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Perio 1 > Staging and Grading > Flashcards

Staging and Grading Flashcards

1
Q

What is the primary cause of tooth loss in the US population over the age of 30?
A. Caries
B. Periodontitis
C. Contact sports
D. Papillon Lefevre Syndrome

A

B. Periodontitis

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2
Q

What is the gold standard of periodontitis disease progression staging (armitage 1999)?

A

Severity of disease based upon Clinical Attachment Level (Gold Standard)
* Slight: 1-2 mm
* Moderate: 3-4 mm
* Severe: ≥ 5mm

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3
Q

Why did we change from the gold standard of periodontitis staging?

A
  • Few practitioners use clinical attachment level (CAL) routinely
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4
Q

AAP formed a Task Force in 2015 to identify alternative criteria including

A
  • Radiographic Bone Loss (RBL)
  • Probing Depth (PD)

However, a 6 mm probing depth with 20% bone loss is significantly different that 6 mm with 75% bone loss

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5
Q

What was changed from the 2015 task force versus the 2017 workshop in terms of periodontal grading?

A

Probing depth not considered diagnostic
* Inflammation has effect on penetration of probe into tissue
* Inflammation (swelling) may move gingival margin coronally (pseudopocket)

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6
Q

What were the recommendations of the 2017 workshop for periodontal staging?

A
  • Use Interproximal Attachment Loss (2 or more non-adjacent teeth)
  • Use probing depth as a ‘complexity’ factor (difficulty of treatment)
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7
Q

What is the 2017 classification of periodontal and peri-implant disease and conditions?

A

New classification based on strongest current evidence
* Adaptive System-3 dimensional
— Severity/Extent (number of teeth affected rather than sites)
— Prognosis (affects no teeth, up to 4 teeth, 5 or more teeth)
— Progression (Grading)

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8
Q

What is the adaptive system (3 dimensional) that the 2017 workshop came up with?

(3)

A

— Severity/Extent (number of teeth affected rather than sites)
— Prognosis (affects no teeth, up to 4 teeth, 5 or more teeth)
— Progression (Grading)

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9
Q

What was the rationale for change from the 2017 AAP classification?

A
  • Recognize and monitor systemic influences INFLOWING to Periodontal Disease such as Smoking and Diabetes
  • Control Inflammatory and Microbial influences from Periodontal Disease OUTFLOWING to systemic targets to decrease the co-morbid effect of the periodontal disease
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10
Q

What are the different periodontal disease and peri-implant disease conditions as of 2017?

A
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11
Q

What are the different sections of periodontal health and gingival diseases?

A
  • periodontal gingival health
  • gingivitis caused by biofilm (bacteria)
  • gingivitis not caused by biofilm
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12
Q

What are the different sections of periodontitis?

A
  • necrotizing diseases
  • periodontitis as a manifestation of systemic diseases
  • periodontitis
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13
Q

What are the different sections of other conditions affecting the periodontium?

A
  • systemic diseases
  • periodontal abscess or endodontic lesions
  • mucogingival deformities and conditions
  • traumatic occlusal forces
  • tooth and prosthesis related factors
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14
Q

What did the NHANES study in 2009-2014 find?

10,683 dentate subjects 30 years or older

A
  • 7.8% severe
  • 34.4% non-severe
  • Prevalence of non-severe and total increased with age
  • Greatest amongst men (50.2%), Mexican Americans (59.7%), adults below 100% of Federal poverty level (60.4%), current smokers (62.4%) and self reported diabetes (59.9%)
  • Prevalence of total disease highest in those who did not use dental floss or visit dentist regularly
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15
Q

Centers for Disease Control and Prevention-approximately ____% of adults >30 years old have periodontitis and this is the primary cause of tooth loss in adults.

A

47%

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16
Q

What are the goals of the new system of staging and grading?

A
  • Easy to use
  • Should promote better communication (?) with
    — Patient
    — Referring dentists, hygienists
    — Other health care professionals
  • Identify response to treatment
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17
Q

What are the three steps to staging and grading a patient?

