Perio - Classification

Question 1

How do we classify/provide a diagnostic statement for periodontal disease?

Answer 1

Type and extent, stage, grade, stable/unstable and the risk factors

T- generalised/localised
E - local, general, MIP
S - 1-4
G - A-C
Stable/unstable = related to bleeding 
RF - smoking, uncontrolled diabetes

Question 2

List the classifications of periodontal disease? (10)

Answer 2

• Health
• Plaque induced gingivitis
• Non plaque induced gingival diseases and conditions
• Periodontitis
• Necrotising periodontal diseases
• Periodontitis as a manifestation of systemic disease
• Systemic disorders affecting the periodontal tissues
• Periodontal abscesses
• Periodontal- endodontic lesions
• Mucogingival deformities and conditions.

Question 3

how do we stage periodontal disease? (4)

Answer 3

use the worst affected site in the whole mouth

Stage 1 = Early/mild
< 15% of inter proximal bone loss at the worst site

Stage 2 = Moderate
Bone loss at coronal third of root

Stage 3 = Severe (potential for tooth loss)
Bone loss to the mid third of the root

Stage 4 = Very severe (potential for tooth loss)
Bone loss to the apical third of the root

Question 4

what staging does a patient who has lost teeth before to peridontal disease get?

Answer 4

stage 4

Question 5

how do we grade periodontal disease? (3)

Answer 5

Measured using the patients age and the percentage bone loss at the worst affected site.

Slow
if % bone loss / age = < 0.5

Moderate
if % bone loss / age = between 0.5 to 1.0

Rapid
if % bone loss / age = > 1

Question 6

what percentage is generalised periodontal disease?

Answer 6

> 30%

Question 7

what percentage is localised periodontal disease?

Answer 7

< 30%

Question 8

what indicates that the disease is uncontrolled?

Answer 8

bleeding

Question 9

what are the bleeding percentage in a healthy periodontium?

Answer 9

< 10%

Question 10

what are cause of non-plaque induced gingival disease?

Answer 10

genetic/developmental disorders
e.g. Hereditary gingival fibromatosis

Specific infections
e.g. herpetic gingival stomatitis

Inflammatory and immune conditions
e.g. Lichen planus

Endocrine, nutritional and metabolic diseases
e.g. Vitamin C deficiency

Question 11

what are predisposing factors to necrotising gingivitis/periodontitis In adults? (6)

Answer 11

HIV/Aids 
Immunosuppression 
Uncontrolled stress
poor nutrition/malnourished
smoking 

all paired with gingivitis from poor oral hygiene

Question 12

what are predisposing factors to necrotising gingivitis/periodontitis in children? (3)

Answer 12

Severe malnourishment
Extreme living conditions
Severe viral infections

Question 13

what conditions are associated with Periodontitis as a manifestation of systemic diseases? (5)

Answer 13

Papillion Lefevre Syndrome
Leukocyte adhesion deficiency 
Hypophosphatasia
Down syndrome 
Ehlers- Danlos

Question 14

describe recession type 1.

Answer 14

Gingival recession with no loss of inter-proximal attachment.

Question 15

describe recession type 2.

Answer 15

Gingival recession associated with loss of inter proximal attachment.
The inter proximal attachment loss is LESS than/equal to the buccal attachment loss.

Question 16

describe recession type 3.

Answer 16

Gingival recession associated with loss of inter proximal attachment.
The amount of interproximal attachment loss is GREATER than the buccal attachment loss.

Question 17

how do we measure successful outcomes in periodontitis patients?

Answer 17

reduced bleeding sites = < 10%

reduce pocket depths

plaque index = < 15%

we cannot be too strict with these however as large improvements can be seen even if the score is > those above.

Question 18

what are the symptoms of necrotising periodontal disease? (4)

Answer 18

crater like ulcerations
slough - necrotic tissue, bacteria and cells
loss of the papillae
halitosis

Question 19

what medications are used in treating necrotising periodontal disease (drug, dose, frequency?

When are these used?

Answer 19

Metronidazole
400mg 3x per day for 3 days

when? - accompanied by systemic symptoms such as fever and lymphadenopathy

Question 20

what are the indications for carrying out HPT before surgical methods (3)

Answer 20

allows you to assess patient motivation

stabilise the gingiva before surgery

HPT can can help to reduce need for surgery?? by reducing probing depths and reducing bleeding on probing.

Question 21

what is the review period and the indications for surgical intervention? (3)

Answer 21

4-6 weeks after non-surgical methods

persisting pockets > 5mm
alongside
Excellent oral hygiene

Question 22

what is the GDP’s role after the completion of surgical intervention? (3)

Answer 22

Reinforce OH instruction and motivate

Review - examine to see if there have been any positive changes or relapse

Carry out the appropriate treatment according to findings I.e more HPT

Question 23

what is the guidance when prescribing metronidazole for necrotising gingivitis? (3)

Answer 23

Avoid consumption of alcohol

Avoid if pregnant

Avoid if using warfarin

Question 24

When reviewing a patient with necrotising gingivitis what should we do? (3)

Answer 24

upon review - (after chlorhexidine and metronidazole have been used) and after the acute symptoms have subsided, we should;

• Carry out more thorough supra and subgingival scaling
• If there is no resolution and persistent symptoms consider referral

Question 25

List the modifying factors of plaque induced gingivitis.

Answer 25

puberty - hormones exaggerates response to plaque

poor restorative margins/overhangs

drugs e.g. Ca channel blockers and immunosuppressants

Question 26

Describe a currently stable periodontal status.

Answer 26

< 10% Bleeding sites

pockets of ≤ 4mm with no bleeding

Question 27

Describe a currently in remission periodontal status.

Answer 27

≥ 10% bleeding sites

Pocket depths ≤ 4mm

no bleeding at 4mm sites

Question 28

Describe a currently unstable periodontal status.

Answer 28

pocket depths of ≥ 5mm
or
PPD ≥ 4mm & BoP.

Question 29

How do we treat necrotising periodontitis? (5)

Answer 29

Ultrasonic debridement of the necrotic tissue to facilitate healing

0.2% Chlorhexidine mouthwash twice daily (pain makes it unbearable to brush)

Antibiotics for acute form

Smoking cessation, vitamin supplementation and dietary advice

Hygiene phase therapy (to treat the perio disease)