Periodontal Risk Assessment

Periodontal diseases are

inflammatory conditions involving the periodontium, a term used to describe the supportive structure surround the tooth, which includes the gingival tissue, alveolar bone, cementum, and periodontal ligament

___% of adults aged 30 years and older have some form of periodontal disease

47.2

__% of adults aged 65 years and older have some form of periodontal disease

70.1

Excessive Occlusal Forces (bruxism and/or malocclusion:

Sustained pressure can lead to microtrauma of the periodontal ligament and alveolar bone. Over time, these forces can exceed the adaptive capacity of the bone, resulting in resorption

Orthodontic Treatment:

tooth movement in orthodontics relies on bone resorption on the pressure side (where the tooth is moving toward) and bone deposition on the tension side (where the tooth is moving away). Ideally, this process is balanced, but if resorption exceeds deposition, bone loss may occur.

Extractions:

Without functional loading, bone resorption occurs in the edentulous areas.

Symptoms of Periodontal Disease

• Redness, swelling, bleeding

• Halitosis

• Pain/discomfort

• *Gingival recession: apical migration of marginal gingiva (gingiva wears away or pulls down, exposing more of the tooth's root)

• In advanced stages: mobile teeth, pus, changes in bite alignment

Disease Process

1. Periodontal disease is an infection associated with specific groups of bacteria. Periodontal disease is often polymicrobial, meaning that multiple bacteria work together to contribute to the disease process. Most common: Porphyromonas gingivalis

2. Inflammatory response to dental biofilm typically occurs within 2–4 days in response to bacterial accumulation.

3. ⚠⚠An individual’s susceptibility to periodontal diseases depends on the person’s host response to the oral bacteria. This host susceptibility explains why individuals present with varying clinical findings, types, and extent of the disease.

4. The progression of periodontal disease also depends on risk factors (modifiable & non-modifiable) that impact the host’s susceptibility to the bacterial infection.

In general, pocket depths of _ millimeters or more may indicate inflammation. Especially in conjunction with bleeding on probing (BOP).

4

Gingivitis:

• The inflammatory response in gingivitis is limited to the gingiva and has not yet affected the supporting structures of the teeth. That is, gingival inflammation WITHOUT alveolar bone loss.

• Reversible/treatable: mechanical disruption of bacteria through oral hygiene and dental hygiene care; anti-bacterial agents

• Basically, treatment involves the removal/reduction of the irritating factor (usually plaque).

Periodontitis:

• Inflammatory condition affecting the entire periodontium. That is, inflammation WITH bone loss.

• Destruction of the periodontium is irreversible. Surgical grafting surgery is the only way to replace lost tissue (tertiary prevention).

• Periodontitis can be stabilized by removal/reduction of the irritating factors. (e.g., dental hygiene care; anti-bacterial agents; anti-cytokine therapy)

Diagnosing Periodontal Disease

• Visual examination

• Periodontal probing

• Radiographic assessment

• Microbial testing: identifies bacterial species

• Patient history and risk factor assessment

What's included on a periodontal chart?

• Probing depths (mm)

• Gingival recession or swelling (mm)

• Plaque/Biofilm (Y/N)

• Bleeding on probing (Y/N)

• Suppuration/Pus/Exudate (Y/N)

• Furcation involvement (I, II, III)

• Mobility (0, I, II, III)

Clinical attachment loss (CAL) is:

measured loss of connective tissue attachment to the tooth

Formula for CAL:

CAL=probing depth (PD) + gingival recession (GR)
CAL= Probing depth (PD) - gingival overgrowth (GO)

Probing Depth (PD):

Distance from the gingival margin to the base of the pocket.

Gingival Recession (GR):

Distance from the CEJ to the gingival margin (if recession is present).

Gingival Overgrowth (GO):

If the gingival margin is above the CEJ, this amount is subtracted from the probing depth.

Risk Factors;

• Risk factors are associated with incidence, extent, and progression of periodontal diseases and are usually identified through longitudinal studies (research studies in which the subjects are followed for a long period of time to study the natural course of a disease).

• Risk factors are those factors that influence the likelihood of periodontitis developing in

Risk Assessment:

has the potential to reduce the need for complex periodontal therapy and to improve patient outcomes that will lead to reduced cost for oral health care.

Local risk factors:

• can either be acquired (such as plaque and calculus, overhanging and poorly contoured restorations) or anatomical (such as malpositioned teeth, enamel pearls, root grooves, concavities and furcations).

Systemic risk factors:

A number of systemic diseases, states or conditions can affect the periodontium in a generalized manner. These can be modifiable, such as smoking, or non-modifiable, such as socioeconomic status.

The most important known risk factor for periodontitis is …

cigarette smoking

Primary Prevention:

to prevent and control gingivitis. Scaling to remove calculus and bacterial plaque to promote a healthy oral environment.

Secondary Prevention

To treat periodontitis; to achieve connective tissue reattachment. Scaling and root debridement to eliminate microorganisms, endotoxins, and calculus to reduce inflammation, promote connective tissue regeneration, and make root surface biologically acceptable to gingival tissues