is the primary criteria for Grading?
Direct Evidence:
- RBL 0mm/5yrs | <2mm/5yrs | >2mm/5yrs
Indirect Evidence:
- RBL <0.25 | 0.25-1.0 | >1.0
- Biofilm: Heavy/low progress | Even | Low/Heavy progress
What are Grade Modifiers?
Risk factors Smoking or Diabetes
Case definition of Peri-Implant Health (citation)
Araujo and Lindhe 2018
Absence of mucositis
No bone-loss beyond initial remodeling
What is the case definition of Peri-Implantitis (Citation)
Schwarz et al. 2018
Peri-implant signs of inflammation
RBL following initial healing (>2mm after 1year of prosthesis delivery)
Increased PD vs. initial delivery of prosthesis
in the absence of pervious radiographs - RBL _>_3mm w/ BOP and PD _>_6mm
Can Stage improve after initial assignment?
NO - not even after improvement post-therapy!
What defines a hopeless tooth?
Kornman 2020 - Guest editorial (Clarification article)
Hopeless tooth AKA “Irrational to treat”
Teeth which the attachment loss approximates the root WITH a high degree of hypermobility (Grade III)
What is a periodontal abscess?
a localized accumulation of pus located within the gingival wall of the periodontal pocket, with an expressed periodontal breakdown occurring during a limited period of time, and with easily detectable clinical symptoms
