Periodontitis (Staging and Grading) Exam 5 Flashcards
What are the three components for defining a periodontitis case?
- Identification of a patient as a perio case
- Identification of the specific form of periodontitis
- Description of the clinical presentations- elements affecting clinical management and prognosis, broader influences on both oral and systemic health.
What are the stages of periodontitis?
- Stage i: initial
- ii: Mod
- iii: Severe: may have additional tooth loss
- iv: Severe: loss of dentition
Based on severity and complexity managment
Extend and Distribution is based on what?
Localized , Generalized and molar-incisor
What are the Grades of Periodontitis?
Grade A- slow rate
B- Mod rate
C- rapid rate
evidence or risk of rapid progression, anticipated treatment response
Defining a perio case differes based on what ?
- Age of the patient
- Lesion number
- Distribution
- Severity
- Location within the dental arch
- Level of oral biofilm contamination
Staging is determined at presentation of three elements what are they?
Severity
Complexity of management
Extent and distribution
what is the meaning of changes in severity?
Loss of worse affected tooth= decrease severity
Severity at slight cal measurement ?
1-2mm
Severity at moderate cal measurement ?
3-4mm
Severity at severe cal measurement ?
greater than or equal to 5mm
What are the measurement for radiographic bone loss (RBL) for severity?
Coronal 3rd- <15%
Coronal 3rd - 15%-33%
Middle 3rd and beyond - >33%
What is the amount for tooth loss during the each stage?
- None
- Less than or equal to 4
- More than or equal to 5
What is the severity destruction levels?
Slight (Mild)
No more than 1 to 2 mm of attachment loss
Moderate
3 to 4 mm of attachment loss
Class I or II furcation involvement
Tooth mobility
Severe
Major loss of bone support > 30%
5 mm or more of attachment loss
Class III furcation involvement
What is the staging complexity management for local factors?
Important
- Probing depths
- Type of bone loss (vertical and/or horizontal)
- Furcation status
- Tooth mobility
- Missing teeth
- Bite collapse
- Ridge defect size
What are the three patterns ?
- Localized
Few sites demonstrate attachment and bone loss 30% or less - Generalized
Many sites affected
>30% - Molar-incisor
Extend and distrubution is based on what?
- Extent: Different degrees or amounts of destruction
- Distrubtion: Based on number of teeth with tissue destruction
What are the three set parameters?
1) rate of periodontitis progression;
2) recognized risk factors for periodontitis progression;
3) risk of an individual’s case affecting the systemic health
What is the rate of disease progression?
- Change or advancement of destruction as compared from previous visit
- Slow rate of progression: May be modified by systemic/environmental/ factors
- Current view
1. Destruction not continuous
1. Occurs in short bursts with destruction
1. Random occurrence over time
1. Random sites in mouth
What is increased disease progression ?
- Rapid progressive lesions
* Interproximal areas
* Areas of greater plaque accumulation
* Areas inaccessible to plaque control
*. Furcations
* Overhangs
* Malposed teeth
* Areas of food impaction - U nequal rate of progression of affected sites
What are the predictors or disease progression?
- Previous history of periodontitis (risk determinant)
- Greater risk for progressive disease
If not successfully treated
Plaque allowed to accumulate in a treated patient - Importance of monitoring and maintenance
What are the primary Criteria for grading?
- Direct evidence of progression
- Indirect evident of progression
What are some grading modifiers?
- risk factors like smoking diabetes
What are the causes of periodontitis ?
- Pathogenic bacteria
- Destruction consistent with local factors
- Oneset and severity determined by: plaque biofilm, host immune response interaction and evironment
What are the symptoms of periodontitis?
▪ Red or swollen gingiva
▪ Bleeding during brushing
▪ Bad taste
▪ Persistent bad breath
▪ Sensitive teeth
▪ Loose teeth
▪ Purulence
* Usually painless
* mimics odontogenic pain
* Gingival tenderness or itching
* Pain associated with food impaction
Periodontitis affect deep tissues of?
the periodontium
True or False
Appearance of gingival tissues is not a reliable
indicator of the presence or severity of periodontitis
True
What are the clinical appearance of gingival tissue
▪ Evident Clinical Signs
▪ Bright red to purple tissue
▪ Minimal Signs
▪ Pale pink
▪ Often mistaken for health
▪ Fibrotic
▪ Pocketing
What are some clinical features?
