Classification of Periodontal Disease PDF

26/10/2023 Classification of Periodontal Disease Sarah Balian Oral and Dental Science 1 2 Key GDC learning outcomes 1.11.1 Assess and manage the health of periodontal and soft tissues taking into account risk and lifestyle factors 1.11.4 Monitor and record...

26/10/2023 Classification of Periodontal Disease Sarah Balian Oral and Dental Science 1 2 Key GDC learning outcomes 1.11.1 Assess and manage the health of periodontal and soft tissues taking into account risk and lifestyle factors 1.11.4 Monitor and record changes in periodontal health as necessary using appropriate indices 2 1  26/10/2023 3 Intended learning outcomes List a brief history of periodontal classification Explain the rationale behind the need for classification systems Describe the justification for each component of the 2017 periodontal classification system Use the BSP flowchart to aid with diagnosis Produce a diagnosis based on the 2017 classification 3 History of Periodontal Disease Classification Clinical characteristics Classical pathology Infection / host paradigm paradigm response paradigm 1870 – 1920 1920 - 1970 1970 - present No information about Inflammatory/non- No longer simple pathogenesis inflammatory bacteria infections Dependent on clinical Some bacterial Complex multifactorial appearance / patient influence involving subgingival reports microbiota, the host, Observation some PD’s inflammatory were due to responses and degenerative changes environmental factors. 4 2  26/10/2023 Chronology of Classification Systems Kantorowicz - 1924 Fish – 1944 McCall and Box -1925 Hine and Hine – 1944 Simonton -1927 Hulin – 1949 Haupl and Lang - 1927 Pucci - 1950 Gottlieb - 1928 Miller – 1950 Becks - 1929 Lyons - 1951 Jaccard -1930 Kerr - 1951 Isadore Weinmann -1934 Goldman -1956 Roy – 1935 McCall -1956 Robinson - 1935 American Academy of Periodontology - Weski - 1937 1957 Thoma and Goldman – 1937 Robinson -1959 Orban - 1942 Carranza -1959 Glickman - 1964 Drum -1975 World Workshop in Clinical Periodontics - 1989 European Workshop in Periodontology - 1993 American Academy of Periodontology - 1999 World Workshop on Classification of Periodontal and Peri-Implant diseases and conditions - 2017 5 Previous Classifications World Workshop in Clinical Periodontics World Workshop in Clinical Periodontics 1989 1993 Early- onset Periodontitis Adult Periodontitis (beings at the 4th Prepubertal Periodontitis (Localised or decade of life, slow rate of progression) Generalised) Early onset Periodontitis (begins before Juvenile Periodontitis (Localised or the 4th decade of life, rapid rate of Generalised) progression, altered host response) Adult Periodontitis Necrotising Periodontitis (tissue necrosis with clinical attachment and Necrotising Ulcerative Periodontitis bone loss seen) Refractory Periodontitis Periodontitis associated with Systemic diseases 6 3  26/10/2023 OUTDATED American Academy of Periodontology -1999 Developed to meet issues regarding previous classifications (mainly 1989): Gingival diseases (plaque and non-plaque induced; modification by systemic factors, medications, malnutrition) “Adult periodontitis” to “chronic periodontitis” “Early onset periodontitis” to “aggressive periodontitis” Removal of “refractory periodontitis” as a separate category Periodontitis as a Manifestation of Systemic Diseases “Necrotising Ulcerative Periodontitis” with “Necrotising Periodontal Diseases” Periodontal Abscess & Periodontic-Endodontic Lesions Developmental/Acquired Deformities and Conditions 7 Pathogenesis down to root apex - poor prognosis - irreversible Periapical infection Why do we need a classification system? To communicate/translate what to patient they have - measure of prognosis 8 4  26/10/2023 Classification of Periodontal and Peri-implant Diseases & Conditions 2017 9 10 5  26/10/2023 Periodontal health and Gingival Health 11 12 6  26/10/2023 Gingivitis Dental Biofilm Induced Disease 13 Risk factors gained from history taking Plaque-induced gingivitis is exacerbated by systemic conditions. 14 7  26/10/2023 Gingivitis Dental Biofilm Induced Disease 15 Gingivitis not relating to plaque - but may still have plaque present Gingival diseases – non biofilm induced 16 8  26/10/2023 All impact cleaning ability - gingival health Risk factor - anything that will increase plaque biofilm 17 18 9  26/10/2023 Grey slothing - smoking, radiotherapy Vascolation stopped - smells Necrotising Diseases Deep pocketing Hydrogen peroxide mouthwash Enlarged gingiva Influence and stop risk factor - smoking 19 Generalised or localised Periodontitis We agree periodontitis is a spectrum disorder. Note risk factors in diagnosis Definition: We want to consider several Microbially-associated, host- factors: mediated inflammation that results in loss of periodontal attachment. Severity Complexity Extent/distribution Rate of progression Current disease status Risk Factor 20 10  26/10/2023 European federation of periodontology EFP vs BSP British society of periodontology - Simplified EFP for clinical practice in the UK - Differences in classification between the 2 can occur - There are still limitations with the new EFP/BSP classification 21 Let's try and work this out 22 11  26/10/2023 23 This is the headline 24 12  26/10/2023 Type of periodontal disease Is it periodontitis? Yes What is the key sign of periodontitis? Bone loss What has caused the bone loss? Impacted wisdom tooth 25 Generalised periodontitis - stage IV, grade C, currently unstable. Risk factors: previous smoker Or does it look like this? 26 13  26/10/2023 Extent / Distribution Molar/incisor Localised Generalised pattern Up to 30% of More than 30% teeth of teeth 27 Staging 28 14  26/10/2023 Worst tooth/site Staging Staging is about severity Based on % bone loss to the root length. Looking at worst site of bone loss. Worst case scenario 29 Health - perpendicular to long axis of tooth - within 2mm below CEJ Staging process Coronal Divide the root = Mid third Apical third 30 15  26/10/2023 Healthy Periodontium 31 32 16  26/10/2023 Only stage for what is present in the mouth at the time Tooth loss If a patient has lost a tooth / teeth due to advanced periodontal bone loss on a case by case basis Assign to Stage IV 33 Grading 34 17  26/10/2023 Grading Still looking at worst tooth bone loss How susceptible is my patient? Now taking into account patients age 35 Severity and prognosis of teeth Why is this useful? 36 18  26/10/2023 37 Grades A B C Is % bone loss Otherwise Loss at % bone less than half loss exceeds patient’s age patient’s age e.g. 10% bone e.g. 80% bone loss age 50 loss age 20 38 19  26/10/2023 Current Disease Status 39 Need long term supportive care/maintenance Current Disease Status Stage and grading also take into account historic disease as bone loss is not reversible Once a perio patient always a perio patient So we need to see if the disease is active Status may change - stable, in remission, unstable Patients may have received periodontal treatment in the past 40 20  26/10/2023 Current disease status 41 Classification to Diagnosis Classification relates to stage and grade Diagnosis comes when you add in current status and lifestyle risks 42 21  26/10/2023 Lifestyle factors 43 Risk Factor Assessment What does risk factor mean? Why is it useful? And previous smokers -Can be changed Modifiable vs non- modifiable & Connective tissue disorders Family history 44 22  26/10/2023 Diagnostic statement 45 23