Unit 4 - Diagnosis of Periodontal Diseases Flashcards
(100 cards)
1
Q
What are three rationales for a diagnosis?
A
- Communication with other health professionals
- Medico-legal
- Insurance reporting
2
Q
What is a differential diagnosis?
A
The distinguishing between two or more diseases with similar symptoms by systematically comparing their signs and symptoms
3
Q
What are the three parts of a periodontal exam?
A
- Visual exam
- Periodontal chart
- Radiographic exam
4
Q
What is the probing depths on an intact periodontium?
A
1-3 mm
5
Q
Is there inflammation on an intact periodontium?
A
No
6
Q
What is the percentage a mount of bleeding on probing that is still considered an intact periodontium?
A
Less than 10%
7
Q
Is there any attachment loss on an intact periodontium?
A
No
8
Q
Is there any attachment loss on a reduced periodontium?
A
Yes
9
Q
What is the probing depths on a reduced periodontium?
A
1-3 mm
10
Q
Is there inflammation on a reduced periodontium?
A
No
11
Q
What is the percentage a mount of bleeding on probing that is still considered a reduced periodontium?
A
Less than 10%
12
Q
What is the main difference between an intact and reduced periodontium?
A
Both are healthy, just reduced periodontium has attachment loss
13
Q
What is it called when a patient had periodontitis but has successfully been treated?
A
Stable periodontitis patient
14
Q
What is the recall time for a stable periodontitis patient? Why?
A
3-4 months, they are at continued risk of disease progression
15
Q
What is it called when a patient has had no history of periodontitis but has attachment loss unrelated to inflammation?
A
Non-periodonitis patient
16
Q
What are other reasons for attachment loss besides inflammation?
A
Tooth abrasion, crown-lengthening surgery, or orthodontic treatment
17
Q
What is the recall time for a non-periodontitis patient? Why?
A
6 months, they are not at increased risk of peridontitis
18
Q
What are the two types of periodontal health?
A
- Intact periodontium
- Reduced periodontium (stable and non-perio patients)
19
Q
Is gingivitis that is associated with biofilm alone reversible? If so, how?
A
- Yes
- Removing biofilm
20
Q
Is gingivitis that is associated with biofilm alone have any attachment loss?
A
No, gingiva is still attached to the CEJ
21
Q
What is the probing depths of gingivitis that is associated with biofilm alone?
A
1-3 mm
22
Q
What is the bleeding on probing for gingivitis that is associated with biofilm alone?
A
More than 10%
23
Q
What are some signs of gingivitis that is associated with biofilm alone?
A
Inflammation, redness, edema, loss of stippling
24
Q
What type of gingivitis is typical on teenagers?
A
Biofilm-indiced gingivitis on an intact peridontium
25
What are the signs of gingivitis on a radiograph?
None, everything appears healthy
26
What is the percentage of affected teeth of localized biofilm-induced gingivitis?
Less than 30% of teeth involved
27
What is the percentage of affected teeth of generalized biofilm-induced gingivitis?
More than 30% of teeth involved
28
What are the three degrees of inflammation of gingivitis?
Slight, moderate, and severe
29
Can a reduced periodontium be diagnosed within a single appointment? Why?
- Must have longitudinal attachment measurements over 12 months to support diagnosis
- If no BOP, can be having an episodic disease
- BOP can't be determine if it is just gingivitis or perio on first appointment
30
What are a few systemic risk factors of biofilm-induced gingivitis?
- Smoking
- Diabetes
- Nutritional factors
- Pharmacologic agents
- Sex steroid hormones
31
What are a few localized risk factors of biofilm-induced gingivitis?
- Xerostomia
- local factors for plaque retention
32
What is the overgrowth of gingival tissue without a primary inflammatory etiology commonly caused by?
Can be drug induced gingival enlargement
33
Why is the probing depths of drug induced gingival enlargement increased?
Deep pockets are from overgrowth of gingiva, must check attachment loss to know if it is periodontal disease
34
What is the etiology of drug induced gingival enlargement?
Excessive production of collagen fibers by fibroblasts
35
What are three common medications that cause drug induced gingival enlargement increased?
- Calcium channel blockers
- Anti-convulsants
- Cyclosporin A
36
What is an example of genetic/developmental disorders that cause non-biofilm related gingival disease?
Hereditary gingival fibrzomatosis
37
Can specific bacterial, viral, and fungal infections cause non-dental biofilm induced gingival disease?
- Yes
- If bacterial, it is not part of the regular dental biofilm
38
What are two autoimmune diseases that can cause non-biofilm induced gingival disease?
- Pemphigus
- Lichen planus
39
What is periodontitis?
Inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing
40
What was the old term for periodontitis?
Pyorrhea
41
What are three main clinical features of periodontitis?
- Attachment loss
- Increased probing depths
- Radiographic bone loss
42
What are two histological features of periodontitis?
- Inflammatory changes
- Periodontal attachment apical to the CEJ
43
What is necrotizing periodontal disease?
Infection with necrosis of the gingival tissues
44
What systemic conditions are most commonly associated with necrotizing periodontal disease?
- HIV
- Malnutrition
- Immunosippression
45
Histologically, what feature is present in necrotizing gingivitis?
Spriochetes
46
What is necrotizing stomatitis?
More extensive destruction necrosis that goes beyond the mucogingival junction
47
What are the main clinical symptoms that are used to diagnosis periodontist?
- Interdental CAL detected at more than 2 non adjacent teeth
- Buccal or lingual CAL more than 3 mm with 3 mm or greater pockets at 2 or more teeth
48
What are a few examples of CAL from non-periodontist related causes?
