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Questions and Answers
What does the grading of periodontal disease assess?
What does the grading of periodontal disease assess?
In terms of grading, how is a patient's bone loss categorized?
In terms of grading, how is a patient's bone loss categorized?
What is indicated by the statement 'Once a perio patient, always a perio patient'?
What is indicated by the statement 'Once a perio patient, always a perio patient'?
What additional factors are considered in the diagnosis of periodontal disease?
What additional factors are considered in the diagnosis of periodontal disease?
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What does the 'current disease status' reflect in periodontal assessment?
What does the 'current disease status' reflect in periodontal assessment?
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What was the main paradigm shift in periodontal disease classification around 1970?
What was the main paradigm shift in periodontal disease classification around 1970?
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The 2017 periodontal classification system builds upon which of the following concepts?
The 2017 periodontal classification system builds upon which of the following concepts?
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Which time period is associated with the observation that some periodontal diseases were due to degenerative changes?
Which time period is associated with the observation that some periodontal diseases were due to degenerative changes?
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What key learning outcome involves monitoring and recording changes in periodontal health?
What key learning outcome involves monitoring and recording changes in periodontal health?
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The rationale behind classification systems in periodontal disease primarily serves to:
The rationale behind classification systems in periodontal disease primarily serves to:
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Which of the following best describes clinical characteristics in the context of periodontal disease classification?
Which of the following best describes clinical characteristics in the context of periodontal disease classification?
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What component is essential for producing a diagnosis based on the 2017 periodontal classification?
What component is essential for producing a diagnosis based on the 2017 periodontal classification?
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Prior to 1970, periodontal disease classification largely depended on which factor?
Prior to 1970, periodontal disease classification largely depended on which factor?
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Which classification introduced the term 'chronic periodontitis'?
Which classification introduced the term 'chronic periodontitis'?
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What was a notable change made in the American Academy of Periodontology classification in 1999?
What was a notable change made in the American Academy of Periodontology classification in 1999?
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Which classification system focused on 'Necrotising Periodontal Diseases'?
Which classification system focused on 'Necrotising Periodontal Diseases'?
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Which of the following classifications introduced 'aggressive periodontitis'?
Which of the following classifications introduced 'aggressive periodontitis'?
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What type of periodontitis is characterized by a rapid rate of progression before the 4th decade of life?
What type of periodontitis is characterized by a rapid rate of progression before the 4th decade of life?
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Which classification system addressed systemic factors in gingival diseases?
Which classification system addressed systemic factors in gingival diseases?
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What is a characteristic of Necrotising Ulcerative Periodontitis?
What is a characteristic of Necrotising Ulcerative Periodontitis?
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Which emergence of periodontitis is considered associated with systemic diseases?
Which emergence of periodontitis is considered associated with systemic diseases?
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In what year was the World Workshop on Classification of Periodontal and Peri-Implant diseases and conditions held?
In what year was the World Workshop on Classification of Periodontal and Peri-Implant diseases and conditions held?
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What characterizes gingivitis that is induced by dental biofilm?
What characterizes gingivitis that is induced by dental biofilm?
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Which of the following best defines periodontitis?
Which of the following best defines periodontitis?
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Which of the following is NOT a characteristic of necrotizing diseases?
Which of the following is NOT a characteristic of necrotizing diseases?
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What does the term 'periodontal attachment loss' refer to?
What does the term 'periodontal attachment loss' refer to?
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What type of diseases are gingival diseases categorized into?
What type of diseases are gingival diseases categorized into?
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How is periodontitis regarded in the context of dental health?
How is periodontitis regarded in the context of dental health?
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Which of the following best describes plaque-induced gingivitis?
Which of the following best describes plaque-induced gingivitis?
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Which of these factors is NOT relevant to the diagnosis of gingival diseases?
Which of these factors is NOT relevant to the diagnosis of gingival diseases?
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What is one common result of untreated gingivitis?
What is one common result of untreated gingivitis?
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Which condition is characterized by a host-mediated inflammatory response affecting the periodontium?
Which condition is characterized by a host-mediated inflammatory response affecting the periodontium?
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What does the staging of periodontal disease primarily assess?
What does the staging of periodontal disease primarily assess?
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Which classification is simplified for clinical practice in the UK?
Which classification is simplified for clinical practice in the UK?
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What percentage of teeth indicates a localized distribution of periodontal disease?
What percentage of teeth indicates a localized distribution of periodontal disease?
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What is a key sign of periodontitis?
What is a key sign of periodontitis?
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Which of the following is NOT a factor considered in assessing periodontal disease?
Which of the following is NOT a factor considered in assessing periodontal disease?
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What measure primarily determines the staging of periodontal disease?
What measure primarily determines the staging of periodontal disease?
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Which aspect can influence the classification differences between EFP and BSP?
Which aspect can influence the classification differences between EFP and BSP?
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What defines a generalised distribution of periodontal disease?
What defines a generalised distribution of periodontal disease?
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What limitation is associated with the EFP/BSP classification?
What limitation is associated with the EFP/BSP classification?
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In assessing periodontal disease, which factor is NOT part of the evaluation criteria?
In assessing periodontal disease, which factor is NOT part of the evaluation criteria?