A
  1. initial case overview to assess disease
  2. establish stage
  3. establish grade
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18
Q

Every patient categorized based on the _______ periodontal site and specific factors that may impact long term management

A

worst

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19
Q

Staging is divided into…

A
  • Severity
  • Complexity
  • Extent and distribution
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20
Q

____________ (1-4) based upon severity of disease and complexity of case management

A

“Staging”

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21
Q

What does staging consider?

A
  • Clinical attachment loss (CAL)-using worst site
  • Amount and % of bone loss
  • Probing depth
  • Presence/extent of ridge defects and furcation involvement
  • Tooth mobility
  • Tooth loss (due to periodontitis if known)
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22
Q

What are the four stages of periodontal disease?

A
  • Stage 1 (Initial)
  • Stage 2 (moderate)
  • Stage 3 (severe with potential for additional tooth loss)
  • Stage 4 (severe with potential for loss of dentition)
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23
Q

What are the criteria for defining periodontitis?

A
  • Interdental Clinical Attachment Loss at 2 or more non-adjacent teeth
    OR
  • Buccal or Oral Clinical Attachment Loss ≥ 3 mm
  • with pocketing >3mm
  • on 2 or more teeth
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24
Q

What is the interproximal CAL of stage I in mm?

slight (old definition)

A

1-2 mm

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25
Q

What is the interproximal CAL of stage II in mm?

moderate (old definition)

A

3-4 mm

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26
Q

What is the interproximal CAL of stage III in mm?

severe (old definition)

A

greater than or equal to 5 mm

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27
Q

What is the interproximal CAL of stage IV in mm?

very severe (old definition)

A

greater than or equal to 5 mm

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28
Q

The problem with CAL (clinical attachment loss) could be due to non-periodontal problems such as…

A
  • Gingival recession due to trauma (toothbrush trauma/toothpaste abrasion)
  • Dental caries extending to or below the gingival margin
  • Defect on distal of 2nd molars caused by malposition or extraction of a 3rd molar
  • Endodontic lesion draining through marginal periodontium
  • Vertical root fracture (usually isolated deep probing depth)
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29
Q

What are complexity problems that affect periodontitis?

A
  • Takes into account overall probing depths
  • Evaluates radiographic bone loss, horizontal and vertical
  • Evaluates furcation involvements, number of missing teeth, function
30
Q

What are the complexity factors that do with stage I?

A
  • Max probing depth ≤ 4 mm
  • Mostly horizontal bone loss
31
Q

What are the complexity factors that do with stage II?

A
  • Max probing depth ≤ 5 mm
  • Mostly horizontal bone loss
32
Q

What are the complexity factors that do with stage III?

A

In addition to Stage II complexity
* Probing depths ≥ 6mm
* Vertical bone loss ≥ 3mm
* Class II or III Furcation Involvements
* Moderate ridge defects

33
Q

What are the complexity factors that do with stage IV?

A

In addition to Stage III complexity
Need for complex rehabilitation due to
* Masticatory dysfunction
* Secondary Occlusal Trauma (≥ 2 mobility)
* Bite collapse, drifting, flaring
* <10 opposing pairs remaining teeth (<20 teeth total)
* Severe ridge defects

34
Q

What is the prognosis for stage I and II?

A

No tooth loss likely

35
Q

What is the prognosis for stage III?

A

Risk of tooth loss (up to 4)

36
Q

What is the prognosis for stage IV?

A

Risk of loss of arch or dentition (>5 teeth)

37
Q

What is stage 1?

A
  • Stage I (initial)
  • 1–2 mm clinical attachment loss (CAL), less than 15% bone loss (BL) around root, no tooth loss due to periodontal disease, probing depth (PD) 4 mm or less, mostly horizontal BL
38
Q

What is stage 2?

A
  • Stage II (moderate)
  • 3–4 mm CAL, 15%–33% BL, no tooth loss due to periodontal disease, PD 5 mm or less, mostly horizontal BL
39
Q

What is stage 3?

A
  • Stage III (severe with potential for additional tooth loss)
  • 5 mm or more CAL, BL beyond 33%, tooth loss of four teeth or less (due to periodontal disease), with complex issues such as PD 6 mm or more, vertical BL 3 mm or more, Class II–III furcations, and/or moderate ridge defects
40
Q

What is stage 4?

