L9. Conditions

Periodontal health has levels:

intact

reduced

Reduced periodontium can be in/among:

successfully-treated periodontitis patient

non-periodontitis patient

What is the primary gingival disease?

periodontitis

Periodontitis must be ___ and ___ based on characteristics

staged

graded

Periodontal health is defined as a state free from inflammatory periodontal disease such as ... and other periodontal conditions

gingivitis, periodontitis

In addition to the patients without a history of periodontal diseases, periodontal health can be applied to patients who ___ and are able to maintain periodontal tissues without clinical inflammation

had a history of successfully treated periodontal

diseases

Clinically, there are two categories of periodontal health diagnosis:

Clinical health on an intact periodontium

Clinical gingival health on a reduced periodontium in a stable periodontitis patient or non-periodontitis patient

A patient with a history of periodontitis has a ___ for periodontal disease progression than a patient without a history of it

higher risk

___ of BOP sites is used to define clinical health because it is not common to identify an adult who has no BOP during the periodontal examination

Less than 10%

(this is considered healthy)

___ is measured by % of sites with BOP

Gingivitis

Periodontitis is measured by ___

% of teeth affected

Healthy status implies having an ___ periodontium

intact

T/F: A patient can have reduced periodontium without having periodontitis

true

T/F: A successfully treated patient (for periodontitis) can still have reduced periodontium

true

For a person in the category of "successfully treated patient," how are their symptoms/measurements defined?

it seems, on a pre-tx basis

Reiterate the three categories of periodontal health/periodontium status:

intact

reduced — not periodontitis

reduced — successfully tx periodontitis

Which category is evidently not included in this table/classification system?

active periodontitis

Intact: Probing Attachment Loss

no

Reduced (no): Probing Attachment Loss

yes

Reduced (succ tx): Probing Attachment Loss

yes

Intact: Probing Pocket Depths

under or equal to 3

Reduced (no): Probing Pocket Depths

under or equal to 3

Reduced (succ tx): Probing Pocket Depths

under or equal to 4

Intact: BOP

under 10%

Reduced (no): BOP

under 10%

Reduced (succ tx): BOP

under 10%

Intact: Radiographic Bone Loss

no

Reduced (no): Radiographic Bone Loss

possible

Reduced (succ tx): Radiographic Bone Loss

yes

can be restored, but maybe not fully

How can periodontium be reduced in a non-periodontitis patient?

crown lengthening surgery

gingival recession due to toothbrushing trauma

When measuring probing pocket depth, you assume that no ___ are present

pseudopockets

Pseudopockets

false pocket . . . because there is no destruction of PDL fibers or alveolar bone

For a succ tx patient, periodontal pockets cannot be over 4mm and present with ___

BOP

Can you have gingival inflammation on an intact periodontium?

yes

How about on a reduced periodontium?

yes, of course

Gingival diseases are caused by biofilms... biofilms can be ___ and ___ induced

dental (we obviously discuss this category)

non-dental

As compared to periodontal health, patients with ___ present with signs of inflammation such as swelling, bleeding, and/or redness in the gingiva

gingivitis

Gingivitis can be ___ (10-30% of sites) or ___ (>30%)

localized

generalized

So far, there is not strong evidence to classify the severity of gingivitis. However, to facilitate communications, clinicians may use terms like mild, moderate or severe gingivitis based on percentages of sites with BOP (mild = ___%; moderate = ___% to

___%; severe = ___%)

<10%

10% to 30%

>30%

___ is a progression (more severe form) of ___

Periodontitis

Gingivitis

Gingivitis: Radiological Bone Loss

no

Gingivitis: Probing Depth

under or equal to 3mm

Gingivitis: BOP

equal or over to 10%

Gingivitis can generally be treated with ___

prophylaxis

There are 2 types/classifications of periodontitis:

aggressive

chronic

Periodontitis is defined as "an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms,

resulting in progressive destruction of the periodontal ligament and ___, with increased ___ & ___, or both

alveolar bone

probing depth formation & recession

The clinical feature that distinguishes periodontitis from gingivitis is the presence of a clinically detectable ___ resulting from the inflammatory destruction of

the periodontal ligament and alveolar bone

attachment loss

Attachment loss is often accompanied by ___ formation

periodontal pocket

Attachment loss is also often accompanied by changes in the ...

density and height of the subjacent alveolar bone

For a definitive diagnosis of periodontitis, it is required that the patient present with detectable ___, OR ___

interdental clinical attachment loss in at least two non-adjacent teeth

buccal or lingual clinical attachment loss (≥3 mm) jointly with probing depths (>3 mm) on two or more teeth

