Classification of Periodontal Diseases (2)

Question 1

Can you have periodontal health on a reduced periodontium?

Answer 1

• Yes
• Can have recession but due to a cause other than periodontitis e.g. crown lengthening surgery or wisdom tooth extraction that leaves a defect on the distal of the 7

Question 2

If a patient has a reduced periodontium due to periodontitis will they always be a periodontitis patient?

Answer 2

• Yes

Question 3

What are the new definitions of periodontal health? (3)

Answer 3

• Patients with an intact periodontium
• Patients with a reduced periodontium due to causes other than periodontitis and
• Patients with a reduced periodontium due to periodontitis

Question 4

What is the definition/requirements for gingival health?

Answer 4

• Clinical gingival health in an intact periodontium is characterised by the absence of bleeding on probing, erythema and edema, patient symptoms and attachment and bone loss
• Physiological bone levels range from 1.0-3.0mm apical to the cemento-enamel junction
• For an intact periodontium and a reduced and stable periodontium, gingival health is defined as <10% bleeding sites and no pocket depths exceeding 3mm

Question 5

What 2 types of periodontium can be included as ‘plaque-induced gingivitis’ (localised/generalised)?

Answer 5

• Intact periodontium

- Reduced periodontium

Question 6

What can cause plaque-induced gingivitis? (3)

Answer 6

• Associated with dental biofilm alone
• Mediated by systemic or local risk factors
• Drug influenced gingival enlargement

Question 7

When is bleeding on probing localised?

Answer 7

When there are less than 30% of sites affected

Question 8

When is bleeding on probing generalised?

Answer 8

When there are more than 30% of sites affected

Question 9

Is gingivitis stable if there is bleeding on probing?

Answer 9

• No

Question 10

What do the probing pocket depths need to be if periodontitis is stable?

Answer 10

• Need to be 4mm or less

Question 11

What are modifying factors for plaque-induced gingivitis?

Answer 11

1. Systemic conditions
   a) Sex steroid hormones
   1) Puberty
   2) Menstrual cycle
   3) Pregnancy
   4) Oral contraceptives

b) Hyperglycaemia
c) Leukaemia
d) Smoking
e) Malnutrition

2. Oral factors enhancing plaque accumulation
   a) Prominent subgingival restoration margins
   b) Hyposalivation
3. Drug-influenced gingival enlargements

Question 12

Will hormonal changes itself cause gingivitis?

Answer 12

• No

- The plaque causes the gingivitis and change in hormones may exaggerate the response

Question 13

What is a pregnancy epulis considered as?

Answer 13

• Considered a mucogingival deformity

Question 14

Are Pregnancy epulis’s common?

Answer 14

• Yes

- They are made worse by the presence of plaque

Question 15

Drug influenced gingival enlargement is relatively common. What are 2 types of drug that can cause this?

Answer 15

• Calcium channel blockers

- Immunosuppressants

Question 16

What are possible causes of non-dental biofilm induced gingival diseases? (8)

Answer 16

• Genetic/developmental disorders
• Specific infections
• Inflammatory and immune conditions
• Reactive processes
• Neoplasms
• Endocrine, nutritional & metabolic diseases
• Traumatic lesions
• Gingival pigmentation

Question 17

What is an example of an inflammatory/immune condition that can cause non-plaque induced gingival diseases?

Answer 17

• Lichen planus

Question 18

What nutritional deficiency can cause plaque indices gingival diseases?

Answer 18

• Vitamin C deficiency

Question 19

What is usually present in a patient with necrotising gingivitis? (7)

Answer 19

• Necrosis and ulcer in the interdental papilla
• Gingival bleeding
• Pain
• Pseudo membrane formation
• Halitosis
• Extra oral - regional lymphadenopathy/ fever
• In children, pain and halitosis less frequent, whereas fever, lymphadenopathy and sialorrhea were more frequent

Question 20

What is halitosis?

Answer 20

• Offensive smelling breath

Question 21

What is usually present in a patient with necrotising periodontitis? (4)

Answer 21

• In addition to S&S of necrotising gingivitis:
• Periodontal attachment and bone destruction (this can happen rapidly)
• Frequent extraoral signs
• In severely immune-compromised patients, bone sequestrum may occur

Question 22

What is usually present in patients with necrotising stomatitis? (2)

Answer 22

• Bone destruction extended through the alveolar mucosa

- Larger areas of osteitis and bone sequestrum

Question 23

What are characteristics of necrotising gingivitis? (6)

Answer 23

• Quite distinctive
• Sluffing of the gingival margin
• White/grey fibrin coating
• Looks very sore
• Ulceration
• Papilla have lost their normal architecture

Question 24

What are characteristics of necrotising periodontitis? (3)

Answer 24

• Get negative architecture
• Crater like defect
• Very localised and very dramatic loss of bone and tissue

Question 25

Give examples of rare diseases that affect the course of periodontitis resulting in the early presentation of severe periodontitis? (5)

Answer 25

- Papillon Lefevre syndrome - Leukocyte adhesion deficiency - Hypophosphatasia - Down's syndrome - Ehlers-Danlos

Question 26

There are rare conditions that affect the periodontal supporting tissues independently of dental plaque biofilm-induced inflammation. Give 2 examples of these?

Answer 26

- This is a more heterogenous group of conditions which result in breakdown of periodontal tissues and some of which may mimic the clinical presentation of periodontitis. - Squamous cell carcinoma - Langerhans cell histiocytosis

Question 27

Are periodontal abscesses common?

Answer 27

- Yes

Question 28

How do periodontal abscesses often present?

Answer 28

Present often with pus draining through a pocket or sinus

Question 29

When might we see periodontal abscesses? (3)

Answer 29

- People with periodontitis who don't get periodontal treatment will get abscesses - People who do get periodontal treatment might get some but much less - Sometimes see periodontal abscesses in people who don't have periodontitis - this could be because something is stuck there or could be the dentists fault e.g. leaving a bit of dam or floss to get stuck there

Question 30

What is a periodontal endodontic lesion?

Answer 30

- Essentially a non-vital tooth with abscess - Need to find out if there is root damage or not - If there is then need to work out what is wrong - If no root damage then need to find out if it is a periodontal patient or not

Question 31

What is the most common mucogingival deformity/condition?

Answer 31

- Gingival recession

Question 32

What is type 1 gingival recession?

Answer 32

Gingival recession with no loss of inter-proximal attachment. Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth

Question 33

What is type 2 gingival recession?

Answer 33

Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the depth of the interproximal sulcus/pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket)

Question 34

What is type 3 gingival recession?

Answer 34

Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the apical end of the sulcus/pocket) is greater than the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket)

Question 35

Look at lecture for examples

Answer 35

:)