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PERI 326 > Unit 4 - Diagnosis of Periodontal Diseases > Flashcards

Unit 4 - Diagnosis of Periodontal Diseases Flashcards

1
Q

What are three rationales for a diagnosis?

A
  • Communication with other health professionals
  • Medico-legal
  • Insurance reporting
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2
Q

What is a differential diagnosis?

A

The distinguishing between two or more diseases with similar symptoms by systematically comparing their signs and symptoms

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3
Q

What are the three parts of a periodontal exam?

A
  • Visual exam
  • Periodontal chart
  • Radiographic exam
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4
Q

What is the probing depths on an intact periodontium?

A

1-3 mm

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5
Q

Is there inflammation on an intact periodontium?

A

No

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6
Q

What is the percentage a mount of bleeding on probing that is still considered an intact periodontium?

A

Less than 10%

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7
Q

Is there any attachment loss on an intact periodontium?

A

No

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8
Q

Is there any attachment loss on a reduced periodontium?

A

Yes

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9
Q

What is the probing depths on a reduced periodontium?

A

1-3 mm

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10
Q

Is there inflammation on a reduced periodontium?

A

No

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11
Q

What is the percentage a mount of bleeding on probing that is still considered a reduced periodontium?

A

Less than 10%

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12
Q

What is the main difference between an intact and reduced periodontium?

A

Both are healthy, just reduced periodontium has attachment loss

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13
Q

What is it called when a patient had periodontitis but has successfully been treated?

A

Stable periodontitis patient

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14
Q

What is the recall time for a stable periodontitis patient? Why?

A

3-4 months, they are at continued risk of disease progression

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15
Q

What is it called when a patient has had no history of periodontitis but has attachment loss unrelated to inflammation?

A

Non-periodonitis patient

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16
Q

What are other reasons for attachment loss besides inflammation?

A

Tooth abrasion, crown-lengthening surgery, or orthodontic treatment

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17
Q

What is the recall time for a non-periodontitis patient? Why?

A

6 months, they are not at increased risk of peridontitis

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18
Q

What are the two types of periodontal health?

A
  • Intact periodontium
  • Reduced periodontium (stable and non-perio patients)
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19
Q

Is gingivitis that is associated with biofilm alone reversible? If so, how?

A
  • Yes
  • Removing biofilm
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20
Q

Is gingivitis that is associated with biofilm alone have any attachment loss?

A

No, gingiva is still attached to the CEJ

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21
Q

What is the probing depths of gingivitis that is associated with biofilm alone?

A

1-3 mm

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22
Q

What is the bleeding on probing for gingivitis that is associated with biofilm alone?

A

More than 10%

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23
Q

What are some signs of gingivitis that is associated with biofilm alone?

A

Inflammation, redness, edema, loss of stippling

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24
Q

What type of gingivitis is typical on teenagers?

A

Biofilm-indiced gingivitis on an intact peridontium

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25
Q

What are the signs of gingivitis on a radiograph?

A

None, everything appears healthy

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26
Q

What is the percentage of affected teeth of localized biofilm-induced gingivitis?

A

Less than 30% of teeth involved

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27
Q

What is the percentage of affected teeth of generalized biofilm-induced gingivitis?

A

More than 30% of teeth involved

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28
Q

What are the three degrees of inflammation of gingivitis?

A

Slight, moderate, and severe

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29
Q

Can a reduced periodontium be diagnosed within a single appointment? Why?

A
  • Must have longitudinal attachment measurements over 12 months to support diagnosis
  • If no BOP, can be having an episodic disease
  • BOP can’t be determine if it is just gingivitis or perio on first appointment
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30
Q

What are a few systemic risk factors of biofilm-induced gingivitis?

A
  • Smoking
  • Diabetes
  • Nutritional factors
  • Pharmacologic agents
  • Sex steroid hormones
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31
Q

What are a few localized risk factors of biofilm-induced gingivitis?

A
  • Xerostomia
  • local factors for plaque retention
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32
Q

What is the overgrowth of gingival tissue without a primary inflammatory etiology commonly caused by?

A

Can be drug induced gingival enlargement

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33
Q

Why is the probing depths of drug induced gingival enlargement increased?

