W1: Classifying PD

Question 1

What do you see in PD?

Answer 1

Destruction of periodontitis

Question 2

What is diff btw old vs new system of classification?

Answer 2

Old: terms: mild, mod, severe, forms of
New: biggest change is PD is staged and graded

Question 3

What are forms of PD?

Answer 3

Question 4

How many stages/grade of PD are there

Answer 4

4 stage,
grade ABC
extent/dist

Question 5

What are the stages of PD? and Why were they put in place?

Answer 5

• higher= worse 1 is better than 4 (staging lets us know how bad PD, extent of ‘death’ of teeth.

◦ Classify Severity and Extent of an individual based on
currently measurable extent of destroyed and damaged
tissue attributable to periodontitis
◦ Assess Complexity. Assess specific factors that may
determine complexity of controlling current disease and
managing long-term function and aesthetics of the
patient’s dentition

Question 6

Stage 1

Answer 6

Gingival inflammation
- Mx: get pt educated abt OH (important)

Question 7

Stage 2 PD

Answer 7

Est. PD. periodontium destroyed.
Mx: non surgical still simple, make sure pt got good OH, right tools, goal is to STOP or stabilise disease
Tx: deep clean, ongoing monitor

Question 8

Stage 3

Answer 8

quite bad
PD sig. damage to periodontium
- tooth loss if you dont get specialist deep cleans
- huge pockets down to mid roots
- Mx complicated bc bony defects
- probs surg. intervention needed
- tooth loss not as bad as stage 4

Question 9

Describe stage 4 periodontitis and how management may be different from stage 3:

Answer 9

• ## lots of infection, Bone loss

Question 10

How us extent described? In what percentage?

Answer 10

-local: less than 30%
- gen: more than 30%

Question 11

Diff btw LOA and CAL

Answer 11

• start with looking at base of pocket to CEJ: ho much PD tissue has occured (lig, fibres, relocation of junction)

Question 12

Why must we feel for CEJ?

Answer 12

It’s not always visible you might have false readings from pseudopockets. so practice loctaing it. When measuring CAL- CEJ is crucial.

• surg tx, flap raised
• bone loss heaps
• CEJ looks high up
  CAL : IP/CEJ to depth of pocket
• look or feel for CEJ

good knowing this can help m. CAL
- CEJ is static, it won’t move

Question 13

Measure CAL

Answer 13

Recession is where gums go down

loa is pocket down to CEJ/ more

Question 14

What is total loss of Att?

Answer 14

Question 15

Healthy CAL is…

Answer 15

Question 16

How else beside measurement, can we calc PD? Give percentage and classifications for it:

Answer 16

xrays
sub gingival calculus
last pic is stage 3-4

Question 17

Describe stage

Answer 17

loss of lamina dura
duzzy
black triangles
flat line bone loss = cloudy look

Question 18

Stage 2 x-ray PD looks like…

Answer 18

Question 19

What stage is this?

Answer 19

Stage 3 & 4

Question 20

What 6 factors of the AAP perio grading/staging must we consider?

Answer 20

• CAL first- we tend not to do in private practice bc takes long, if not available then use..
• xrays to look at BL, RBL
• look at severity and complexity
• tooth loss- know HOW they lost it, some ppl don’t know (not looking at fractures, caries or other issues, that is not considered in staging)
• probing depth: under 4= s1, less than 5,,= s2
• distribution: molar/incisor patterm, gen, loc?

Question 21

What stage is this?

Answer 21

Stage 1
- also need other evidence so

Question 22

What stage is this?

Answer 22

Stage 4
splain
tooth loss (if more than 5, and breakdown of dentition/occlusion= stage 4)

Question 23

What stage is this?

Answer 23

Stage 3
any where to right of staging= where we sit.

might be stage 1
but Stage 3 bc RBL + vertical bone loss

pockets (if we don’t have CAL then look at RBL) + 30% bone loss

Question 24

Why do we grade?

Answer 24

look at gen health, systemic disease, lifestyle factors.

some ppl can respond better to tx depending on these factors

tailors Dx to pt.

To est potential risk

Question 25

What grades are given for PD

Answer 25

A: slow, no loss
B: mod, less than 2mm loss
C: rapid= more than 2.5 mm LOA

Question 26

What grade should we assume?

Answer 26

B

and then shift to A or C when have evidence

other criteria
1. ask if they smoke and how much (you can smell)= automatic B or C
2. diabetes? HBa1c b
3. Can calc RBL x-ray. AMt bone loss/ over age of pt.

Question 27

What is a HBA1c?

Answer 27

monitor blood sugar- test 2-3 month period for diabetics. talk with GP.

Question 28

What is a metabolic disease that is considered a PD risk factor?

Answer 28

Diabetes

Question 29

For grading if no RF of smoking or diabetes what can you use to grade?

Answer 29

% of bone loss

Question 30

Answer 30

Grade A

Question 31

Grade

Answer 31

Grade C, stage 4, referral

Question 32

Grade

Answer 32

Stage 3, Grade C
- concerning bc disease progressing quickly

Grade C bc they have good hygiene yet progression is still p bad.

1. tell pt what is happening
2. can manage if confident or refer bc amt bone loss is pretty bad, there is furcation, hard to mx non surg
3. pt young= refer
   - B:, intrabony defects, need big guns= raise flap and clean
   - potential of losing teeth, if left PD could prgress, leads to all loss of teeth

Question 33

What is 3 step guide for PD classification?

Answer 33

1. gather info: tak etime to get accurate measurements periochart, mobility, furcation,r ecession, bleeding (25 or mor mins) + Missing teeth (ASK WHY)
2. est stage- use table: RBL xrays, pattern,extent
3. systemic/lifestyle factors

Question 34

Question 35

Does PD end for a pt?

Answer 35

“A Periodontitis patient is a Periodontitis patient for life”

10 yrs time still need PD mx to ensure they stay stable. But always at risk of relapse esp when older (dexterity changes, systemic illnesses)

Question 36

Can you have good OH yet still have perio?

Answer 36

Yes. some pt have best OH but heaps destruction happens still