▪ Tissue enlargement
▪ Tissue redness
▪ Bleeding on probing
▪ Periodontal pockets
▪ Loss of stippling
▪ Fibrotic tissue
▪ Exudate / suppuration
▪ Subgingival calculus
▪ Flat or cratered papilla
▪ Blunted or rolled gingival margins
▪ Tooth mobility in advanced cases
▪ Alveolar and supporting bone destruction
What are the variables of inflammation?
- Localized
One site/one tooth
Several sites/one tooth
Several teeth - Generalized
Entire dentition
What is of horizontal bone loss?
- Most prevalent bone loss presentation
- Can occur in individuals of any age
▪ Most common in adults >30
▪ Old Names
Chronic Adult Periodontitis
Chronic Periodontitis
COMPLEXITY: VERTICAL BONE LOSS
EXTENT: MOLAR-INCISOR PATTERN
▪ Less common than horizontal
▪ Old Names
Early Onset Periodontitis (1989)
Included prepubertal periodontitis, juvenile periodontitis and rapidly progressive
periodontitis
Aggressive Periodontitis (1999)
What are the three overlapping issues for complexity- vertical bone loss?
- Time
- Place (Topographic location)
- Person (Age, gender and race)
What are the general characteristics for complexity- vertical bone loss?
- *No obvious signs/ symptoms of systemicdisease
- Rapid destruction of attachment
- Rapid loss of supporting bone High risk for tooth loss
- Affected tissue may have normal
- appearance
- Periodontal pockets
- Small amount of plaque
- Severity not consistent with amount of plaque
- Immune deficiencies
- Genetic links possible contributing factors
- Presentation with age (puberity to < 30)
- Gender affiliation
- Inflammatory/immune response
- maybe self arresting
What are the clinical features for complexity- vertical bone loss during the FIRST PRESENTATION?
- Characteristic distribution of lesions
1st molar and incisors - Inter proximal attachment loss on at least two permanent teeth
One of which is a 1st molar
Involving no more than two teeth other than first molars and incisors
What are the clinical features for complexity- vertical bone loss during the SECOND PRESENTATION?
Characteristic distribution of lesions
Most teeth
Generalized interproximal attachment loss
Affecting at least 3 permanent teeth
Other than 1st molars and incisors
What are the clinical features for vertical bone loss with molar incisor patterns?
Lack of clinical inflammation despite deep periodontal pockets
What is vertical bone loss extent: molar incisor pattern disease progression ?
- Rapid progression
- 3-4x faster than horizontal bone loss development
- **Diastema formation **
- Increase mobility of 1st molars
- Periodontal abscesses
- Pain
What are the microbiological factors for Complexity: Vertical bone loss with molar incisor pattern ?
- A. actinomycetemcomitans- primary pathogen
- Red complex bacteria involvemnet: P. gingivalis, T. Forsythia
- Other bacteria include: P. Intermedia, E. Corrodens, C. Rectus, Capnocytophaga species
- Amount of plaque minimal
- Inconsistent with amount of destruction
- Rarely forms calculus
What are the radiographic findings for vertical bone loss- molar incisor pattern ?
- vertical bone loss (1st molar and incisors)
- arc shaped bone loss
How to define a periodontitis case?
Clinically:
* interdental CAl is detectable at Greater or equal to 2
* Buccal/ lingual CAL is 3 or greater with pocketing > 3 is detectable but cannot be non-perio because of other factors.
What are some causes that can make a case non-periodontitis-related?
- recession due to trauma
- Caries within the cervical 3rd
- CAL on the distal of a second molar and associated with malpositon/extraction of thirds
- An endodontic lesion draining through the marginal periodontium
- Occurrece of a vertical root fracture
