9. Diagnosis and Classification of Periodontal Disease Flashcards by J L

Prevalence of Periodontitis
• NHANES 1988 - 1994: ____ periodontitis in US adults age 30 and older
• NHANES 2009 - 2010: ____ periodontitis in US adults age 30 and older
• NHANES 2009 - 2010: ____ moderate or severe periodontitis in US adults
age 65 and older

• How was perio disease defined? Classification is also important; in order to interpret the research data that we get

35
47
65%

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• ____ Classification (Armitage) - outcome out international workshop

1999

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What is Necessary for a Periodontal Diagnosis?

____
Systemic Diseases Medication Allergies
Smoking

____
Probing Depth (PD)
Recession (REC)
Clinical Attachment Level (CAL) Bleeding On Probing (BOP) Mobility
Furcation Involvement Plaque Index Bleeding Index

____Panoramic
Full Mouth Radiographs

medical history
clinical examination
radiographic examination

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Probing Depth

• Sulcus 1-3mm; >\_\_\_\_mm is a pocket
• Happens as a result of inflammation > coronal migration of gingival margin; also an apical migration of attachment apparatus > true periodontitis
	○ True pocket (different from a \_\_\_\_)

pseudopocket

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Probing Depth vs Clinical Attachment Level

• True pocket, by \_\_\_\_ migration and \_\_\_\_ migration (causing \_\_\_\_)

coronal
apical
CAL

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Pocket vs Pseudopocket

• No attachment loss, but presence of a pocket - \_\_\_\_ (bc of lack of attachment loss)

pseudopocket

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“Basic” Periodontal Disease Diagnosis

Health
I. Gingivitis
Periodontitis 
II. Chronic
III. Aggressive
IV. Periodontitis as a Manifestation of Systemic Diseases

* Superficial inflammation > \_\_\_\_
* Inflammation and attachment loss > \_\_\_\_
* Every patient should be in one of these three \_\_\_\_
* This is her classification

gingivitis
periodontitis
categories

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“Special” Periodontal Disease Diagnosis

V. Necrotizing Periodontal Diseases
A. ____
B. ____

VI. Abscesses of the Periodontium
A. ____
B. Periodontal
C. ____

VII. Periodontitis Associated with Endodontic Lesions
A. Combined endodontic – periodontic lesions

necrotizing ulcerative gingivitis (NUG)
necrotizing ulcerative periodontitis (NUP)
gingival
pericoronal

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Gingivitis

____
____ Index
____ Index
Clinical attachment level (CAL)
- CAL = ____; CAL > ____, with no evidence of ____ attachment loss

BOP
Plaque
Bleeding
0
0
progressive

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o VIII. A. Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis
• 1. Tooth ____ factors
• 2. Dental ____
• 3. Root ____
• 4. ____ root resorption and ____ tears

anatomic
restorations/appliances
fractures
cervical
cemental

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• 2. Gingival diseases modified by systemic factors

a. associated with the endocrine system
1) puberty-associated gingivitis
- • Inflammation, swelling, that doesn’t directly correlate to amount of ____ present - when a systemic factor is affecting it

2) ____ cycle-associated gingivitis
3) pregnancy-associated
a) gingivitis
b) pyogenic granuloma
- • Associated with ____
• ____ lesion

4) ____ mellitus-associated gingivitis
b. associated with blood dyscrasias (_____)

plaque
menstrual
pregnancy
localized

leukemia

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Dental Plaque Induced Gingival Diseases

• 3. Gingival diseases modified by medications
a. drug-influenced gingival enlargements
(____, ____, ____ blockers)
- • Doesn’t correlate to amounts of ____
• Used for h____ patients (nifedipine/Ca channel blockers)

b. drug-influenced gingivitis
1) oral ____-associated gingivitis
2) other

anticonvulsants
immunosuppressive
Ca-channel

plaque
hypetensives
contraceptives

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Dental Plaque Induced Gingival Diseases

