W1: Classifying PD Flashcards
What do you see in PD?
Destruction of periodontitis
What is diff btw old vs new system of classification?
Old: terms: mild, mod, severe, forms of
New: biggest change is PD is staged and graded
What are forms of PD?
How many stages/grade of PD are there
4 stage,
grade ABC
extent/dist
What are the stages of PD? and Why were they put in place?
- 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
Stage 1
Gingival inflammation
- Mx: get pt educated abt OH (important)
Stage 2 PD
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
Stage 3
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
Describe stage 4 periodontitis and how management may be different from stage 3:
- ## lots of infection, Bone loss
How us extent described? In what percentage?
-local: less than 30%
- gen: more than 30%
Diff btw LOA and CAL
- start with looking at base of pocket to CEJ: ho much PD tissue has occured (lig, fibres, relocation of junction)
Why must we feel for CEJ?
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
Measure CAL
Recession is where gums go down
loa is pocket down to CEJ/ more
What is total loss of Att?
Healthy CAL is…
How else beside measurement, can we calc PD? Give percentage and classifications for it:
xrays
sub gingival calculus
last pic is stage 3-4
Describe stage
loss of lamina dura
duzzy
black triangles
flat line bone loss = cloudy look
Stage 2 x-ray PD looks like…
What stage is this?
Stage 3 & 4
What 6 factors of the AAP perio grading/staging must we consider?
- 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?
What stage is this?
Stage 1
- also need other evidence so
What stage is this?
Stage 4
splain
tooth loss (if more than 5, and breakdown of dentition/occlusion= stage 4)
What stage is this?
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
Why do we grade?
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
What grades are given for PD
A: slow, no loss
B: mod, less than 2mm loss
C: rapid= more than 2.5 mm LOA
What grade should we assume?
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.
What is a HBA1c?
monitor blood sugar- test 2-3 month period for diabetics. talk with GP.
What is a metabolic disease that is considered a PD risk factor?
Diabetes
For grading if no RF of smoking or diabetes what can you use to grade?
% of bone loss
Grade A
Grade
Grade C, stage 4, referral
Grade
Stage 3, Grade C
- concerning bc disease progressing quickly
Grade C bc they have good hygiene yet progression is still p bad.
- tell pt what is happening
- can manage if confident or refer bc amt bone loss is pretty bad, there is furcation, hard to mx non surg
- 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
What is 3 step guide for PD classification?
- gather info: tak etime to get accurate measurements periochart, mobility, furcation,r ecession, bleeding (25 or mor mins) + Missing teeth (ASK WHY)
- est stage- use table: RBL xrays, pattern,extent
- systemic/lifestyle factors
Does PD end for a pt?
“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)
Can you have good OH yet still have perio?
Yes. some pt have best OH but heaps destruction happens still
