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Periodontics > Week 7 Ch. 7 Periodontics > Flashcards

Week 7 Ch. 7 Periodontics Flashcards

1
Q

Periodontitis

A
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2
Q

PERIODONTITIS

A

Number 1 cause of tooth loss in adults:
41% of aduits over 30 have periodontitis.
• Is a bacterial infection
• Causes progressive destruction of the periodontal ligament.
• Gradual loss of supporting alveolar bone.
•Can have onset of any age, but more common over age of 35.
Usually progresses at slow to moderate rate,
• Begins as plaque-induced gingivitis that progressed to periodontitis.
Plaque-induced gingivitis is reversible, periodontitis is not reversible.

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3
Q

ALTERNATIVE TERMINOLOGY

A

May see references in literature to:
• Chronic Periodontitis
• Aggressive Periodontitis
• Localized Juvenile Periodontitis
• These are older terms that have been replaced with the larger umbrella of
PERIODONTITIS with stages and grades.

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4
Q

SIGNS AND SYMPTOMS OF
PERIODONTITIS

A

• Abundance of mature plaque and calculus.
• Reddish to purplish tissue OR tissues may appear pale pink.
• Gingival bleeding.
• Loss of attachment - mobility.
• Tissue Edema (swelling).
• Suppuration (pus).

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5
Q

CLIENT CHIEF CONCERNS

A

CLIENT CHIEF CONCERNS
• Red, swollen gingiva
• Bleeding during brushing
• Bad taste in mouth
• Bad breath
• Sensitive teeth
• Loose teeth
• Pus

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6
Q

DO NOT RELY ON
CLINICAL APPEARANCE

A

Clinical appearance is NOT a reliable indicator of the presence or severity of chronic periodontitis:
May exhibit pronounced changes in appearance
May exhibit minimal changes in appearance

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7
Q

PLAQUE BIOFILM AND CALCULUS

A

• Periodontitis characterized by mature supra- and subgingival soft and hard deposits.
• Can have very thick and complex deposits of plaque on affected root surfaces.
• Host factors determine pathogenesis and rate of progression of the disease.

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8
Q

CLINICAL ATTACHMENT LOSS (CAL)

A

Can occur in one site of a single tooth or several teeth or entire dentition:
1. Apical migration (relocation) of the JE to the tooth root.
2. Destruction of fibers of the gingiva.
3. Destruction of periodontal ligament fibers.
4. Loss of alveolar bone support around the tooth.
CLINICAL ATTACHMENT LOSS (CONT.)
• Loss of alveolar bone support from around the tooth:
• Progressive bone loss may result in tooth loss
• Furcation involvement becomes evident in multirooted teeth
.Tooth mobility and/or drifting occurs

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9
Q

ABSENCE OF
PAIN

A

• With periodontitis pain usually is NOT a symptom.
•Why, you may ask ???
•Clients do not seek treatment early in the disease.
• Clients do not follow through with treatment after the disease is diagnosed.

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10
Q

EXTENT OF DESTRUCTION

A

• Distribution of disease throughout the entire dentition.
• Characterized on percentage of affected teeth:
- Localized:
may involve one site on a single tooth or several sites on several teeth.
• Involves $0% or loss of the teeth.
- Generalized:
• may involve most or entire dentition.
• Involves more than 30% of teeth.

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11
Q

DESIRED OUTCOME OF THERAPY

A

For progression of periodontal disease to stop and prevent further attachment loss!

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12
Q

WHAT DOES CAL MEAN TO YOU?

A

Relocation of junctions epithelium
P

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13
Q

THERAPEUTIC ENDPOINTS OF PERIODONTAL THERAPY

A
  1. Elimination of microbial etiology and contributing factors that perpetuate inflammation.
  2. Preservation of state of the teeth and periodontium in a state of health, function and stability.
  3. Prevention of disease recurrence.
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14
Q

TREATMENT MODALITIES

A

• Focus on reinforcing daily self-care.
• Periodontal instrumentation to remove microbial etiology.
• Eliminate local intraoral factors.
• Periodontal surgery.
• Adherence to periodontal maintenance regimen.