• 4. Gingival diseases modified by malnutrition

a. ascorbic acid-deficiency gingivitis
b. other

• Ascorbic acid - \_\_\_\_ deficiency

vitamin C

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o I. B. Non-Plaque-Induced Gingival Lesions
• 1. Gingival diseases of specific bacterial origin
a. Neisseria ____-associated lesions
b. Treponema ____-associated lesions
c. ____l species-associated lesions
d. other

Primary syphilitic chancre
• On the ____

Secondary oral syphilis
• Can have secondary presentations in the ____

gonorrhea
pallidrum
streptococcal

tongue
mucosa

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Non-Plaque Induced gingival

• 2. Gingival diseases of viral origin a. herpesvirus infections
1) primary ____
• Mainly seen in ____, but seen in adults also
• Presents when exposed to HSV1
• Generalized in both the ____ and ____
• And very ____

2) recurrent oral herpes
• Common, >90% have recurrent oral herpes - inducer is ____
• Can happen also on ____ (keratinized tissue), not mucosa
• Happens as a response to localized stress - can occur as a response to ____ surgery
• Typical lesions - connective tissue graft for pontic development - recurrent oral herpes and a nathos lesion on the mucosa

3) ____ zoster infections
b. other

herpetic gingivastomatitis
children
gingiva mucosa
painful

stress
gingiva
periodontal

varicella

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Non-plaque induced gingiva

Gingival diseases of fungal origin
a. Candida-species infections
1) generalized gingival candidosis
• ____ patches on gingiva or mucosa
• Acute pseudomembranous candidio
• No white patches > ____
• Mainly seen in ____ patients, who may have been missing ____ > reduced vertical dimension of ____

white
erythematous
elderly
teeth
occlusion

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Non-plaque induced gingiva

Gingival diseases of fungal origin a. Candida-species infections
1) generalized gingival candidosis
b. linear gingival erythema• Line along ____ that is red, due to fungal

gingival margin

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Non-plaque induced gingival lesions

• 3. Gingival diseases of fungal origin a. Candida-species infections

1) generalized gingival candidosis
b. linear gingival erythema
c. ____
d. other

histoplasmosis

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Non plaque induced gingiva

•  4. Gingival lesions of \_\_\_\_ origin 
a. hereditary gingival fibromatosis
	• Was in the patient's family - \_\_\_\_
	• 4 y/o > \_\_\_\_ lesions (reminds similar to \_\_\_\_-induced)
	• \_\_\_\_ to manage in young patients

b. other

genetic
hereditary
generalized
drug
difficult

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Non-plaque induced gingival lesions

• 5. Gingival manifestations of systemic conditions a. mucocutaneous disorders

1) ____
2) ____
3) pemphigus vulgaris
4) erythema multiforme
5) lupus erythematosus
6) drug-induced
7) other

lichen planus

pemphigoid

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Characteristics of Pemphigoid
• Approximately ____ of desquamative gingivitis cases
• ____l and ____ lesions, conjunctiva lesions, genital lesions
• Subepithelial ____
• ____ deposits of ____ and ____

50%
gingival
mucosal
bullae
basement membrane
IgG
C3

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Characteristics of Lichen Planus
• Approximately ____ of desquamative gingivitis cases
• Reticular: striae of ____, sawtooth ____ [most ____]
• ____: bullous plaques with erythematous halo and striae
• ____: erosions with striae
• Different clinical manifestation - more ____ of a lesion
• Both mucosa and gingiva
• ____: tongue loses papillae, gingiva is thinned

25%
wickham
rete pegs
common
bullous
erosive
red
atrophic

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Non-plaque induced gingival lesions

• 5. Gingival manifestations of systemic conditions

a. mucocutaneous disorders
b. allergic reactions
1) ____ materials
2) reactions attributable to
a) toothpastes/dentifrices
b) mouthrinses/mouthwashes c) ____ additives
d) food additives
3) other

dental restorative

chewing gum

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Allergic reaction to ____

* PFM crown that include \_\_\_\_
* \_\_\_\_ gingiva

nickel
nickel
erythematous

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Allergic reaction to chewing gum additives * ____ in chewing gum is a common allergen * ____ - difficult diagnosis - generalized reaction

cinnamon | uncommon

Non-plaque induced gingival lesions 6. Traumatic lesions (factitious, iatrogenic, accidental) a. ____ injury b. ____ injury c. ____ injury