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Study Notes
Classification of Periodontal Disease
- Periodontitis is a spectrum disorder, requiring consideration of several factors.
- Key learning outcomes include assessing and managing periodontal and soft tissue health, considering risk factors and lifestyles. Monitoring and recording changes in periodontal health is also important.
- Clinical characteristics paradigm (1870-1920): No information on pathogenesis, dependent on clinical appearance/patient reports.
- Classical pathology paradigm (1920-1970): Inflammatory/non-inflammatory, some influence of bacteria, observation of some degenerative changes.
- Infection/host response paradigm (1970-present): No simple bacteria infections, now complex multifactorial, involving subgingival microbiota and environmental factors.
Intended Learning Outcomes
- Students will list a brief history of periodontal classification.
- Students will explain the rationale behind the need for classification systems.
- Students will describe the rationale for each component of the 2017 periodontal classification system.
- Students will use the BSP flowchart to aid diagnosis and produce a diagnosis based on the 2017 classification.
Chronology of Classification Systems
- Various researchers and organizations have contributed to the history of classifications. Examples include Kantorowicz (1924), McCall and Box (1925), Simonton (1927), Haupl and Lang (1927), Gottlieb (1928), Becks (1929), and many more.
- These classifications have evolved over time.
Previous Classifications
- World Workshop in Clinical Periodontics (1989) included early-onset periodontitis, prepubertal periodontitis (localized/generalized), juvenile periodontitis (localized/generalized), adult periodontitis, necrotising ulcerative periodontitis, refractory periodontitis, and periodontitis associated with systemic diseases.
- World Workshop in Clinical Periodontics (1993) focused on adult periodontitis (beginning at the fourth decade of life,) early-onset periodontitis (before the fourth decade, rapid progression, altered host response), and necrotising periodontitis (tissue necrosis with attachment and bone loss).
American Academy of Periodontology (1999)
- Developed to address issues with previous classifications, primarily the 1989 classification.
- Included gingival diseases (plaque and non-plaque induced), modification by systemic factors, medications, and malnutrition.
- Renamed "adult periodontitis" to "chronic periodontitis", "early-onset periodontitis" to "aggressive periodontitis", and removed "refractory periodontitis".
- Classified periodontitis as a manifestation of systemic diseases and included categories for periodontal abscesses, periodontic-endodontic lesions, and developmental/acquired deformities and conditions.
Why Classify Periodontal Disease?
- A classification system is needed to improve diagnostics and treatment.
Periodontal Diagnosis with 2017 Classification System
- The 2017 classification system is designed for clinical practice implementation.
- It includes periodontal health, gingival diseases, and associated conditions as well as peri-implant diseases and conditions.
- Recommendations of the British Society of Periodontology (BSP) are described for the implementation of the 2017 classification of periodontal diseases and conditions in British dental practices.
- A diagnostic pathway is illustrated for patients with dental biofilm-induced periodontitis using the Basic Periodontal Examination (BPE) and grading/staging of periodontitis.
Gingivitis
- Plaque-induced gingivitis is exacerbated by systemic conditions.
- Gingival diseases are classified.
Necrotizing Diseases
- Microbially-associated, host-mediated inflammation resulting in periodontal attachment loss.
Periodontitis Definition
- Microbially-associated, host-mediated inflammation resulting in loss of periodontal attachment.
Extent/Distribution
- Localised (up to 30% of teeth)
- Generalised (more than 30% of teeth)
- Molar/incisor pattern
Staging
- Based on the percentage of bone loss relative to the root length.
- The worst case scenario is considered.
Staging Process
- Stages of periodontitis (early/mild, moderate, severe, very severe) are defined based on interproximal bone loss.
Healthy Periodontium
- Images of healthy periodontium and periodontitis cases are included for visual reference.
Tooth Loss
- Tooth loss is assigned to Stage IV if it results from advanced periodontal bone loss.
Grading
- Grading considers the worst bone loss, susceptibility of the patient, and patient age.
Current Disease Status
- Stage and grading incorporate historic disease as bone loss is irreversible.
- Periodontal treatment history needs to be considered.
- Patients may have received past periodontal treatment.
Current Disease Status (Assessment)
- Stable, in Remission, or Unstable periodontal status assessments are based on bleeding on probing (BOP) and probing pocket depth (PPD).
Classification to Diagnosis
- Classification relates to stage and grade of periodontitis.
- Diagnosis is informed by current health/disease status to enable prognosis and therapeutic strategy.
Lifestyle Factors
- Lifestyle factors such as smoking, diabetes, etc. are identified as risk factors for periodontal disease.
Risk Factor Assessment
- Smoking and sub-optimally controlled diabetes are provided as examples of modifiable risk factors.
Diagnostic Statement
- The diagnostic statement includes the extent, stage, grade, stability, and risk factors of periodontitis to improve personalized periodontal treatment strategies.
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Description
This quiz explores the classification of periodontal diseases, focusing on the evolution of its understanding from historical perspectives to modern paradigms. Students will learn about the importance of assessing periodontal health, risk factors, and the complexities surrounding the disease's classification. Test your knowledge on the history, rationale, and key learning outcomes related to periodontal disease.
