BDS2 > Perio 2 - classification > Flashcards

Perio 2 - classification Flashcards

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1
Q

Why do diseases need to be classified?

A

so clinicians can properly diagnose and treat patients as well as for scientists to investigate aetiology, pathogenesis, natural history and treatment of the diseases and condition

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2
Q

What was the 1989 periodontal disease classification (obsolete)?

A

rapidly progressing periodontitis, early onset periodontitis, localised juvenile periodontitis, adult (>35yrs) periodontitis, refractory periodontitis

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3
Q

What was the 1999 periodontal disease classification?

A

I Gingival disease
II Chronic periodontitis
III Aggressive periodontitis
IV Periodontitis as a manifestation of systemic diseases
V Necrotizing periodontal diseases
VI Abscesses of the periodontium
VII Periodontitis associated with endodontic lesions
VIII Development or acquired deformities and conditions

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4
Q

What were the problems with the 1999 classification?

A

vague distrinction between chronic (II) and aggressive (III) periodontitis, does not diagnose/define gingival health, does not diagnose previous periodontitis

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5
Q

Which periodontal disease classification is currently used?

A

2017 classification

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6
Q

What is the 2017 disease classification?

A
  1. Health
  2. Plaque-induced gingivitis
  3. Non plaque-induced gingival diseases and conditions
  4. Periodontitis
  5. Necrotising Periodontal Disease
  6. Periodontitis as a manifestation of systemic disease
  7. Systemic diseases or conditions affecting the periodontal tissues
  8. Periodontal abscess
  9. Periodontal-endodontic lesions
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7
Q

Can a patient with a reduced periodontium still be classified with gingival health / gingivitis?

A

yes - as long as the reduced periodontium is due to causes other than periodontitis e.g. crown lengthening surgery, extraction of 8 leading to bone loss of 7 distal

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8
Q

What are the characteristics of gingival health on an intact periodontium?

A

absence of: BoP, erythema, oedema, patient symptoms, loss of attachment and bone, with physiological bone levels 1-3mm apical to ACJ

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9
Q

What is the definition of gingival health for an intact periodontium and a reduced and stable periodontium?

A

<10% bleeding sites with probing depths <=3mm

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10
Q

Which features present in periodontitis are absent in gingivitis?

A

gingivitis has no radiological bone loss or interdental recession

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11
Q

How can plaque-induced gingivitis be categorised?

A

into localised or generalised gingivitis

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12
Q

What is localised plaque-induced gingivitis defined as?

A

10% < bleeding on probing < 30%

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13
Q

What is generalised plaque-induced gingivitis defined as?

A

> 30% bleeding on probing (BoP)

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14
Q

What is the difference between an intact periodontium and a reduced periodontium (both of which can be healthy if <10% BoP, or both gingivitis if BoP >10%)?

A

a reduced periodontium will have probing attachment loss and possible radiological bone loss whereas an intact periodontium will not

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15
Q

Describe findings of probing attachment loss, probing pocket depths, BoP and radiological bone loss for a successfully treated periodontitis patient who in now in health (stable)

A

probing attachment loss: yes
probing pocket depths: <=4mm (no site >=4mm with bleeding)
BoP: <10%
Radiological bone loss: yes

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16
Q

Describe findings of probing attachment loss, probing pocket depths, BoP and radiological bone loss for a patient with gingival inflammation and a history of periodontitis (remission)

A

probing attachment loss: yes
probing pocket depths: <=4mm (no site >=4mm with bleeding)
BoP: >=10%
Radiological bone loss: yes

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17
Q

What are some examples of systemic conditions that are modifying factors of plaque-induced gingivitis?

A

sex hormones (puberty, menstrual cycle, pregnancy, oral contraceptives), hyperglycaemia, leukaemia, smoking malnutrition

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18
Q

Example of a form of malnutrition that is a modifying factor for plaque-induced gingivitis?

A

scurvy

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19
Q

Aside from systemic conditions, what are other modifying factors of plaque-induced gingivitis?

A

plaque retentive factors (poor subgingival restoration margins, hyposalivation), drug-influenced gingival enlargements

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20
Q

Example of an exaggerated response to plaque or calculus which may arise during pregnancy

A

pregnancy epulis (considered a mucogingival deformity - 10)

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21
Q

Why is drug-influenced gingival enlargement seen as a vicious cycle?

A

inflamed and enlarged gingival makes it difficult to clean the gingival margin and subgingivally

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22
Q

Why is it important to identify and reverse gingivitis?

A

teeth with gingivitis are more likely to be lost / more likely to show loss of attachment

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23
Q

What is the screening tool for periodontitis?

A

Basic Periodontal Examination (BPE)

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24
Q

When would a BPE score of 0 be given?

