Perio Classification

Question 1

Give examples of non-plaque induced gingival diseases

Answer 1

• herpetic gingival stomatitis
• genetic
• immune conditions e.g. lichen planus
• vitamin c deficiency

Question 2

What are the signs and symptoms of necrotising gingivitis?

Answer 2

• pain
• gingival bleeding
• necrosis and ulcer in the interdental papilla

Question 3

Periodontal health definitions

Answer 3

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

Question 4

gingival health definition for an intact periodontium

Answer 4

absence of:
- bleeding on probing
- erythema and edema
- patient symptoms
- attachment and bone loss

physiological bone levels range from 1 to 3mm apical to ACJ

Question 5

Gingival health definition for reduced and stable periodontium that’s intact

Answer 5

• <10% bleeding sites
• probing depth less than or equal to 3mm

Question 6

plaque induced gingivitis features

Answer 6

• associated with dental biofilm alone
• mediated by systemic or local risk factors
• drug influenced gingival enlargement
• no radiological bone loss
• no interdental recession

Question 7

Localised vs generalised gingivitis

Answer 7

localised
<30% BOP

generalised
>30% bleeding on probing

Question 8

potential modifying factors of plaque induced gingivitis

Answer 8

systemic conditions
- sex steroid hormones e.g. menstrual cycle, puberty, pregnancy, oral contraceptives
- hyperglycaemia
- leukaemia
- smoking
- malnutrition
oral factors enhancing plaque accumulation
- prominent sub gingival restoration margins
- hyposalivation

Question 9

necrotising gingivitis - features

Answer 9

• necrosis and ulcer in interdental papilla
• gingival bleeding
• pain
• pseudomembrane formation
• halitosis
• regional lymphadenopathy
• fever

Question 10

necrotising periodontitis features

Answer 10

in addition to signs and symptoms of NG:
- periodontal attachment and bone destruction
- frequent extraoral signs
- bone sequestrum possible in severely immune-compromised patient

Question 11

necrotising stomatitis signs

Answer 11

• bone destruction extended through alveolar mucosa
• larger areas of osteitis and bone sequestrum

Question 12

Periodontitis as a manifestation of systemic disease

Answer 12

classification based on primary systemic disease
mainly rare diseases affecting course of periodontitis in early presentation of severe periodontitis:
- papillon lefervre syndrome
- leucocyte adhesion deficiency
- Down’s syndrome

Question 13

systemic diseases or conditions affecting periodontal tissues

Answer 13

mainly rare conditions affecting the periodontal sporting tissues independently of dental plaque biofilm induced inflammations:
- squamous cell carcinoma
- langerhans cell histicytosis

Question 14

mucogingival deformities and conditions

Answer 14

gingival recession
- lack of keratinised gingiva/abnormal frenal attachment

Question 15

Recession type 1 characteristics

Answer 15

gingival recession with no loss of inter-proximal attachment

Question 16

Recession type 2 characteristics

Answer 16

gingival recession associated with loss of inter proximal attachment
- interproximal attachment loss less than or equal to buccal attachment loss

Question 17

Recession type 3 characteristics

Answer 17

gingival recession associated with loss of inter-proximal attachment
- interporximal attachment loss greater than buccal attachment loss

Question 18

what bpe code indicates the need for a radiographic assessment

Answer 18

3 or 4

Question 19

Stage 1 periodontitis severity and bone loss at worst affected site

Answer 19

early/mild
<15% or 2mm

Question 20

stage 2 periodontitis severity and bone loss at worst affected site

Answer 20

moderate
coronal third of root

Question 21

stage 3 periodontitis severity and bone loss at worst affected site

Answer 21

severe
- potential for additional tooth loss
mid third of root

Question 22

stage 4 periodontitis severity and bone loss at worst affected site

Answer 22

very severe
- potential for loss of dentition
apical third of root

Question 23

Periodontiits - how to describe the distribution/extent of disease

Answer 23

localised
< 30% of teeth
generalised
> 30% of teeth
molar incisal pattern

Question 24

step 2 - how to determine whether patient is engaging

Answer 24

plaque levels <20% and bleeding levels <30%
OR
>50% improvement in plaque and bleeding scores
as well as no obvious risk factors to control

Question 25

In step 3 - what pockets would you re-perform sub gingival instrumentation for

Answer 25

4-5mm

Question 26

step 3 - deep residual pockets still remain (6mm or more) - how would you treat

Answer 26

consider alternative causes - refer for pocket management or regenerative surgery

Question 27

what defines successful periodontal treatment?

Answer 27

good oral hygiene gingival health definition achieved - <10% BOP - < OR = 3mm pocket depth no increasing tooth mobility a functional and comfortable dentition

Question 28

reason for trying to eliminate pockets

Answer 28

teeth with pockets greater than 4mm are more likely to be lost in the future - deeper the pocket, increased likelihood of tooth loss

Question 29

factors influencing decision for periodontal surgery

Answer 29

smoking compliance oral hygiene systemic disease suitability of site prognosis of tooth availability of specialist treatment patient preference

Question 30

when would you proceed to step 4

Answer 30

if stable at 3 month re-evaluation after step 2 or if all sites are stable after step 3

Question 31

step 4 treatment consists of...

Answer 31

supportive periodontal care reinforce OH, risk factor control and behaviour change regular targeted PMPR as required to limit tooth loss consider evidence based adjunctive to control gingival inflammation - toothpaste - mouthwash