chemical physical thermal

Self-inflicted chemical injury (aspirin) • Must take an adequate ____ in order to determine whether it was mechanical, chemical, thermal, etc. ○ Ask specific ____ • Aspirin placed locally > self-inflicted chemical injury • Cannot tell just by looking > need a good history Self-inflicted chemical injury (H2O2) • H2O2 > use as a mouthrise ____ > take good history Facticious physical injury (floss) Self-inflicted thermal injury • ____ mucosa > hot food Iatrogenic thermal injury (ultrasonic) • Ultrasoinc without proper irrigation, or handpiece • Can be both ____ and ____

``` history questions undiluted palatal extraoral intraoral ```

Non-plaque induced gingival lesions • 7. Foreign body reactions * Gingival enlargement, foreign body * ____ treatment

orthodontic

Chronic Perio ____ ____

clinical attachment loss (CAL) | bleeding on probing (BOP)

Chronic Periodontitis 1. Extent • Generalized CAL in > ____% of sites Localized CAL in ≤ ____% of sites ``` 2. Severity Slight CAL = ____ mm Moderate CAL = ____ mm Severe CAL ≥ ____ mm ```

``` 30 30 1-2 3-4 5 ```

Characteristics of Chronic Periodontitis * ____ progression rate with possible periods of ____ progression * More prevalent in ____ but can occur in younger individuals * Amount of destruction consistent with ____ factors * Associated with a variable ____ pattern * ____ calculus frequently present * Not a ____ bacteria responsible > large numbers of bacterium involved * Subging calculus - visual, tactile and radiograph (a lot if ____)

``` slow rapid adults local microbial subgingival ``` specific radiograph

Generalized Slight Chronic Periodontitis • Some local factors present - plaque, calculus • May have some bone loss (or loss) ○ Attachemtn loss preceds bone loss by ____ months Generalized Moderate Chronic Periodontitis • A little bit older • Generalized recession, and generalized bone loss Generalized Severe Chronic Periodontitis • Wouldn’t suspect ____ > not a lot of plaque, and no ____; would have to insert probe • Not a lot of plaque > may have just had their prophy done • FMX > a lot of bone loss, generalized and lcoalized bone loss • Shouldn't judge by age, or just by looking - have to do ____ measurements (probing) and ____

``` 6 visually recession clinical FMX ```

Periodontitis Update - Probing depth (PD) - CAL - BOP - Full mouth radiographs • Safest bet to stick with clinical attachment loss • Table summarizes update and the 1999 classification • Update: three categories, slight (mild),moderate severe (advanced) • Keep same guidelaines for CAL (1-2, mild, 3-4, mod >5 severe), keep BOP • Include ____, and ____ ○ More >3mm <5mm, that can be slight perio; 5-6 is mod; >7 severe; probing depth by itself doesn't mean much, need radiograph ○ 15% silgt, 16-30 mod, >30 severe ○ Combine > use own ____ if not agreeing > then you look at ____

probing depth radiographic bone loss judgement CAL

Inflammation on Reduced Periodontium Update - Probing depth (PD) (=< ____mm) - CAL (>____) - BOP - Full mouth radiographs

3 | 0

Healthy but Reduced Periodontium Update - Probing depth (PD) (=< ____) - CAL (>____) - NO ____!!!! - Full mouth radiographs

3 0 BOP

Aggressive Periodontitis Systemic Diseases Medication CAL BOP Plaque Index Radiographs • For aggressive, you also need absence of ____, no ____ that affecting periodontium, and ____ index (very little relative to disease, opposite of chronic) ○ Little amounts, but a lot of disease • Radiograph - bone loss, but also typical characteristic patterns of bone loss

systemic diseases medications plaque

SAME EXTENT AND SEVERITE FOR AGGRESSIVE PERIO AS THERE IS FOR CHRONIC!!