A
  • Stage IV (severe with potential for loss of dentition)
  • Encompasses all of Stage III with additional features that will require the need for complex rehabilitation due to masticatory dysfunction, secondary occlusal trauma, severe ridge defects, bite collapse, pathologic migration of teeth, less than 20 remaining teeth (10 opposing pairs)
41
Q

What stage are you with no tooth loss due to periodontitis?

A

stage I or II

42
Q

What stage are you with less than or equal to 4 teeth loss due to periodontitis?

43
Q

What stage are you with more than 5 teeth loss due to periodontitis?

44
Q

If there are any teeth lost due to periodontitis what is the automatic stage?

45
Q

Furcation involvement of Grade 2 or 3 automatically puts patient into Periodontitis Stage…

A

3 or 4 (Severe or Very Severe)

46
Q

How do they measure extend and distribution of periodontitis?

A

Concept is to know the percentage of teeth affected by periodontitis of ANY Stage
- localized
- generalized
- molar-incisor

47
Q

What is localized periodontitis?

A

Bone Loss involves less than 30% of teeth in mouth

48
Q

What is generalized periodontitis?

A

Bone Loss involves more than 30% of teeth in mouth

49
Q

What is molar-incisor periodontitis?

A

BL is found around molar (usually first) and anterior incisors

50
Q

Molar/Incisor pattern generally applies to ‘old’ classifications of

A
  • Localized Aggressive Periodontitis which was known before that as
  • Localized Juvenile Periodontitis
51
Q

What are the biological features considered for grading?

A

*RATE of disease progression
*Risk for further advancement
*Response to standard therapy
*Potential threats to general health (including smoking, diabetes)

52
Q

What are the different grades?

A
  • A: Low risk of progression
  • B: Moderate risk of progression
  • C: High risk of progression
53
Q

Initially assume Grade ____ then seek specific evidence to shift to others

54
Q

What are the primary criteria for grading?

A
  • direct evidence
  • indirect evidence
55
Q

What is the direct evidence for grading primary criteria?

A
  • historical radiographic bone loss or
  • clinical attachment loss
56
Q

What is the indirect evidence for grading primary criteria?

A
  • % bone loss/patient age
  • Case Phenotype (Soft tissue thickness, bone thickness)
  • Heavy plaque accumulation but minimal destruction vs. minimal plaque but major destruction
57
Q

No bone loss for over 5 years is Grade ____

58
Q

< 2mm bone loss over 5 years is Grade ____

59
Q

> 2mm bone loss over 5 years is Grade ____

60
Q

What is the % bone loss for age 30 for…
<0.25 slow
moderate 0.5
rapid > 1.0

A

7.5 %
15 %
30 %

61
Q

What is the % bone loss for age 40 for…
<0.25 slow
moderate 0.5
rapid > 1.0

62
Q

What is the % bone loss for age 50 for…
<0.25 slow
moderate 0.5
rapid > 1.0

A

12.5%
25%
50%

63
Q

What is the % bone loss for age 60 for…
<0.25 slow
moderate 0.5
rapid > 1.0

64
Q

What is the grade A when considering smoking and diabetes?

A

Slow rate
Nonsmoker, nondiabetic

65
Q

What is the grade B when considering smoking and diabetes?

A

Moderate rate
< 10 cigarettes/day
Diabetic with HbA1c <7%

66
Q

What is the grade C when considering smoking and diabetes?

A

Rapid rate
≥ 10 cigarettes/day
Diabetic with HbA1c ≥ 7%

67
Q

When considering Staging and Grading for
periodontitis, factors to consider include all EXCEPT
A. Smoking
B. Diabetes
C. Attachment level
D. Bleeding upon probing

A

D. Bleeding upon probing

68
Q

What is the new vocab for Chronic periodontitis, aggressive periodontitis →

A

Periodontitis

69
Q

What is the new vocab for Periodontal biotype →

A

Periodontal phenotype

70
Q

What is the new vocab for Excessive occlusal force →

A

Traumatic occlusal force

71
Q

What is the new vocab for Biologic width →

A

Supracrestal Attached Tissue

Perio 1 (13 decks)

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