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Periodontics > Periodontitis (Staging and Grading) Exam 5 > Flashcards

Periodontitis (Staging and Grading) Exam 5 Flashcards

1
Q

What are the three components for defining a periodontitis case?

A
  • Identification of a patient as a perio case
  • Identification of the specific form of periodontitis
  • Description of the clinical presentations- elements affecting clinical management and prognosis, broader influences on both oral and systemic health.
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2
Q

What are the stages of periodontitis?

A
  • Stage i: initial
  • ii: Mod
  • iii: Severe: may have additional tooth loss
  • iv: Severe: loss of dentition

Based on severity and complexity managment

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3
Q

Extend and Distribution is based on what?

A

Localized , Generalized and molar-incisor

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4
Q

What are the Grades of Periodontitis?

A

Grade A- slow rate
B- Mod rate
C- rapid rate

evidence or risk of rapid progression, anticipated treatment response

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5
Q

Defining a perio case differes based on what ?

A
  1. Age of the patient
  2. Lesion number
  3. Distribution
  4. Severity
  5. Location within the dental arch
  6. Level of oral biofilm contamination
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6
Q

Staging is determined at presentation of three elements what are they?

A

Severity
Complexity of management
Extent and distribution

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7
Q

what is the meaning of changes in severity?

A

Loss of worse affected tooth= decrease severity

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8
Q

Severity at slight cal measurement ?

A

1-2mm

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9
Q

Severity at moderate cal measurement ?

A

3-4mm

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10
Q

Severity at severe cal measurement ?

A

greater than or equal to 5mm

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11
Q

What are the measurement for radiographic bone loss (RBL) for severity?

A

Coronal 3rd- <15%

Coronal 3rd - 15%-33%

Middle 3rd and beyond - >33%

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12
Q

What is the amount for tooth loss during the each stage?

A
  • None
  • Less than or equal to 4
  • More than or equal to 5
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12
Q

What is the severity destruction levels?

A

Slight (Mild)
 No more than 1 to 2 mm of attachment loss
Moderate
 3 to 4 mm of attachment loss
 Class I or II furcation involvement
 Tooth mobility
Severe
 Major loss of bone support > 30%
 5 mm or more of attachment loss
 Class III furcation involvement

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12
Q

What is the staging complexity management for local factors?

Important

A
  • Probing depths
  • Type of bone loss (vertical and/or horizontal)
  • Furcation status
  • Tooth mobility
  • Missing teeth
  • Bite collapse
  • Ridge defect size
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13
Q

What are the three patterns ?

A
  • Localized
    Few sites demonstrate attachment and bone loss 30% or less
  • Generalized
    Many sites affected
    >30%
  • Molar-incisor
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14
Q

Extend and distrubution is based on what?

A
  • Extent: Different degrees or amounts of destruction
  • Distrubtion: Based on number of teeth with tissue destruction
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15
Q

What are the three set parameters?

A

1) rate of periodontitis progression;
2) recognized risk factors for periodontitis progression;
3) risk of an individual’s case affecting the systemic health

16
Q

What is the rate of disease progression?

A
  • Change or advancement of destruction as compared from previous visit
  • Slow rate of progression: May be modified by systemic/environmental/ factors
  • Current view
    1. Destruction not continuous
    1. Occurs in short bursts with destruction
    1. Random occurrence over time
    1. Random sites in mouth
17
Q

What is increased disease progression ?

A
  1. Rapid progressive lesions
    * Interproximal areas
    * Areas of greater plaque accumulation
    * Areas inaccessible to plaque control
    *. Furcations
    * Overhangs
    * Malposed teeth
    * Areas of food impaction
  2. U nequal rate of progression of affected sites
18
Q

What are the predictors or disease progression?

A
  • Previous history of periodontitis (risk determinant)
  • Greater risk for progressive disease
    If not successfully treated
    Plaque allowed to accumulate in a treated patient
  • Importance of monitoring and maintenance
19
Q

What are the primary Criteria for grading?

A
  • Direct evidence of progression
  • Indirect evident of progression
20
Q

What are some grading modifiers?

A
  • risk factors like smoking diabetes
21
Q

What are the causes of periodontitis ?

A
  • Pathogenic bacteria
  • Destruction consistent with local factors
  • Oneset and severity determined by: plaque biofilm, host immune response interaction and evironment
22
Q

What are the symptoms of periodontitis?

A

▪ Red or swollen gingiva
▪ Bleeding during brushing
▪ Bad taste
▪ Persistent bad breath
▪ Sensitive teeth
▪ Loose teeth
▪ Purulence
* Usually painless
* mimics odontogenic pain
* Gingival tenderness or itching
* Pain associated with food impaction

23
Q

Periodontitis affect deep tissues of?