YAY

Characteristics of Aggressive Periodontitis Otherwise ____ healthy patient Rapid attachment loss and bone destruction Amount of microbial deposits ____ with disease severity ____ aggregation of diseased individuals * No systemic disease or medication affecting CAL * Rapid attachment loss and bone destruction (v diff from chronic) * Need at least ____ examinations (in order to determine rate) * Small plaque, a lot of disease; cannot be explained by this only * Family lost teeth at very early age

systemically inconsistent familial

Characteristics of Aggressive Periodontitis Localized Juvenille Periodontitis (LJP, 1989 Classification) Age of onset in the ____ period ____ and ____, usually ____ Associated with ____ Abnormalities in neutrophil or monocyte function * Not a current term - not used to diagnose - comes from ____ classification * Around puberty * AA > certain type of lozalized aggressive perio, this LJP

``` circumpubertal first molars incisors bilateral AA 89 ```

Periodontitis as a Manifestation of Systemic Diseases o IV. A. Associated with hematological disorders • 1. Acquired ____ • 2. Leukemias • 3. Other ``` o IV. B. Associated with genetic disorders • 1. Familial and cyclic neutropenia • 2. ____ syndrome • 3. Leukocyte adhesion deficiency syndromes • 4. ____ syndrome • 5. Chediak-Higashi syndrome • 6. ____ syndromes • 7. Glycogen storage disease • 8. Infantile genetic agranulocytosis • 9. ____ syndrome • 10. Ehlers-Danlos syndrome (Types IV and VIII) • 11. ____ • 12. Other ```

``` neutropenia down papillon hisocytosis cohen hypophosphatasia ```

Perio as a manifestation of systemic disease ____ disease ____ ____ SAME EXTENT AND SEVERITY FOR PERIO!

systemic CAL BOP

"Special" Periodontal Disease Diagnosis V. Necrotizing Periodontal Diseases A. ____ B. ____

Necrotizing ulcerative gingivitis (NUG) | necrotizing ulcerative periodontitis (NUP)

Clinical Characteristics of NUG • Interproximal necrosis and ulceration, ____ and ____ papillae • ____ – spontaneous or on slight provocation • ____ gingiva * Gray ____ * Fetor oris (bad ____) * Slight fever, ____ , lymphadenopathy * First three must be present for NUG *** * Periodontal disease - no pain * The last three may be present, but not necessary * Systemic ____ > slight fever, malaise, lymphadenopathy

punched-out cratered bleeding painful pseudomembrane breath malaise manifestations

Pathogenesis of NUG * Usually ____ individuals * Associated with impaired ____ * Associated with ____ factors, such as stress, smoking, fatigue * Associated with ____, spirochetes, ____ intermedia * Typical in students around ____ period * Specific bacteria

``` younger host response predisposing fusiform bacilli prevotella exam ```

Clinical Characteristics of NUP • Interproximal necrosis and ulceration, punched-out and cratered papillae • Bleeding – spontaneous or on slight provocation • Painful gingiva • Gray pseudomembrane • Fetor oris (bad breath) • Slight fever, malaise , lymphadenopathy • In addition, ____ and ____

clinical attachment loss | alveolar bone loss

Abscesses of the Periodontium A localized purulent infection * ____: involves the marginal gingiva or interdental papilla * ____: within the tissues adjacent to the periodontal pocket that may lead to the destruction of periodontal ligament and alveolar bone * ____: within the tissue surrounding the crown of a partially erupted tooth abscesses Usually seen with ____

gingival periodontal pericoronal third molars

``` Characteristics of Periodontal Abscesses • ____ • Swelling • ____ • BOP • ____ • Tooth mobility ```

Pain pocket suppuration

Etiology of Periodontal Abscesses Absence of periodontitis ____ impaction Associated with ____ lesions Presence of periodontitis Untreated ____ after systemic antibiotic therapy Residual apical calculus in deep pockets after non-surgical ____ * A lot of local factors > receive antibiotics > the marginal tissue is reduced, and the tissue can tighten > formation of an abscess when theres' subging calc in the pocket * IF some calculus is left, then the ifnlammation goes down but then it forms an abscess***

