Peridontics : 1/classification Of Periodontal Disease/ First Semester

Front 1

Why to classify the periodontal diseases ?

Back 1

Frameworks to study the etiology and
pathogenesis

Help establish diagnosis, determine prognosis,
and facilitate treatment planning

*Way of communicating in a common language

Front 2

Look at the picture in slide 5

Back 2

look at it

Front 3

List the charactrstics common to gingival diseases

Back 3

Signs and symptoms are confined to the gingiva

No attachment loss or on a periodontium with
attachment loss that is not progressing

The presence of dental plaque to initiate and /or
exacerbate the severity of lesion

Reversibility of the disease by removing the
etiology(ies)

Front 4

Gingivitis is classifed based on the extent ... to ?

Back 4

Localiazed and generalized gingivitis

Front 5

gingivitis is classied based on the distribution .... to ?

Back 5

Marginal and diffused gingivits

Front 6

gingivitis is bsed on the severitey ...to ?

Back 6

mild ---> moderate ---> severe

Front 7

look at the image in slide 10

Back 7

look at it

Front 8

look at the image in slide 11

Back 8

look at it

Front 9

Define " Chronic Peridontits "

Back 9

An infectious disease resulting in inflammation
within the supporting tissues of the teeth,
progressive attachment and bone loss.

Front 10

Chronic peridontis replaced an older term , what was it ?

Back 10

”adult periodontitis”
or “chronic adult periodontitis”

Front 11

Talk about Chronic Peridontits

Back 11

Extent
* Localized <30% of sites affected
* Generalized >30% of sites affected


Severity:
* Mild: 1-2 mm CAL
* Moderate: 3-4 mm CAL
* Severe: ≥5 mm CAL

Front 12

how do we write the diagnosis treatment ?

Back 12

Extent + Severity + Name of the disease

Front 13

Define " Aggressive peridontits "

Back 13

A specific type of periodontitis with clearly
identifiable clinical and laboratory findings
that make it sufficiently different from
Chronic Periodontitis

Front 14

Aggersvie peridontits is classified into : Localized aggersive and generalized aggersive , talk about these two types .

Back 14

Localiazed Aggersive : Attachment loss on at least two
permanent teeth, one of which
is a first molar and involving no
more than two teeth other than
first molars and incisors

Generalized aggersive : Generalized proximal
attachment loss affecting at
least three teeth other than first
molars and incisors

Front 15

List the characterstics of a healthy peridomntium

Back 15

Pink, firm gingiva, with a knife edge gingival
margin, no signs of redness or edema.
• Intact periodontal ligament with no attachment
loss.
• Cementum covering the root surface with
inserting sharpey’s fibers.
• No alveolar bone loss with the level of alveolar
bone crest 0.75-1.49mm below the cemento-enamel
junction.

Front 16

List the methods of peridontal screening examaniton

Back 16

Demographic information: Name, Date of Birth, Gender,
Occupation …..

C/C

=== History==== :
▫ Medical history
▫ Dental History
▫ Family History
▫ Smoking
▫ Oral hygiene measures

Examination
▫ Visual vs. Instrumentation

Front 17

What does the extra oral examnation consists of ?

Back 17

Inspection, palpation
• Face and Lips.
• Muscles of Mastication.
• Lymph Nodes.

Front 18

What does the intra-oral examnation consists of ?

Back 18

Examination of lining mucosa

Examination of the teeth:
- Caries, restorations, crowns and bridges.
- Overhanging restorations, open contacts.
- Plaque and calculus.
- Staining.
- Assessment of occlusion.

Front 19

what are the things that make up for the comprehensive periodontal assemesnet

Back 19

Oral Hygiene
• Gingival Inflammation
• Probing Depth
• Attachment level
• Bleeding on Probing
• Presence of Exudate
• Level of the free gingival
Margin
• Mucogingival Junction
• Tooth Mobility
• Furcation Involvement
• Occlusion
• Radiographic evidence of
Alveolar Bone Loss
• Presence of Local
Contributing Factors

Front 20

Talk about the plaque index

Back 20

was coined by Silness and Loe

0 --> No plaque

1--> Thin film at the gingival margin , viable ONLY when scraped with an explorer

2 --> moderate amount of plaque along the gingval margin : interdental space free of plaque ; plaque viable with the naked eye

3---> heavy plaque accumulation at the gingval margin ; intradental space filled with plaque