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15
Q

• SUBCATEGORY 2

A

Periodontitis
Necrotizing Periodontal Diseases
Periodontitis
*. Periodontitis as a Manifestation of Systemic Disease
- Periodontal Abscesses and Endodontic Periodontal Lesions

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16
Q

NECROTIZING PERIODONTAL DISEASES

A
17
Q

NECROTOZING PERIODONTAL DISEASE
NECROTIZING GINGIVITIS

A

• Necrosis is limited to the gingiva
Examples:
• HIV
• AIDS
• Immunosuppression
• Severe malnutrition
• Severe viral infections
• Stress
• Smoking
• Previous episodes of necrotizing periodontal disease

18
Q

NECROTOZING PERIODONTAL DISEASE
NECROTIZING PERIODONTITIS

A

•It affects the periodontal attachment and bone
• Examples:
• HIV
• AIDS
• Immunosuppression
• Severe malnutrition
•Severe viral infections
• Stress
• Smoking
•Previous episodes of necrotizing periodontal disease

19
Q

NECROTOZING PERIODONTAL DISEASE
NECROTIZING STOMATITIS

A

• It affects the oral mucosa

20
Q

• SUBCATEGORY 3
CLASSIFICATION AT-A-GLANCE

A
21
Q

PERIODONTITIS CASE

A

• The following Two Categories are the starting point:
1. Full periodontal assessment to determine CAL
2. Radiographs to determine RBL

22
Q

STAGING & GRADING PERIODONTITIS

A

• Importance of Staging & Grading
• Discuss implications ol severity, complexity, extent and distribution of es stage - in client terms
• Eucate client in a manner that is clear and understandable
Connect risk factors to rate of periodontitis progression using chart as a guide
• Allows dental hygienist to ‘paint a pieture’ that is specifie to elient characteristics
•Rocognize and lead to acceptance of therapy protocol

23
Q

STEPS TO STAGING & GRADING A PERIODONTITIS CLIENTs

A

•STEP 1: INITIAL CASE OVERVIEW TO ASSESS THE DISEASE
Screening
Full Mouth Probing, Full Mouth Radiographs, Missing Teeth
Two Divisions
1. Mild to Moderate (Stage I or Stage I)
2. Moderate to Severe (Stage III or Stage IV)
•STEP 2: ESTABLISH STAGE
Three Categories of Staging
1. Severity: Interdental CAL, RBL & Tooth Loss (periodontal related)
2. Complexity: Local - Probing Depths, Bone Loss, Furcation, Occlusal Trauma
3. Extent & Distribution: Descriptor - Localized, Generalized, Molar/Incisor Pattern
•STEP 3: ESTABLISH GRADE
Three Categories of Grading
1. Primary Criteria: Direct Evidence of Progression - RBL or CAL &
Indirect Evidence of Progression - Percentage of Bone Loss Divided by Age & Case Phenotype
2. Grade Modifiers: Risk Factors - Smoking & Diabetes

24
Q

STAGING OF PERIODONTITIS
DIVISION OF ROOT INTO THIRDS

A
25
Q

STAGE I
PERIODONTITIS

A

• Severity
• Interdental CAL of 1-2 mm (at site of greatest loss)
Radiographic bone loss extending to coronal third of root (<15%)
• No tooth loss (due to periodontitis)
• Complexity
• Local
• Maximum probing depths < or = 4mm
• Mostly horizontal bone loss
• Extent & Distribution
• Add to stage as descriptor
• Localized (<30% teeth involved)
•Generalized (>30% teeth involved)
Molar/Incisor Pattern

26
Q

STAGE II
PERIODONTITIS

A

• Severity
• Interdental CAL of 3-4 mm (at site of greatest loss)
•Radiographic bone loss extending to coronal third of root (15% - 33%)
• No tooth loss (due to periodontitis)
• Complexity
• Local
Maximum probing depths < or = 5mm
• Mostly horizontal bone loss
• Extent & Distribution
• Add to stage as descriptor
• Localized (<30% teeth involved)
• Generalized (>30% teeth involved)
• Molar/Incisor Pattern