A

Deep pockets are from overgrowth of gingiva, must check attachment loss to know if it is periodontal disease

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34
Q

What is the etiology of drug induced gingival enlargement?

A

Excessive production of collagen fibers by fibroblasts

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35
Q

What are three common medications that cause drug induced gingival enlargement increased?

A
  • Calcium channel blockers
  • Anti-convulsants
  • Cyclosporin A
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36
Q

What is an example of genetic/developmental disorders that cause non-biofilm related gingival disease?

A

Hereditary gingival fibrzomatosis

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37
Q

Can specific bacterial, viral, and fungal infections cause non-dental biofilm induced gingival disease?

A
  • Yes
  • If bacterial, it is not part of the regular dental biofilm
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38
Q

What are two autoimmune diseases that can cause non-biofilm induced gingival disease?

A
  • Pemphigus
  • Lichen planus
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39
Q

What is periodontitis?

A

Inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing

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40
Q

What was the old term for periodontitis?

A

Pyorrhea

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41
Q

What are three main clinical features of periodontitis?

A
  • Attachment loss
  • Increased probing depths
  • Radiographic bone loss
42
Q

What are two histological features of periodontitis?

A
  • Inflammatory changes
  • Periodontal attachment apical to the CEJ
43
Q

What is necrotizing periodontal disease?

A

Infection with necrosis of the gingival tissues

44
Q

What systemic conditions are most commonly associated with necrotizing periodontal disease?

A
  • HIV
  • Malnutrition
  • Immunosippression
45
Q

Histologically, what feature is present in necrotizing gingivitis?

A

Spriochetes

46
Q

What is necrotizing stomatitis?

A

More extensive destruction necrosis that goes beyond the mucogingival junction

47
Q

What are the main clinical symptoms that are used to diagnosis periodontist?

A
  • Interdental CAL detected at more than 2 non adjacent teeth
  • Buccal or lingual CAL more than 3 mm with 3 mm or greater pockets at 2 or more teeth
48
Q

What are a few examples of CAL from non-periodontist related causes?

A
  • Gingival recession of traumatic origin
  • Dental caries above the cervical area of the tooth
  • Endodontic lesion drainage
  • Vertical root fracture
49
Q

What is the interdental CAL in stage 1 perio?

A

1-2 mm

50
Q

What is the radiographic bone loss in stage 1 perio?

A
  • Less than 15%
  • Mostly horizontal
51
Q

What is the tooth loss in stage 1 perio?

A

No tooth loss due to periodontitis

52
Q

What is the probing depth in stage 1 perio?

A

Less than 4 mm

53
Q

What is the interdental CAL in stage 2 perio?

A

3-4 mm

54
Q

What is the radiographic bone loss in stage 2 perio?

A
  • 15% to 33%
  • Mostly horizontal
55
Q

What is the tooth loss in stage 2 perio?

A

No tooth loss due to periodontitis

56
Q

What is the probing depth of stage 2 perio?

A

Less than 5 mm

57
Q

What is the interdental CAL of stage 3 perio?

A

5 mm or more

58
Q

What is the radiographic bone loss in stage 3 perio?

A
  • 33% or more
  • Horizontal
  • Vertical less than 3 mm
59
Q

What is the tooth loss of stage 3 perio?

A

Up to 4 teeth lost due to periodontitis

60
Q

What is the probing depth of stage 3 perio?

A

6 mm or more

61
Q

What is the furcation involvement of stage 3 perio?

A

Class 2 or 3

62
Q

What features does stage 4 perio have?

A

All the same as stage 3 with features that require the need for complex rehabilitation

63
Q

What are some of the additional features in stage 4 perio?

A
  • Masticatory dysfunction/less than 10 opposing pairs of teeth
  • Secondary occlusal trauma
  • Bite collapse
64
Q

How many stages of perio can a patient have?

A

Only one, use the worst stage presented in the mouth

65
Q

What is the purpose of periodontal grading?

A

Estimate the rate of progression and future responsiveness to treatment

66
Q

What grade should you assume until clinical or medical history provides more evidence of slower/faster progression?

A

Grade B

67
Q

What is the direct evidence of Grade A perio?

