Classification Scheme for Periodontal & Peri-Implant Diseases

Question 1

The periodontitis Armitage 1999 states that the severity of disease is based upon:

Answer 1

clinical attachment level (gold standard)

Question 2

The periodontitis Armitage 1999 states that the severity of disease is based upon clinical attachment level (gold standard)

Slight:
Moderate:
Severe:

Answer 2

Slight: 1-2 mm
Moderate: 3-4mm
Severe: >= 5mm

Question 3

The periodontitis Armitage 1999 states that the severity of disease is based upon clinical attachment level (gold standard)

________: 1-2mm
________: 3-4mm
________: greater than or equal to 5mm

Answer 3

Slight: 1-2mm
Moderate: 3-4mm
Severe: greater than or equal to 5mm

Question 4

What is the PRIMARY cause of tooth loss in the US population over the age of 30?

Answer 4

Periodontitis

Question 5

With the 1999 classification of periodontal diseases and conditions, why was there concern with the categories chronic periodontitis and aggressive periodontitis?

Answer 5

there was not enough evidence that they were two different entities

Question 6

In simple terms what’s it mean if you have periodontitis?

Answer 6

attachment loss

Question 7

What can cause pseudo pockets?

Answer 7

gingival hyperplasia due to medications, genetic diseases etc.

Question 8

Attachment loss can be measured via:

Answer 8

radiographic bone loss & probing depths

Question 9

If there is no attachment loss there is no _____ because its not ____

Answer 9

staging & grading; periodontitis

Question 10

Few practitioners use _____ routinely

Answer 10

clinical attachment level (CAL)

Question 11

AAP formed a task force in 2015 to identify alternative criteria including:

Answer 11

1. radiographic bone loss (RBL)
2. probing depth (PD)

Question 12

T/F: A 6mm probing depth with 20% bone loss is significantly different that 6 mm with 75% bone loss

Answer 12

True

Question 13

Probing depth is not considered:

Answer 13

diagnostic

Question 14

Probing depth is not considered diagnostic because: (2)

Answer 14

1. Inflammation has effect on penetration of probe into tissue
2. Inflammation (swelling) may move gingival margin coronally (pseudo pocket)

Question 15

When inflammation moves the gingival margin coronally:

Answer 15

pseudopocket

Question 16

In regard to the 2015 task force guidelines, the 2017 workshop recommended: (2)

Answer 16

1. use interproximal attachment loss (2 or more non-adjacent teeth)
2. use probing depth as a “complexity” factor (difficulty of treatment)

Question 17

How do you use attachment loss?

Answer 17

Use two sites that are not next to each other

Question 18

The 2017 classification of periodontal and peri-implant diseases and conditions new classification is based on strongest:

Answer 18

current evidence

Question 19

The 2017 classification of periodontal and peri-implant diseases and conditions developed a ______ system that is:

Answer 19

adaptive system; 3 dimensional

Question 20

The 2017 classification of periodontal and peri-implant diseases and conditions adaptive system (3 dimensional) takes into account: (3)

Answer 20

1. severity/extent (number of teeth affected rather than sites)
2. prognosis (affects no teeth, up to 4 teeth, 5 or more teeth)
3. progression (grading)

Question 21

answer to something: Plaque in a susceptible host

basically was discussing about if he gave each of us a spoonful of plaque (ew) why we would all not have the same response

Question 22

Periodontal disease is an _____ disease

Answer 22

inflammatory

Question 23

Approximately _____ % of adults over the age of 30 years old have periodontitis and this is the primary cause of tooth loss in adults

Answer 23

47%

Question 24

What is the primary cause of tooth loss in adults?

Answer 24

periodontitis

Question 25

What categories of people show a greater percentage of periodontitis?

Answer 25

- Men - Mexican Americans - Adults below the 100% federal poverty level - current smokers - self reported diabetics

Question 26

Three steps to staging and grading a patient Step 1:

Answer 26

Initial case overview to assess disease

Question 27

Three steps to staging and grading a patient Step 1: Initial case overview to assess disease Screening involves:

Answer 27

1. full mouth probing depths 2. full mouth radiographs 3. missing teeth

Question 28

Mild to moderate periodontitis will typically be either:

Answer 28

stage I or stage II

Question 29

Clinical attachment loss of 1-2mm is stage:

Answer 29

Stage I

Question 30

Clinically attachment loss of 3-4mm is stage:

Answer 30

Stage II

Question 31

Three steps to staging and grading a patient Step 2:

Answer 31

Establish stage

Question 32

When establishing a stage (step 2) for mild to moderate periodontitis (typically stage I or stage II), what else are you determining during this step?

