week eleven - other conditions affecting periodontium

Question 1

describe periodontal abcesses and its effect on the periodontium

Answer 1

• common dental emergency = localised accumulation of pus located within gingival wall of perio pocket
• causes rapid destruction of supporting tissues
• can occur in pre-exsting perio pocket or not

occurs from
- calc depos
- foreign bodies [eg popcorn hulls, toothpicks, floss]
- parafunctional habits [nail biting, brusxim]
- ortho factors [ortho, crossbite]
- gingival enlargement
- alteration of root surface [eg enamel pearls, dens invaginatus]

Question 2

describe endodontic lesions

Answer 2

• rare
• involves both pulp + perio tx [perio pocket reaches close to apex = microbial contamination]
• can occur from endo/perio infections or trauma/iatrogenic factors
• tooth responds - to vitality tests
• v complicated to treat

grades [endo-periodontal lesions in pt with and without periodontitis]
- grade 1 = narrow deep perio pocket in 1 tooth surface
- grade 2 = wide deep periodontal pocket in 1 tooth surface
- grade 3 = deep perio pocket in > 1 tooth surface

other symptoms
- pain to TTP, palpation or spont.
- purulent exudate
- mobility
- colour changes to tooth/gingiva

Question 3

describe 2 mucogingival deformities

Answer 3

1. gingival phenotype [thickness and keratinised tossue width]
2. gingival soft tx recession [apical shift of ging.margin]
   - biotype
   - toothbrushing
   - resto margins
   - ortho

Question 4

distinguish between :
peri-implant health
peri-implant mucositis
peri-implantitis
perio-implant soft/hard tx deficiencies

Answer 4

1. peri-implant health
   - absence of BOP + visual signs of inflammation
   - can be present around implant w normal or reduced bone height
   - no healthy probing depths defined for peri-implant health
2. peri-implant mucositis
   - visual signs of inflammation + BOP
   - strong evidence suggesting this is caused by plaque
   - reversible
3. peri-implantitis
   - inflammation of mucosa + loss of supporting bone around implant
   - plaque assoc. pathologic condition
   - pt may have hx of severe periodontitis
4. perio-implant soft/hard tx deficiencies
   - defects caused by : traumatic extraction, severe periodontal loss, endodontic infection, root fractures, poor tooth position, injury, peri-implantitis

Question 5

discuss the clinical and histological effects of periodontitis

Answer 5

clinically
- blue-purple-red colou, spongy/shiny consistency // light pink - leathery consistency
- swollen, fibrotic gingival margin, recession can be present
- interdental papilla may not fill interdental embrasure
- bleeding + suppuration present
- probing depths > 4mm

histologically
- JE located apical to CEJ
- gingival fibres/collagen = damaged
- alveolar bone = permanently damaged = can cause mobility
- PDL = permanent destruction
- cementum = exposed to biofilm

Question 6

state the clinical definition of periodontitis and describe what constitutes a periodontitis case

Answer 6

“microbially-associated, host-mediated inflammation that results in loss of periodontal attachment”
- loss of marginal PDL fibres
- apical migration of JE
- apical spread of bacterial biofilm along root surface

periodontitis case if:
- interdental CAL is detectable at 2 or more non-adjacent teeth
- buccal/oral CAL of 3mm or more w pocketing over 3mm detectable on 2 or more teeth

CAL cannot be attributed to
- gingival recession due to trauma
- caries extending –> cervical area of tooth
- CAL present on a 7 distal where 8 is malpositioned or missing
- endo lesion draining through marginal periodontium

Question 7

describe necrotising periodontal disease

Answer 7

necrotising periodontal disease : commonly features
- papilla necrosis
- bleeding
- pain
- commonly assoc w host immune response impairements

necrotising gingivitis [NG]
- acute inflammatory process of **gingival tx **
- presence of necrosis/ulcer of interdental papilla, gingival bleeding, pain
- fever, halitosis and pseudomembranes may also be present

necrotising periodontitis [NP]
- inflammatory process of periodontium
- presence of necrosis/ulcer of interdental papilla, gingival bleeding, halitosis, pain and** rapid bone loss **
- fever, halitosis and pseudomembranes may also be present

necrotising stomatitis
- severe inflammatory condition of periodontium + oral cav
- soft tx necrosis beyond gingiva + bone unconvering may occur through alv.muc.
- typically occurs in severely systemically compromised patients
- may rarely devel w/o prior appearance of NG/NP

Question 8

describe the staging classifications for periodontitis

Answer 8

stage 1[initial periodontitis]
- devel in repsonse to persistent gingival inflammation and biofilm maturation
- CAL = 1-2mm
- bone loss = coronal 1/3 [<15%]
- tooth loss = nil
- max probing depth = 4mm or less - mostly horz bone loss

stage 2 [moderate periodontitis]
CAL = 3 - 4 mm
- bone loss = coronal 1/3 [15 - 33%]
- tooth loss = nil
- max probing depth = 5mm or less - mostly horz bone loss

stage 3 [severe periodontitis w potential for additional tooth loss]
- pockets extending to middle portion of root, vertical bone loss, furcation involv, loss of teeth from disease/ridge defects
- CAL = 5 mm or more
- bone loss = extending to middle/apical 1/3
- tooth loss = 4 or less teeth
- max probing depth = 6mm or more
- vert bone loss 3mm or more
- furc involv = class II or III
- moderate ridge defect

stage 4 [severe periodontitis w potential for loss of the dentition]
- complex rehab rq - mobility, occ trauma, bite collapse/drifting
- CAL = 5 mm or more
- bone loss = extending to middle/apical 1/3
- tooth loss = 5 or more teeth
- less than 20 remaining teeth [10 opposing pairs]

extent/distribution
- localised = < 30% teeth
- generalised = > 30% or more teeth
- molar-incis = only these teeth affected

Question 9

describe the grading classifications for periodontitis

Answer 9

grading [potentital for risk progression/mangament of case]

grade A [slow rate or progression]
- bone loss /CAL = evidence of no loss of 5 years
- % bone loss/age = < 0.25
- phenotype = heavy biofilm depo w/ low destruction level
- smoking = nil
- DM = no dx

grade B [moderate rate of progression]
- assume B first then shift according to risk factors
- bone loss /CAL = < 2mm over 5yrs
- % bone loss/age = 0.25 - 1.0
- phenotype = destruction commensurate w biofilm depo
- smoking = < 10 a day
- DM = HbA1c < 7.0% in DM pt

grade C [rapid rate of progression]
bone loss /CAL = 2mm or more over 5yrs
- % bone loss/age = > 1.0
- phenotype = destruction exceeds expectation given biofilm depo
- smoking = > 10 a day
- DM = HbA1c = 7.0% or more in DM pt