Introduction to classification of periodontal disease Flashcards
List the determinants of clinical periodontal health according to the 2017 AAP Periodontal Classification system
- Microbiological determinants
- Host determinants
- Environmental determinants
Identify the microbiological components of the 2017 AAP Periodontal Classification system
• Supragingival plaque composition
* Subgingival biofilm composition
Identify the host determinants of the 2017 AAP Periodontal Classification system
Local predisposing factors ○ Periodontal pockets ○ Dental restorations ○ Root anatomy ○ Tooth position and crowding
Systemic modifying factors
○ Host immune function
○ Systemic health
○ Genetics
Identify the environmental determinants of the 2017 AAP Periodontal Classification system
- Smoking
- Medications
- Stress
- Nutrition
List the general categories included in AAP “Periodontal and Gingival Diseases and Conditions”
- Periodontal and Gingival health
- Biofilm induced gingivitis
- Non- biofilm induced gingival disease
Describe the “Periodontal and Gingival health” component of “Periodontal and Gingival Diseases and Conditions”
• Assesses the gingival health on intact periodontium i.e, no clinical attachment loss or bone loss
• Assesses the gingival health on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable
* Clinical gingival health can be restored following treatment of gingivitis and periodontitis
Describe the “biofilm induced gingivitis” component of “Periodontal and Gingival Diseases and Conditions”
- Associated with dental biofilm alone
- Mediated by local or systemic risk factors
- Drug influenced gingival enlargement
Describe the “non- biofilm induced gingivitis” component of “Periodontal and Gingival Diseases and Conditions”
• Genetic/ developmental; disorders • Specific infections • Immune and inflammatory conditions • Endocrine, nutritional and metabolic diseases Traumatic lesions
List the general categories included in AAP
‘Periodontitis’
- Necrotising Periodontal Diseases
- Periodontitis
- Periodontitis as a Manifestation of Systemic Disease
What are the types of Necrotising Periodontal Diseases?
- Necrotising stomatitis
- Necrotising gingivitis
- Necrotising periodontium
What are the systemic diseases identified in the category of ‘Periodontitis as a Manifestation of Systemic Disease’? (10)
- Genetic diseases
- Diseases associated with immunological disorders; down syndrome, severe neutropenia
- Diseases affecting oral mucosa and gingival tissue; epidermolysis bullosa
- Diseases affecting connective tissues; systemic lupus erythematous
- Metabolic and endocrine disorders; glycogen storage disorders
- Acquired immunodeficiency diseases; HIV, acquired neutropenia
- Inflammatory diseases; inflammatory bowel disease
- Systemic disorders; diabetes, obesity, osteoporosis, arthritis,
- Neoplasms (growths); squamous Cell Carcinoma, secondary metastatic neoplasms of perio tissues
- Other disorders; langerhans cell histiocytosis, hyperparathyroidism
Explain ‘staging’ of periodontitis
Staging is known as classifying the severity and extent of a patients disease based on the measurable amount of destroyed/ damaged tissue
What are elements included in the staging of diseases?
- Complexity
- Severity
- Extent and distribution
Describe the “extent and distribution” staging component
- Disease is localised when less than 30% of teeth have loss of attachment (LOA)
- Disease is generalised when greater than or equal to 30% of teeth have LOA
What does the “complexity” staging component include?
- Probing depth
* Type of bone loss
Describe the “complexity” staging component
Stage 1:
• 4 mm PD
* Horizontal bone loss
Stage 2:
• 5 mm PD
* Horizontal bone loss
Stage 3:
• 6 mm PD
• Vertical bone loss 3 mm
* Furcation of Class II or III
Stage 4: • 6 mm PD • Vertical bone loss • All of stage 3 plus masticatory dysfunction • Tooth mobility * Less than 20 remaining teeth
What does the “severity” staging component include?
- Radiographic bone loss (RBL)
- Tooth loss
- Interdental Clinical Attachment Loss (CAL) or LOA (loss of attachment)
Describe the “CAL or LOA” of the severity staging component
- Measured from CEJ to base of sulcus
- Not the same as probing depth
- To measure when recession is present: probing depth + recession
- No recession but PD of 4mm: probing depth - 3mm (healthy gingiva is 3 mm max)
Stage 1: 1- 2mm
Stage 2: 3- 4 mm
Stage 3: 5mm
Stage 4: 5mm
Describe the “RBL” of the severity staging component
- Stage I: coronal third of root (<15%)
- Stage II: coronal third of root(15 - 33%)
- Stage III and IV: extending to middle third of root and beyond
Describe the “Tooth loss” of the severity staging component
Stage 1: 0
Stage 2: 0
Stage 3: 4
Stage 4: 5+
Discuss the key characteristics of stage 1 periodontitis
• Gingival inflammation
• Microbial dysbiosis
* Early LOA
Discuss the key characteristics of stage 2 periodontitis
• Damage to tooth supporting structures
- Established periodontitis
- Management: simple; professional bacterial removal and monitoring to arrest disease progression
Discuss the key characteristics of stage 3
• Significant LOA
- Deep PD Lesions extending to middle portion of root
- Management: complicated by infraboney defects, and furcation involvement
Discuss the key characteristics of stage 4
• Significant LOA
- Deep PD Lesions extending to middle portion of root
- Management: Complicated by tooth hypermobility
- Requires stabilisation or restoration of masticatory functions
