Periodontitis

Question 1

Clinical features of chronic periodontitis

Answer 1

Widespread periodontal damage, redness, swelling (not always present) BOP, amount of plaque compatible with destruction
Associated with variable microbial pattern and local predisposing factors
SubG calculus

Question 2

Progression rate of untreated periodontitis

Answer 2

0.2 mm per year

Question 3

Chronic periodontitis extent and severity

Answer 3

Local if 30% sites affected and general if more than 30%
Slight 1-2 mm CAL
Moderate 3-4 mm
Severe 5 mm or more

Question 4

Aggressive periodontitis general characteristics

Answer 4

Rapidly progressing in otherwise healthy individual
Absence of large amount of plaque
Altered immunoinflammatory response
Fam Hx of aggressive disease suggestive of genetic trait

Question 5

Aggressive periodontitis non-universal features (6)

Answer 5

Hyper-responsive macrophages producing increased prostaglandins E2 and IL-1 B
Can be self arresting disease
Infected with A. Actinomycetemcomitans (green complex)
Abnormal phagocyte function
Neutrophil defective chemotaxis
Increased production of superoxide anion by neutrophils

Question 6

Clinical signs of Aggressive Periodontitis

Answer 6

Inflammation but not as much as chronic
Plaque may not be compatible with destruction
Histology same as chronic
Deep pockets 6 mm commonly present

Question 7

Localized Periodontitis

Answer 7

Circumpubertal onset
Robust serum antibody to infecting agents
Localized first molar and or incisors: proximal attachment loss on at least 2 permanent teeth and one of which is molar

Question 8

Generalized

Answer 8

30 or older
Poor serum antibody to infection
Episodic destruction
Inter proximal attachment loss 3 permanent teeth other 1st molar and incisors

Question 9

Microbiology of aggressive periodontitis

Answer 9

5 serotypes
Endotoxin
Leukotoxin (forms pores in neutrophil granulocytes, monocytes and lymphocytes, which die due to osmotic pressure)
Significant role in pathogenicity
Collagenase
Protease (cleaves IgG)

Question 10

Tx for aggressive periodontitis

Answer 10

Used to be 1g TTC but 25% didn’t respond
Metronidazole 400 mg or amoxicillin 500 mg

Question 11

Drugs for A.P

Answer 11

Metronidazole and amoxicillin for 7 days - localized/generalized A.P. Mixed infection from a.a + gram negative anaerobes

Metronidazole and ciproflaxcin for 7 days - instead of amoxicillin if allergic to penicillin

Question 12

Histology of chronic and aggressive periodontitis (7)

Answer 12

Acute inflammatory changes (vasculitis) in response to microbial invasion
Influx of neutrophils toward microbial components of subg biofilms
Detachment of JE with conversion to pocket epithelium
Inflammatory destruction of CT adjacent to JE
Accumulation of chronic inflammatory cells
Apical migration of epithelium onto root surface
Osteoclast resorbs the alveolar bone

Question 13

Revision to classification system

Answer 13

Reduction in gingival disease taxonomy + added extent and severity
Mild - minor change in colour
Moderate - glazing, redness, oedema, BOP and enlargement
Severe - overt redness, oedema, bleeding on touching

Question 14

Case definition

Answer 14

Interdental CAL detectable at >2 non-adjacent teeth
Or buccal/lingual cal >3 with pocketing >3 is detectable at >2 teeth

Question 15

Necrotizing periodontitis

Answer 15

Inflammatory process characterized by a prominent bacterial invasion and ulceration of epithelium with inter proximal necrosis and ulceration, pain and bleeding

Question 16

Necrotizing gingivitis

Answer 16

Lesions involving only gingival tissue and no loss of periodontal attachment

Question 17

Necrotizing periodontitis

Answer 17

Central necrosis of papillae may result considerable destruction leading to attachment loss

Question 18

Necrotizing stomatitis

Answer 18

Ulceration extending >1 cm from gingival margin, including tissue beyond MGJ

Question 19

Mucogingival deformity gingival recession

Answer 19

Inter proximal loss of clinical attachment
Periodontal phenotype
Assessment of exposed root and CEJ

Question 20

Good prognosis

Answer 20

Tx highly recommended
Teeth with no attachment loss, no furcation, no pulpal, no PA involvement

Question 21

Fair prognosis

Answer 21

For bridge abutment
Attachment loss <25%
Class I and class II Furcation
Tooth can be maintained

Question 22

Poor prognosis

Answer 22

Risk of teeth loss despite tx
Surgical correction improve px
Bone loss 50%
Class I and II furcation
Tooth can be maintained to some degree
Anatomical features make maintenance more difficult

Question 23

Questionable px

Answer 23

Tooth loss is inevitable
Greater than 50% attachment loss, poor crown to root ratio, class II or III furcation
Grade 2 or more mobility
Significant root proximity

Question 24

Hopeless prognosis

Answer 24

Grade III or IV furcation
Extraction advised initial therapy
Bone loss 80%
Grade 3 mobility
Severe root fluting, vertical root fracture
Tooth can’t be maintained

Question 25

Severe perio

Answer 25

CAL >2 interproximal sites with CAL >6 mm and >1 interproximal site with PD >5mm

Question 26

Moderate perio

Answer 26

> 2 interproximal sites with CAL >4 mm or >2 interproximal sites with PD > 5 mm

Question 27

Acute periodontal lesions characterized by

Answer 27

Pain, tissue destruction and infection

Question 28

Bacteria associated with NUG

Answer 28

Fusiform bacilli
Medium sized spirochetes
P intermedia
Treponema
Selenomonas