A

the periodontium

24
Q

True or False
Appearance of gingival tissues is not a reliable
indicator of the presence or severity of periodontitis

A

True

25
Q

What are the clinical appearance of gingival tissue

A

▪ Evident Clinical Signs
▪ Bright red to purple tissue
▪ Minimal Signs
▪ Pale pink
▪ Often mistaken for health
▪ Fibrotic
▪ Pocketing

26
Q

What are some clinical features?

A

▪ Tissue enlargement
▪ Tissue redness
▪ Bleeding on probing
▪ Periodontal pockets
▪ Loss of stippling
▪ Fibrotic tissue
▪ Exudate / suppuration
▪ Subgingival calculus
▪ Flat or cratered papilla
▪ Blunted or rolled gingival margins
▪ Tooth mobility in advanced cases
▪ Alveolar and supporting bone destruction

27
Q

What are the variables of inflammation?

A
  • Localized
    One site/one tooth
    Several sites/one tooth
    Several teeth
  • Generalized
    Entire dentition
28
Q

What is of horizontal bone loss?

A
  • Most prevalent bone loss presentation
  • Can occur in individuals of any age
    ▪ Most common in adults >30

▪ Old Names
 Chronic Adult Periodontitis
 Chronic Periodontitis

29
Q

COMPLEXITY: VERTICAL BONE LOSS
EXTENT: MOLAR-INCISOR PATTERN

A

▪ Less common than horizontal
▪ Old Names
 Early Onset Periodontitis (1989)
 Included prepubertal periodontitis, juvenile periodontitis and rapidly progressive
periodontitis
 Aggressive Periodontitis (1999)

30
Q

What are the three overlapping issues for complexity- vertical bone loss?

A
  • Time
  • Place (Topographic location)
  • Person (Age, gender and race)
31
Q

What are the general characteristics for complexity- vertical bone loss?

A
  • *No obvious signs/ symptoms of systemicdisease
  • Rapid destruction of attachment
  • Rapid loss of supporting bone High risk for tooth loss
  • Affected tissue may have normal
  • appearance
  • Periodontal pockets
  • Small amount of plaque
  • Severity not consistent with amount of plaque
  • Immune deficiencies
  • Genetic links possible contributing factors
    • Presentation with age (puberity to < 30)
  • Gender affiliation
  • Inflammatory/immune response
  • maybe self arresting
32
Q

What are the clinical features for complexity- vertical bone loss during the FIRST PRESENTATION?

A
  • Characteristic distribution of lesions
    1st molar and incisors
  • Inter proximal attachment loss on at least two permanent teeth
    One of which is a 1st molar
    Involving no more than two teeth other than first molars and incisors
33
Q

What are the clinical features for complexity- vertical bone loss during the SECOND PRESENTATION?

A

 Characteristic distribution of lesions
Most teeth
 Generalized interproximal attachment loss
 Affecting at least 3 permanent teeth
Other than 1st molars and incisors

34
Q

What are the clinical features for vertical bone loss with molar incisor patterns?

A

Lack of clinical inflammation despite deep periodontal pockets

35
Q

What is vertical bone loss extent: molar incisor pattern disease progression ?

A
  • Rapid progression
  • 3-4x faster than horizontal bone loss development
  • **Diastema formation **
  • Increase mobility of 1st molars
  • Periodontal abscesses
  • Pain
36
Q

What are the microbiological factors for Complexity: Vertical bone loss with molar incisor pattern ?

A
  • A. actinomycetemcomitans- primary pathogen
  • Red complex bacteria involvemnet: P. gingivalis, T. Forsythia
  • Other bacteria include: P. Intermedia, E. Corrodens, C. Rectus, Capnocytophaga species
  • Amount of plaque minimal
  • Inconsistent with amount of destruction
  • Rarely forms calculus
37
Q

What are the radiographic findings for vertical bone loss- molar incisor pattern ?

A
  • vertical bone loss (1st molar and incisors)
  • arc shaped bone loss
38
Q

How to define a periodontitis case?

A

Clinically:
* interdental CAl is detectable at Greater or equal to 2
* Buccal/ lingual CAL is 3 or greater with pocketing > 3 is detectable but cannot be non-perio because of other factors.

39
Q

What are some causes that can make a case non-periodontitis-related?

A
  • recession due to trauma
  • Caries within the cervical 3rd
  • CAL on the distal of a second molar and associated with malpositon/extraction of thirds
  • An endodontic lesion draining through the marginal periodontium
  • Occurrece of a vertical root fracture

Periodontics (9 decks)

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