Periodontal disease classification and epidemiology Flashcards
What are the different types of classification systems
- Simple ‘basic’ classification
- ‘Old’ classification (1999)
- ‘New’ Chicago classification (2017)
- Updated in 2018
Describe the simple ‘basic’ classification
- 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
Describe the ‘old’ classification (1999)
- Classified gingival diseases
- Classified periodontitis into chronic and aggressive
- Included lots of ‘other’ categories
Describe the ‘new’ Chicago classification (2017)
- Included updated knowledge
- Acknowledged what we don’t already know→future proofing the system
- Defined what ‘health’ was on an intact and reduced periodontium
What are the 2 sections of Periodontal Diseases and Conditions
Section 1 - Periodontal health, gingival diseases and conditions
Section 2 - Periodontitis
Describe Part 1 (Periodontal health and gingival health) in Section 1
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
Describe Part 2 (Dental biofilm induced gingivitis) in Section 1
- 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’
What are some systemic risk factors
- Puberty associated
- Pregnancy associated
- Diabetes associated gingivitis
- Menstrual cycle associated
What are some local risk factors
- Lack of saliva
- Tooth anatomical factors
- Dental restorations, appliances, retainers, etc
What are some drugs used that can influence gingival enlargement
- Phenytonin (for epilepsy)
- Ciclosporin (for organ transplants)
- Calcium channel blockers (diltiazem)
- Oral contraceptives
Describe Part 3 (Gingival diseases that are non-dental biofilm induced) in Section 1
- Genetic or developmental disorders
- Inflammatory and immune conditions
- Reactive processes
- Specific infections
- Traumatic
Describe Section 2 (Periodontitis)
- 1994: Adult, early onset, and necrotising ulcerative
- 1999: Chronic, aggressive, necrotising periodontal diseases
What is the issue with the old classifications
Lack of clarity between categories, diagnostic imprecision and implementation difficulties
Describe Part 1 (Necrotising periodontal diseases) in Section 2
Characterised by 3 typical clinical factors:
- Papilla necrosis
- Bleeding
- Pain
Describe Part 2 (Periodontitis as a manifestation of a systemic disease) in Section 2
Periodontitis that occurs pre-pubertally is mostly a manifestation of systemic conditions:
- Neutropenia
- Down syndrome
Describe Part 3 (Periodontitis) in Section 2
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
Describe staging
- Mild – less than 15% (or less than 2 mm attachment loss from the CEJ)
- Moderate – bone loss within the coronal third of the root
- Severe – bone loss within the mid third of the root
- Very severe – bone loss within the apical third of the root
When grading, when is something assigned A, B or C
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
What stages are used when formulating a diagnosis
-Grade
- Risk Factors
- Extent
- Disease
- Stage
- Stability
Where is clinical attachment loss measured from
From the CEJ to the base of the pocket
Where is true pocket depth measured from
From the gingival margin to the base of the pocket.
Where is recession measured
From the cementoenamel junction to the gingival margin
What are attributes of periodontitis
- Vertical and horizontal bone loss
- Incisor drifting
- Pus
- Calculus and staining
- Recession and fibrotic gingiva
What are other periodontal categories for the classification
- Periodontal abscesses
- Local factors
- Traumatic occlusal forces
What is periodontal epidemiology
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.
Give some examples of periodontal epidemiology
- Descriptive
- Analytical
- Cross-sectional
- Longitudinal
What is the distribution of periodontal disease (from 2019)
- 5622 adults: CPITN based methodology
- 17% periodontally healthy
- 54% had bleeding