Periodontitis can be ___ (<30% of teeth involved) or ___ (= or > 30% of teeth involved)

localized

generalized

Periodontitis can also present with a ___ pattern

molar-incisor

Why is the presence of > 3mm probing depth important in the diagnosis of periodontitis?

to ensure that tissue destruction (clinical attachment loss) took place due to periodontal diseases and not due to other conditions

Other conditions that may cause tissue destruction (clinical attachment loss) include:

trauma-induced gingival recession

dental caries extending subgingival

clinical attachment loss on the distal aspect of the second molar

endodontic pathology draining thru periodontium

vertical root fracture

What is clinical attachment loss on the distal aspect of the second molar associated with?

malposition or extraction of the third molar

___ measurement alone is inadequate for an assessment of periodontitis

Probing depth

Clinical attachment loss is usually assessed by adding the extent of ___ to the ___ measurement

gingival recession

probing depth

Adding these two gives you an estimate of the total extent of tissue loss from the ___ of the tooth

CEJ

T/F: clinical signs of inflammation are always positive indicators of ongoing attachment loss

false

not always, but definitely can be

T/F: the absence of bleeding is generally not a good & reliable indicator of periodontal stability and health

false

it is a good and reliable indicator!

Periodontitis presents in ___ stages

4

Staging of periodontitis is determined by ...

severity

complexity

extent and distribution

Severity has multiple categories within itself:

clinical attachment loss

radiographic bone loss

tooth loss due to the periodontitis

Stage 1: Severity: Clinical Attachment Loss

1-2 mm

Stage 2: Severity: Clinical Attachment Loss

3-4 mm

Stage 3: Severity: Clinical Attachment Loss

over 5 mm

Stage 4: Severity: Clinical Attachment Loss

over 5 mm

Stage 1: Severity: Radiographic Bone Loss

under 15%

coronal third of root

Stage 2: Severity: Radiographic Bone Loss

15-33%

coronal third of root

Stage 3: Severity: Radiographic Bone Loss

middle or apical third of root

Stage 4: Severity: Radiographic Bone Loss

middle or apical third of root

Stage 1: Severity: Tooth Loss

none

Stage 2: Severity: Tooth Loss

none

Stage 3: Severity: Tooth Loss

< or = to 4 teeth

Stage 4: Severity: Tooth Loss

> or = to 5 teeth

For clinical attachment loss... there are gaps... 1-2, 3-4 ... what do you do if you say 2.5 mm as your measurement?

round up to 3

Stage 1: Complexity

pocket depth < or = to 4 mm

mostly horizontal bone loss

Stage 2: Complexity

pocket depth < or = to 5 mm

mostly horizontal bone loss

Stage 3: Complexity

pocket depth > or = to 6 mm

vertical bone loss > or = to 3 mm

(and horizontal bone loss)

class II or III furcation involvement

moderate ridge defects

Stage 4: Complexity

need for complex rehab due to masticatory dysfunction, tooth mobility, bite collapse, pathological migration, less than 20 teeth remaining

What does the 'extent and distribution' category state that applies for all stages?

can either be localized, generalized, or follow the molar-incisor pattern

Probing depth is measured from the ___ to the bottom of the pocket

gingival margin

Attachment loss is measured from the ___ to the bottom of the pocket

CEJ

Staging is based on a ___ diagnosis

full-mouth

Is staging subdivided into different severity levels for different parts of the mouth?

no

Staging is designed to highlight the patient's ___

most severe areas of destruction

Stages generally should not ___ to a lower level

retrogress

This is because stages are associated with ___

potential future disease progression

However, there IS an exception to the anti-retrogression 'rule...' if ___ is achieved following successful ___

significant bone gain

regenerative therapy

Random throw-in: can you see plaques in x-rays?

no

Which stages of periodontitis are you NOT likely to conduct surgery on?

stages I and II

1999 Classification

established the '2 types' of periodontitis

aggressive & chronic

Are these two classifications still around, today?

not really

they are good to know, since they were a past precedent, but as of 2018 we mainly categorize periodontitis as just 'one' grouping in and of its own

Periodontitis, along with being staged, can also be ___

graded

How many grades are there?

3

A, B, C

Grade A is a ___ rate

slow

Grade B is a ___ rate

moderate

Grade C is a ___ rate

rapid

Grade A has ___ bone loss over 5 years

no

Grade B has ___ bone loss over 5 years

under 2 mm