Front 21

Talk about the gingival index

Back 21

was coined by Silness and Loe

0 --> normal gingiva , no inflmmation , no discoloration and no bleeding

1--> mild inflmmation , slight color change , mild alterantion of gingival surface NO bleeding

2 --> moderate inflmmation , erthmya , swelling and BLEEDING on probing

3--> severe inflmmation , severe erthyma , severe swelling , some ulceration and tedency toward spotenous hemorrphage ( bleeding )

Front 22

Talk about " bleeding on probing "

Back 22

• Insertion of probe to the bottom
of pocket elicits bleeding in
inflamed gingiva
• Non – inflamed sited rarely bleed
• Absence of bleeding an excellent
predictor of periodontal stability

Front 23

when does the " purulent exudate " appears ?

Back 23

appear at the gingival margin after
digital pressure on the lateral aspect
of the gingival margin.

Front 24

Define " probing depth "

Back 24

Distance between the free gingival margin and the
base of the gingival crevice/pocket.

Front 25

talk about the basic princples of probing

Back 25

Basic Principles
• Keep parallel to long axis of tooth
• Walk the probe
• If calculus is present – go around it
• Apply no more than 20g of pressure
• Round to the nearest high millimeter
▫ E.g. 3.5 mm will be 4 mm

Front 26

When do you record all the reading ?

Back 26

Record readings greater then 3mm except when recession
is present (record all readings)

y3ni when having a recession == all , no recession only greater than 3

Front 27

what's the six point charting ?

Back 27

disto-buccal ==== mid buccal === mesio buccal
diso lingual ==== mid lingual === mesio lingual

Front 28

talk about gingival recession

Back 28

• Apical migration of the gingival margin.
• Measured as the distance between CEJ and GM ( gingival margin )

Front 29

Talk about Millers gingival recession classifcation

Back 29

class 1 ---> no loss of interdental paplilla , no extent to the GM

class 2 --> no loss of interdetnal paplilla , extend to MGJ )

class 3 --> loss of interdental papilla extend to MGJ

class 4 --> loss of bone , loss of soft tissue around the entire tooth with open interdetnal area .

Front 30

define attachment level

Back 30

Is expressed as the distance from the cemento-enamel
junction to the bottom of the pocket.

Front 31

How do we calcualte the attachment loss ?

Back 31

A) normal : CAL = PD

B) Overgrowth : CAL = PD - Overgrowth

C) Recession : CAL = PD + Recession

Front 32

Talk about width of attached gingiva

Back 32

Attached gingiva (AG) = Keratinized
gingiva(KG) – free gingiva (PD)

Front 33

define tooth modility and talk about miller tooth mobility classifcation

Back 33

it's Movement of tooth in a facial to lingual direction

class 1 : slight mobility , up to 1 mm of horizontal displacement in a facial-lingual direction

class 2 : moderate mobility >1 mm but < 2 mm of a horizontal displacment in a facial-lingual direction

class 3 : severe mobility >2 mm , of displacment in a facial-lingual direction or vertical ( tooth dpression in socket )

Front 34

Define "Fremitus"

Back 34

is a palpable or visble movemnet of a tooth when in fuction

Front 35

define furcation invlovment and talk about the classifcation

Back 35

Extension of bone loss between
roots of teeth
• broad term
▫ bifurcation of the mandibular
molars or maxillary premolars
▫ trifurcation of the maxillary molars


• The site and extent must be recorded
• Degree 1: probe enters the furcation up to 1/3 the width of the
tooth
• Degree 2: probe enters the furcation > than 1/3 but not the total
width of the tooth
• Degree 3: a horizontal “through and through” destruction

the classifcation was coined by hamp

Front 36

how do we record the extent of the invlovment ?

Back 36

via Naber's probe

Front 37

guidelines

Back 37

Write your name on top of sheet.
• Start with PI and GI. If an indexed tooth is missing either choose an adjacent
one or the opposite side of same arch.
• PD at deepest site, PD > 3mm , except when recession or if KG < 3mm.
• Use color code.
• For BOP, place a red dot at bleeding site where PD is documented.
• For recession, draw it with a red line
• Calculate the CAL
• Mobility value (I-III) is printed on occlusal surfaces of mobile teeth.
• For furcation involvement use a red pencil and the following codes:
▫ Grade I: مثلث نايم لتحت
▫ Grade II: مثلت نايم لتحت كامل
▫ Grade III and IV:مثلث نايم لتحت غامق
• KG < 3 mm: draw an “” at root involved (Facial usually).