Periodontal disease classification and epidemiology

Question 1

What are the different types of classification systems

Answer 1

• Simple ‘basic’ classification
• ‘Old’ classification (1999)
• ‘New’ Chicago classification (2017)
• Updated in 2018

Question 2

Describe the simple ‘basic’ classification

Answer 2

• Gingivitis:
  o Reversible, redness, swelling, bleeding
  o Different types of gingivitis
• Periodontitis:
  o Irreversible, loss of attachment, pocket formation, bone loss
  o Different types of periodontitis

Question 3

Describe the ‘old’ classification (1999)

Answer 3

• Classified gingival diseases
• Classified periodontitis into chronic and aggressive
• Included lots of ‘other’ categories

Question 4

Describe the ‘new’ Chicago classification (2017)

Answer 4

• Included updated knowledge
• Acknowledged what we don’t already know→future proofing the system
• Defined what ‘health’ was on an intact and reduced periodontium

Question 5

What are the 2 sections of Periodontal Diseases and Conditions

Answer 5

Section 1 - Periodontal health, gingival diseases and conditions
Section 2 - Periodontitis

Question 6

Describe Part 1 (Periodontal health and gingival health) in Section 1

Answer 6

An intact periodontium and a reduced and stable periodontium:
- Less than 10% bleeding sites with probing depths of 3mm or less
- May have one or two sites of clinical gingiva inflammation

Question 7

Describe Part 2 (Dental biofilm induced gingivitis) in Section 1

Answer 7

• Associated with the biofilm alone
• Mediated by systemic or local risk factors
• Can be due to drug-influenced gingival enlargement
• False gingival pocket – ‘up to 5mm deep, with the base of the pocket at the cementoenamel junction, with no bone or attachment loss’

Question 8

What are some systemic risk factors

Answer 8

• Puberty associated
• Pregnancy associated
• Diabetes associated gingivitis
• Menstrual cycle associated

Question 9

What are some local risk factors

Answer 9

• Lack of saliva
• Tooth anatomical factors
• Dental restorations, appliances, retainers, etc

Question 10

What are some drugs used that can influence gingival enlargement

Answer 10

• Phenytonin (for epilepsy)
• Ciclosporin (for organ transplants)
• Calcium channel blockers (diltiazem)
• Oral contraceptives

Question 11

Describe Part 3 (Gingival diseases that are non-dental biofilm induced) in Section 1

Answer 11

• Genetic or developmental disorders
• Inflammatory and immune conditions
• Reactive processes
• Specific infections
• Traumatic

Question 12

Describe Section 2 (Periodontitis)

Answer 12

• 1994: Adult, early onset, and necrotising ulcerative
• 1999: Chronic, aggressive, necrotising periodontal diseases

Question 13

What is the issue with the old classifications

Answer 13

Lack of clarity between categories, diagnostic imprecision and implementation difficulties

Question 14

Describe Part 1 (Necrotising periodontal diseases) in Section 2

Answer 14

Characterised by 3 typical clinical factors:
- Papilla necrosis
- Bleeding
- Pain

Question 15

Describe Part 2 (Periodontitis as a manifestation of a systemic disease) in Section 2

Answer 15

Periodontitis that occurs pre-pubertally is mostly a manifestation of systemic conditions:
- Neutropenia
- Down syndrome

Question 16

Describe Part 3 (Periodontitis) in Section 2

Answer 16

Classification occurs by staging and grading:
1. Extent and distribution
2. Stage - extent of clinical attachment loss or bone loss
3. Grades - indicates rate of progression and responsiveness to standard therapy

Question 17

Describe staging

Answer 17

1. Mild – less than 15% (or less than 2 mm attachment loss from the CEJ)
2. Moderate – bone loss within the coronal third of the root
3. Severe – bone loss within the mid third of the root
4. Very severe – bone loss within the apical third of the root

Question 18

When grading, when is something assigned A, B or C

Answer 18

A - If the maximum amount of radiographic bone loss in % is less than half the patients age in years
B - Default and otherwise
C - If the percentage exceeds the patients age

Question 19

What stages are used when formulating a diagnosis

Answer 19

-Grade
- Risk Factors
- Extent
- Disease
- Stage
- Stability

Question 20

Where is clinical attachment loss measured from

Answer 20

From the CEJ to the base of the pocket

Question 21

Where is true pocket depth measured from

Answer 21

From the gingival margin to the base of the pocket.

Question 22

Where is recession measured

Answer 22

From the cementoenamel junction to the gingival margin

Question 23

What are attributes of periodontitis

Answer 23

• Vertical and horizontal bone loss
• Incisor drifting
• Pus
• Calculus and staining
• Recession and fibrotic gingiva

Question 24

What are other periodontal categories for the classification

Answer 24

• Periodontal abscesses
• Local factors
• Traumatic occlusal forces

Question 25

What is periodontal epidemiology

Answer 25

The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.

Question 26

Give some examples of periodontal epidemiology

Answer 26

• Descriptive
• Analytical
• Cross-sectional
• Longitudinal

Question 27

What is the distribution of periodontal disease (from 2019)

Answer 27

• 5622 adults: CPITN based methodology
• 17% periodontally healthy
• 54% had bleeding