27
Q

STAGE III
PERIODONTITIS

A

Interdental CAL 25 mm (at site of greatest loss)
• Radiographic bone loss extending to middle third of root and beyond
•Tooth loss (due to periodontitis) < or = 4 teeth
•Complexity
• Local
•Probing depths > or = 6mm
• Vertical bone loss > or = 3mm
• Furcation involvement CLIl or III
•Moderate ridge defects
• Extent & Distribution
• Add to stage as descriptor
• Localized (<30% teeth involved)
• Generalized (>30% teeth involved)
•Molar/Incisor Pattern

28
Q

STAGE IV
PERIODONTITIS

A

Severity
Interdental CAL ≥5 mm (at site of greatest loss)
Radiographic bone loss extending to middle third of root and beyond
•Tooth loss (due to periodontitis) > or = 5 teeth

• Complexity
• Local
• In addition to Stage III complexity
• Need for Complex Rehabilitation
•Masticatory dysfunction
• Secondary occlusal trauma (> or = M2 Mobility)
• Severe ridge defects
• Bite collapse (drifting/flaring teeth)
• < 20 teeth remaining (10 opposing pairs)

Extent & Distribution
• Add to stage as descriptor
• Localized (<30% teeth involved)
•Generalized (>30% teeth involved)
• Molar/Incisor Pattern

29
Q

GRADE A: SLOW RATE
PERIODONTITIS

A

• Primary Criteria (whenever available, direct evidence should be used
• Direct Evidence of Progression
•RBL or CAl: No loss over 5 years
• Indirect Evidence of Progression
• % Bone Loss / Age: <0.25
• Case Phenotype: heavy bioflim with low lerels oft
• Grade Modifiers
• Risk Factors
• Smoking: Non-smoker
• Diabetes: Normoglycemic / no diagnosis

30
Q

GRADE B: MODERATE RATE
PERIODONTITIS

A

• Primary Criteria (whenever available, direct evidence should be used)
• Direct Evidence of Progression
• RBL or CAL: < 2mm over 5 years
• Indirect Evidence of Progression
• % Bone Loss / Age: 0.25 to 1.0
• Case Phenotype: destruction commensurate with biofilm deposits
• Grade Modifiers
• Risk Factors
•Smoking: < 10 cigarettes/day
• Diabetes: HbAIc <7.0% in clients with diabetes

31
Q

GRADE C: RADID RATE
PERIODONTITIS

A

• Primary Criteria (whenever available, direct evidence should be used)
• Direct Evidence of Progression
• RBL or CAL: > or = 2mm over 5 years
• Indirect Evidence of Progression
• % Bone Loss / Age: > 1.0
• Case Phenotype: destruction exceeds expectations given biofilm deposits, clinical patterns of rapid progression /early onset disease
• Grade Modifiers
• Risk Factors
•Smoking: > or = 10 cigarettes/day
•Diabetes: HbAlc > or = 7.0% in clients with diabetes

32
Q

KEY POINTS TO REMEMBER

A

• Gingivitis client can return to a state of health
• Periodontitis client is a periodontitis client forever
•When it comes to staging, early and moderate periodontitis will be stage 1 and 2
respectively; severe and very severe periodontitis will fall under stages 3 or 4
When grading, the consensus is to assume it is a grade B
•Bleeding is our #1 indicator of gingival inflammation
•10% is the magic number, that is someone can have inflammation in up to 10% of the oral cavity and still be considered healthy
•If there is a 4 mm interdental pocket with bleeding (open pocket) we still grade and stage

33
Q
  1. Periodontitis in which 30% or LESS of the sites in the mouth have experienced attachment loss and bone loss is termed:
    A. Non–plaque-induced gingivitis
    B. Localized periodontitis
    C. Generalized periodontitis
A
34
Q
  1. Periodontitis in which MORE than 30% of the sites in the mouth have experienced attachment loss and bone loss is termed:
    A. Non–plaque-induced gingivitis
    B. Localized periodontitis
    C. Generalized periodontitis
A
35
Q
  1. Probing depth of 5 mm or less that shows as even horizontal bone loss on radiographs occurs in which of the following stages of periodontitis?
    A. Stage I
    B. Stage I
    C. Stage III
    D. Stage IV
A
36
Q
  1. Tissue destruction that is characterized by increased CAL of 2 mm or more over a 5-year period has a grade of:
    A. Grade A
    B. Grade B
    C. Grade C
A

Periodontics (7 decks)

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