A

No radiographic bone loss or clinical attachment loss over the past 5 years

68
Q

What is the indirect evidence of Grade A perio?

A
  • 0.25 bone loss
  • Heavy biofilm but no/minimal periodontal destruction
69
Q

What are the grade modifiers of Grade A perio?

A
  • No smoking
  • No diabetes
70
Q

What is the direct evidence of Grade B perio?

A

2 mm or less of radiographic bone loss or clinical attachment loss over the past 5 years

71
Q

What is the indirect evidence of Grade B perio?

A
  • 0.25 to 1.0 bone loss
  • Biofilm proportionate with periodontal destruction
72
Q

What are the grade modifiers of Grade B perio?

A
  • Less than 10 cigs a day
  • Controlled diabetes, A1C is less than 7%
73
Q

What is the direct evidence of Grade C perio?

A

2 mm or more of radiographic bone loss or clinical attachment loss over the past 5 years

74
Q

What is the indirect evidence of Grade C perio?

A
  • Greater than 1.0 bone loss
  • Destruction exceeds expectation given biofilm deposits
75
Q

What are the grade modifiers of Grade C perio?

A
  • More than 10 cigs a day
  • Uncontrolled diabetes, A1C is more than 7%
76
Q

What is the definition of localized periodontitis?

A

Less than 30% of teeth are involved

77
Q

What is the definition of generalized periodontitis?

A

More than 30% of teeth are involved

78
Q

What is the molar/incisor pattern of periodontitis?

A

Only some molars and incisors are involved

79
Q

How do you report your final diagnosis?

A

Stage (worst stage) Periodontitis, Extent of worst stage, Grade (worst grade)

80
Q

What is a localized purulent infection involving the marginal or interdental gingiva?

A

Gingival abscess

81
Q

What is a localized purulent infection within the tissues of adjacent to the periodontal pocket that may lead to destruction of periodontal ligament and alveolar bone?

A

Periodontal abscess

82
Q

Does a periodontal abscess go to the apex of the tooth root?

A

No

83
Q

What is a localized, circumscribed area of infection involving both the periodontal and/or pulpal tissue?

A

Endo-perio lesions

84
Q

What is an endo-perio lesion that has a primary endodontic origin?

A

Lesion is extending coronally into periodontal tissue and the oral cavity

85
Q

What is an endo-perio lesion that has a primary periodontal origin?

A

Lesion communicating through accessory canal or the apical foramen to secondarily infect the pulp

86
Q

What are mucogingival deformities?

A

Deviations from the normal anatomic relationship between the gingival margin and the mucogingival junction

87
Q

What gingival phenotype is triangular shaped and delicate?

A

Thin scalloped gingiva

88
Q

What gingival phenotype is square shaped, has a large inter proximal contact, and has thick gingiva?

A

Thick flat gingiva

89
Q

What gingival phenotype is thick, has a narrow zone of keratinized gingiva, and is rounded?

A

Thick scalloped gingiva

90
Q

What is class 1 recession?

A

Gingival recession with no loss of inter proximal attachment

91
Q

What is class 2 recession?

A

Interproximal attachment loss less than or equal to the buccal site

92
Q

What is class 3 recession?

A

Interproximal attachment loss more than the buccal site

93
Q

What are some features of lack of attached gingiva (a mucogingival deformity)?

A
  • Narrowest on the buccal of mandibular premolars
  • Not really keratinized, pay attention if keratinized attached gingiva is less than 2 mm
94
Q

What is primary occlusal trauma?

A

Injury from excessive occlusal forces applied to normal healthy periodontium

95
Q

What is secondary occlusal trauma?

A

Injury from normal or excessive forces on a reduced periodontium

96
Q

What are some signs of occlusal trauma?

A
  • Mobility
  • Fremitus
  • Migration of teeth
  • Widened PDL
97
Q

What is peri-implant health defined as?

A
  • No inflammation
  • No bone loss
98
Q

What is peri-implant mucositis defined as?

A
  • Gingival inflammation around implant
  • No bone loss
99
Q

What is the same thing as gingivitis around an implant?

A

Mucositis

100
Q

What is peri-implant soft and hard tissue deficiencies?

A

No active inflammation, just bone loss

PERI 326 (4 decks)

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