A

<3.5mm pockets (black band entirely visible), no calculus/overhangs, no BoP

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25
When would a BPE score of 1 be given?
<3.5mm pockets (black band entirely visible), no calculus/overhangs, BoP
26
When would a BPE score of 2 be given?
<3.5mm pockets (black band entirely visible), supra or subgingival calculus/overhangs
27
When would a BPE score of 3 be given?
3.5-5.5 mm probing depth (black band partially visible)
28
When would a BPE score of 4 be given?
>5.5mm probing depth (black band disappears)
29
What does a * in a BPE indicate?
furcation involvement
30
Why is periodontitis still unconfirmed with a BPE of 4?
could be a false pocket - need radiograph
31
What action is required for BPE scores of 0?
no need for periodontal treatment
32
What action is required for BPE scores of 1?
OHI
33
What action is required for BPE scores of 2?
OHI + removal of plaque retentive factors including all supra and subgingival calculus
34
What action is required for BPE scores of 3?
OHI + removal of plaque retentive factors + radiograph + root surface debridement / initial therapy + 3 months later do 6 point pocket chart for that sextant only
35
What action is required for BPE scores of 4?
radiographs, 6 point pocket chart of entire dentition. OHI + RSD + assess need for more complex treatment / specialist referral
36
What action is required for BPE scores with *?
treat according to number, assess need for more complex treatment / specialist referral
37
What is the purpose of a BPE?
as a screening tool for periodontitis and to guide you on the next actions to take (which help formulate diagnosis)
38
Which patients require periodontitis staging/grading at initial consultation?
all patients with historical or current periodontitis
39
What is the staging of periodontitis based on?
severity - maximum bone loss at worst site
40
How many stages of periodontitis are there?
4 stages based on severity (I, II, III, IV)
41
What is the grading of periodontitis based on?
disease susceptibility and progression - percent bone loss / age
42
How many grades of periodontitis are there?
3 grades (A, B, C)
43
What is the severity of stage 1 periodontitis?
early / mild
44
What is the level of interproximal bone loss at the worst site of stage 1 periodontitis?
<15% or 2mm
45
What is the severity of stage 2 periodontitis?
moderate
46
What is the level of interproximal bone loss at the worst site of stage 2 periodontitis?
coronal third of root
47
What is the severity of stage 3 periodontitis?
severe (potential for additional tooth loss)
48
What is the level of interproximal bone loss at the worst site of stage 3 periodontitis?
mid third of root
49
What is the severity of stage 4 periodontitis?
very severe (potential for loss of dentition)
50
What is the level of interproximal bone loss at the worst site of stage 4 periodontitis?
apical third of root
51
How can you stage a periodontitis patient if bitewings are the only radiographs available?
measure bone loss from ACJ and estimate
52
What stage can be assigned to a patient who is known to have lost teeth due to periodontitis?
stage 4
53
How is grading calculated?
percentage bone loss / age (A = max % bone loss less than half patient age, C = max % bone loss more than patient age)
54
What is the progression of grade A periodontitis?
slow
55
What is the percentage bone loss / age for grade A periodontitis?
<0.5 (max bone loss less than half patient age)
56
What is the progression of grade B periodontitis?
moderate
57
What is the percentage bone loss / age for grade B periodontitis?
0.5-1.0 (max bone loss more than half patient age but less than age)
58
What is the progression of grade C periodontitis?
rapid
59
What is the percentage bone loss / age for grade C periodontitis?
>1.0 (max bone loss more than patient age)
60
What is the extent of a disease based on?
the distribution / how many teeth are involved
61
How is the extent of periodontitis categorised?
localised (<30% of teeth), generalized (>30% of teeth), molar incisor pattern
62
What special investigation is required for staging and grading periodontitis?
radiographs (preferably periapicals)
63
How is the stability of periodontitis / current periodontitis status assessed?
based on bleeding on probing and depth of pockets
64
What are the categories of current periodontitis status (stability)?
currently stable, currently in remission, currently unstable
65
What are the features of a currently stable periodontitis patient?
BoP <10%, probing pocket depth (PPD) <=4mm, no BoP at 4mm sites
66
What are the features of a currently in remission periodontitis patient?
BoP >= 10% (some gingival inflammation) PPD <= 4mm no BoP at 4mm sites
67
What are the features of a currently unstable periodontitis patient?
PPD >= 5mm or PPD >= 4mm and BoP
68
Example of a risk factor assessment of as part of a diagnosis for a periodontitis patient
smoking (including cigarettes / day), sub-optimally controlled diabetes
69
What are the steps in a diagnostic pathway / components of a diagnostic statement?
- identifying the disease - extent - severity (staging for periodontitis) - rate and risk of disease progression (grading for periodontitis) - whether active or controlled (stability) - risk factors
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