DH Theory unit 9

Periodontal diagnosis is determined after

analyzing information collected during the assessment phase of therapy

An important determination in disease severity is

whether periodontitis is progressing and if so, ar

colour of inflammed gingiva

Red, bluish, blue-red, pink/fibrotic

bleeding of inflammed gingiva

Exhibits ≥ 10% bleeding sites

surface texture of inflamed gingiva

Loss of stippling occurs – is shiny

Fibrotic with stippling, is nodular and hyperkeratotic

contour of inflammed gingiva

Margins are irregular from edema, fibrosis, clefting and/or festooning

May be rounded, rolled, or bulbous, thus is more coronal to the CEJ

Is bulbous, flattened, blunted, and cratered

size of inflammed gingiva

Is enlarged from excess extracellular fluid in the tissues or fibrotic from the formation of scar tissue within the connective tissue

Free marginal gingiva may be highly retractable with air

local risk factors

• Calculus

• Tooth conditions – concavities, enamel pearl, palatogingival groove, malocclusion, crowding that causes increased biofilm retention, untreated caries, recurrent caries

• Restos that are poorly contoured, overhangs, open contacts, rough margins

• Ortho or prosthetic appliances

• Oral habits such as tongue thrusting, mouth breathing, oral jewelry

• Recession

• Frenum attachments

• Occlusal trauma

• xerostomia

systemic risk factors

• Tobacco smoking

• Undiagnosed diabetes (if someone says they are pre-diabetic you can indicate this as undiagnosed)

• Uncontrolled diabetes

• Leukemia or Neutropenia

• Hormonal – pregnancy, puberty. Menopause, hormone therapy

Meds: any med that causes hyposalivation, gingival overgrowth, increased biofilm (includes anticonvulsants, antianxiety agents, antihypertensives, calcium blockers, immunosuppressive)

Considerations when classifying Periodontitis: Interdental CAL is detectable at

≥ 2 non-adjacent teeth (more than 1 site interdentally)

Considerations when classifying Periodontitis: Buccal or lingual CAL

≥ 3mm with pocketing >3 mm is detectable at ≥ 2 teeth

Stage I

(Initial stages of attachment loss)

stage II

• (Moderate/Established periodontitis)  

stage III

• (Severe periodontitis with significant destruction and potential for tooth loss) 

stage IV

Advanced periodontitis with extensive tooth loss

Staging is based on

on the severity of the periodontal disease and complexity of the management of the case.

Grading is based on

evidence of CAL, radiographic bone loss, % of bone loss divided by age, phenotype and grade modifiers (smoking and diabetes).

According the new AAP Grading Criteria

Clinicians should initially assume grade B disease and seek specific evidence to shift to grade A or C

grade a is

slow progression

grade b is

moderate progression

grade c

is rapid progression