Answer 32

- confirm clinical attachment loss (CAL) - rule out non-periodontitis causes of CAL (e.g. cervical restorations or caries, root fractures, CAL due to traumatic causes) - Determine maximum CAL or radiographic bone loss - Confirm RBL patterns

Question 33

For moderate to severe periodontitis these guys are typically:

Answer 33

Stage III or IV

Question 34

When establishing a stage (step 2) for moderate to severe periodontitis (typically stage III or stage IV), what else are you determining during this step?

Answer 34

- determine maximum CAL or RBL - confirm RBL patterns - assess tooth loss due to periodontitis - evaluate case complexity factors (e.g. severe CAL frequency, surgical challenges)

Question 35

Three steps to staging and grading a patient Step 3:

Answer 35

Establish grade

Question 36

What should be done in step 3- establishing the grade of the patient?

Answer 36

- calculate RBL (% of root length x 100) divided by age - assess risk factors (such as smoking or diabetes) - measure response to scaling and root planing and plaque control - assess expected rate of bone loss - conduct detailed risk assessment - account for medical and systemic inflammatory considerations

Question 37

According to the AAP 2017 classification, in regards to staging and grading: Every patient categorized based on the _______ periodontal site and specific factors that may impact long term management

Answer 37

WORST

Question 38

According the the AAP 2017 classification, staging is divided into:

Answer 38

1. severity 2. complexity 3. extend and distribution

Question 39

Classify the following stages- Stage 1: Stage 2: Stage 3: Stage 4:

Answer 39

Stage 1: Initial Stage 2: Moderate Stage 3: Severe with potential for additional tooth loss Stage 4: Severe with potential for loss of dentition

Question 40

Staging 1-4 is based upon:

Answer 40

severity of disease and complexity of case management

Question 41

What should be taken into consideration when staging?

Answer 41

1. Clinical attachment loss (CAL) - USING WORST SITE 2. Amount and % of bone loss 3. Probing depth 4. Presence/extend of ridge defects and furcation involvement 5. Tooth mobility 6. Tooth loss (due to periodontitis if known)

Question 42

Criteria for Defining Periodontitis:

Answer 42

- Interdental clinical attachment loss at 2 or more NON-ADJACENT teeth OR - Buccal or oral clinical attachment loss of > or = 3mm with a) pocketing of greater than 3 mm b) on 2 or more teeth

Question 43

According to the New staging guidelines using interproximal CAL; a CAL of 1-2 mm would classify someone as:

Answer 43

Stage I

Question 44

According to the New staging guidelines using interproximal CAL; a CAL of 3-4 mm would classify someone as:

Answer 44

Stage II

Question 45

According to the New staging guidelines using interproximal CAL; a CAL of greater than equal to 5mm would classify someone as:

Answer 45

Stage III or IV

Question 46

CAUTION: Ensure the problem cannot be attributed to non-periodontal causes such as:

Answer 46

1. Gingival recession- due to trauma (toothbrush trauma/toothpaste abrasion) 2. Dental caries- extending to or below the gingival margin 3. Defect on distal of 2nd molars caused by malposition or extraction of a 3rd molar 4. Endodontic lesion-draining through marginal periodontium (deep probing depth) 5. Vertical root fracture (usually isolated deep probing depth)

Question 47

Complexity: 1. Takes into account ____ 2. Evaluates ____ 3. Evaluates ____

Answer 47

1. overall probing depths 2. radiographic bone loss, horizontal and vertical 3. furcation involvements, number of missing teeth, function

Question 48

When considering staging and grading for periodontitis, factors to consider include all EXCEPT: - smoking - diabetes - attachment level - bleeding on probing

Answer 48

- bleeding on probing because this is just a sign of inflammation

Question 49

Prognosis based upon staging and tooth loss Stage I or II =

Answer 49

No tooth loss likely