foreign object endodontic periodontitis SRP

Periodontitis Associated with Endodontic Lesions • Primary Endodontic Lesion • Primary Endodontic Lesion with Secondary Periodontal Involvement • Primary Periodontal Lesion • Primary Periodontal Lesion with Secondary Endodontic Involvement • “True” Combined Endodontic and Periodontal Involvement * PPL > ____ pocket that can be an endodontic lesion, if it hits the pulp * True - bacteria from pulp and perio and ____ * ____ origin of lesion can tell you the course of treatment

deep meet primary

What is Gingival Recession? Gingival Recession: location of the gingival margin (GM) ____ to the cementoenamel junction (CEJ)

apical

What is Gingival Recession? Gingival Recession: location of the gingival margin (GM) apical to the cementoenamel junction (CEJ) • due to periodontitis, that affects all ____ surfaces and is usually ____ • primarily related to ____ factors, that affects facial or lingual surfaces and is ____ or partially reversible with periodontal reconstructive surgery • Or mechanical (facial or lignual) > ____ > can treat with grafting and can cover roots

``` tooth irreversible mechanical reversible reversible ```

MILLER CLASS FROM WANG! Class I: ____ root coverage can be anticipated Class II: ____ root coverage can be anticipated Class III: ____ root coverage can be anticipated Class IV: Root coverage ____ be anticipated

100% 100% partial cannot

VIII. B. Mucogingival deformities and conditions around teeth 2. Lack of keratinized gingiva • Inability of patient to ____ effectively, and in placing a ____ - the soft tissue surrounding may not be able to withstand ____

brush restoration forces

VIII. B. Mucogingival deformities and conditions around teeth 4. Aberrant frenum/muscle position • Bt max central incisors, or wherever ____ - ____ type defects

frenum | recession

o VIII. B. Mucogingival deformities and conditions around teeth 5. Gingival excess a. pseudopocket • Gingival ____ b. inconsistent gingival margin • Gingival ____ • More aesthetic conditions • Can be ____ c. excessive gingival display • Gummy smile, showing a lot of ____ • Can be ____ d. gingival enlargement • ____ patients - related to rotho appliances

``` excess excess treated soft tissue treated ortho ```

o VIII. B. Mucogingival deformities and conditions around teeth 6. Abnormal color • ____ tattoo - used for apilocteomy • Discoloration to ____ used

amalgam | restoration material

o VIII. C. Mucogingival deformities and conditions on edentulous ridges • 1. Vertical and/or horizontal ridge deficiency Class I: ____ (____) Class II: ____ (____) Class III: ____ * Cannot find II > when tooth extracted, horizontal doesn't always happen by itself, rare, ____ usually always happens * III> deficiency in both * In order to prepare for implant, need ____

``` bucco-lingual horizontal apico-coronal vertical combination ``` vertical ridge dimensions

VIII. Developmental or Acquired Deformities and Conditions D. Occlusal Trauma Injury resulting in tissue changes within the attachment apparatus as a result of ____

occlusal forces

VIII. D. Occlusal Trauma • 1.Primary occlusal trauma: injury resulting in tissue changes from excessive ____ applied to a tooth or teeth with ____ support • 2.Secondary occlusal trauma: injury resulting in tissue changes from ____ or ____ occlusal forces applied to a tooth or teeth with ____ support * Primary - in the absence of ____ * Secondary - pt with ____, even normal forces, the perio cannot withstand bc its reduced

``` occlusal forces normal normal excessive reduced ``` periodontitis perio

``` Clinical Signs of Occlusal Trauma • ____ • Fremitus • Occlusalprematurities • ____ (in presence of other clinical indicators) • Seen on ____/____ ``` * Tooth migration * Fractured tooth(teeth) * ____ sensitivity * How do we diagnose? Not easy, no ____ measures * Clinical or radiograph signs used to diagnose * Fremitus - when you bite and your teeth move a lot; and ____ mobility * Wear facets in presence of others, not by themselves * Need to have some of these signs present

``` mobility (progressive) wear facets functional cusps incisal edges thermal objective functional ```

Radiographic Signs of Occlusal Trauma • Widened ____ space • Bone loss (____; vertical; ____) • Root ____ • PDL is widened when compared to other teeth

PDL furcation circumferential resorption

9. Diagnosis and Classification of Periodontal Disease Flashcards

(61 cards)