- Gingival recession of traumatic origin
- Dental caries above the cervical area of the tooth
- Endodontic lesion drainage
- Vertical root fracture
49
What is the interdental CAL in stage 1 perio?
1-2 mm
50
What is the radiographic bone loss in stage 1 perio?
- Less than 15%
- Mostly horizontal
51
What is the tooth loss in stage 1 perio?
No tooth loss due to periodontitis
52
What is the probing depth in stage 1 perio?
Less than 4 mm
53
What is the interdental CAL in stage 2 perio?
3-4 mm
54
What is the radiographic bone loss in stage 2 perio?
- 15% to 33%
- Mostly horizontal
55
What is the tooth loss in stage 2 perio?
No tooth loss due to periodontitis
56
What is the probing depth of stage 2 perio?
Less than 5 mm
57
What is the interdental CAL of stage 3 perio?
5 mm or more
58
What is the radiographic bone loss in stage 3 perio?
- 33% or more
- Horizontal
- Vertical less than 3 mm
59
What is the tooth loss of stage 3 perio?
Up to 4 teeth lost due to periodontitis
60
What is the probing depth of stage 3 perio?
6 mm or more
61
What is the furcation involvement of stage 3 perio?
Class 2 or 3
62
What features does stage 4 perio have?
All the same as stage 3 with features that require the need for complex rehabilitation
63
What are some of the additional features in stage 4 perio?
- Masticatory dysfunction/less than 10 opposing pairs of teeth
- Secondary occlusal trauma
- Bite collapse
64
How many stages of perio can a patient have?
Only one, use the worst stage presented in the mouth
65
What is the purpose of periodontal grading?
Estimate the rate of progression and future responsiveness to treatment
66
What grade should you assume until clinical or medical history provides more evidence of slower/faster progression?
Grade B
67
What is the direct evidence of Grade A perio?
No radiographic bone loss or clinical attachment loss over the past 5 years
68
What is the indirect evidence of Grade A perio?
- 0.25 bone loss
- Heavy biofilm but no/minimal periodontal destruction
69
What are the grade modifiers of Grade A perio?
- No smoking
- No diabetes
70
What is the direct evidence of Grade B perio?
2 mm or less of radiographic bone loss or clinical attachment loss over the past 5 years
71
What is the indirect evidence of Grade B perio?
- 0.25 to 1.0 bone loss
- Biofilm proportionate with periodontal destruction
72
What are the grade modifiers of Grade B perio?
- Less than 10 cigs a day
- Controlled diabetes, A1C is less than 7%
73
What is the direct evidence of Grade C perio?
2 mm or more of radiographic bone loss or clinical attachment loss over the past 5 years
74
What is the indirect evidence of Grade C perio?
- Greater than 1.0 bone loss
- Destruction exceeds expectation given biofilm deposits
75
What are the grade modifiers of Grade C perio?
- More than 10 cigs a day
- Uncontrolled diabetes, A1C is more than 7%
76
What is the definition of localized periodontitis?
Less than 30% of teeth are involved
77
What is the definition of generalized periodontitis?
More than 30% of teeth are involved
78
What is the molar/incisor pattern of periodontitis?
Only some molars and incisors are involved
79
How do you report your final diagnosis?
Stage (worst stage) Periodontitis, Extent of worst stage, Grade (worst grade)
80
What is a localized purulent infection involving the marginal or interdental gingiva?
Gingival abscess
81
What is a localized purulent infection within the tissues of adjacent to the periodontal pocket that may lead to destruction of periodontal ligament and alveolar bone?
Periodontal abscess
82
Does a periodontal abscess go to the apex of the tooth root?
No
83
What is a localized, circumscribed area of infection involving both the periodontal and/or pulpal tissue?
Endo-perio lesions
84
What is an endo-perio lesion that has a primary endodontic origin?
Lesion is extending coronally into periodontal tissue and the oral cavity
85
What is an endo-perio lesion that has a primary periodontal origin?
Lesion communicating through accessory canal or the apical foramen to secondarily infect the pulp
86
What are mucogingival deformities?
Deviations from the normal anatomic relationship between the gingival margin and the mucogingival junction
87
What gingival phenotype is triangular shaped and delicate?
Thin scalloped gingiva
88
What gingival phenotype is square shaped, has a large inter proximal contact, and has thick gingiva?
Thick flat gingiva
89
What gingival phenotype is thick, has a narrow zone of keratinized gingiva, and is rounded?
Thick scalloped gingiva
90
What is class 1 recession?
Gingival recession with no loss of inter proximal attachment
91
What is class 2 recession?
Interproximal attachment loss less than or equal to the buccal site
92
What is class 3 recession?
Interproximal attachment loss more than the buccal site
93
What are some features of lack of attached gingiva (a mucogingival deformity)?
- Narrowest on the buccal of mandibular premolars
- Not really keratinized, pay attention if keratinized attached gingiva is less than 2 mm
94
What is primary occlusal trauma?
Injury from excessive occlusal forces applied to normal healthy periodontium
95
What is secondary occlusal trauma?
Injury from normal or excessive forces on a reduced periodontium
96
What are some signs of occlusal trauma?
- Mobility
- Fremitus
- Migration of teeth
- Widened PDL
97
What is peri-implant health defined as?
- No inflammation
- No bone loss
98
What is peri-implant mucositis defined as?
- Gingival inflammation around implant
- No bone loss
99
What is the same thing as gingivitis around an implant?
Mucositis
100
What is peri-implant soft and hard tissue deficiencies?
No active inflammation, just bone loss
