Classification of periodontal diseases-the eternal ... - Dentinal Tubules

Preyesh Patel and Alaa Guni, BDS 4 studentsClassification of periodontal diseases-the eternal questClassifying and grouping entities is integral to human nature. It enforces a sense of belonging so much so, that the entire human species is subdivided into various races, religions andcastes. It would be interesting to see if this phenomenon is reciprocated amongst animals.When it came to tackling the age old concern of classifying periodontal disease, various factors were considered when formulating the classification that is now accepted worldwide:World Worskshop in Periodontology, 1999. These factors included: Aetiology, clinical presentation as well as prognosis/outcome.As a dental student appreciation of these finely tuned (so far) classifications can be difficult. However, after sifting through many resources, we have formulated a table of our own. Asummary of the classifications of the periodontal diseases coupled with its appropriate management. This will serve as a quick and simple tool when revising for exams or even as a referencewhen in practice.

Preyesh Patel and Alaa Guni, BDS 4 studentsDiagnosis Features TreatmentGingivitis Plaque-induced only No loss of Connective Tissue Attachment (CTA) or Alveolar OH reinforcementBone (AB)Plaque present at gingival marginRednessOedematousIncrease in gingival exudatesLoss of stipplingBleeding on probingSulcular temperature changeReversible upon plaque removalModified by systemic conditions Hormonal-increase in gingivitis during circumpubertal age,without simultaneous plaque increase diabetesModified by medications Anti-convulsants-Phenytoin calcium channel blockers-Amlodipine Immunosuppressants-CyclosporinreviewCorrect or reduce predisposing systemic factors(eg. Control diabetes, smoking cessation)OH reinforcementReviewAttempt to change medication (discuss) withphysicianOH reinforcementreviewModified by malnutrition Lack of vitamin c seen from their diet history Review Diet Discuss diet supplements with physician OH reinforcement reviewNon-plaque inducedBacterial origin-N.gonorrhea, T.pallidum, Streptococci, MycobacteriumchelonaeOH reinforcement possibly with an antibacterialadjunctFeatures: fiery red, oedematous, painful ulceration(asymptomatic chancres, mucous patches or a typical nonulceratedhighly inflamed gingivitis)Viral origin-herpetic ginigivostomatitisFeatures– generalised pain in the gingival and oral mucosa,inflammation, ulceration of gingival and mucosa, lymphadenopathy,fever, malaiseGentle debridement and relief of pain usinganalgesiaInstruction in proper nutrition, appropriate fluidintakeReassurance that condition is self-limitingAntiviral adjunctViral origin-herpes zosterFeatures– small ulcers on the tongue, mucosa and gingivaHealing usually occurs within 1-2 weeksSoft/liquid dietRestAtraumatic plaque removal– CHX mouthrinsesAntiviral adjunct

Preyesh Patel and Alaa Guni, BDS 4 studentsDiagnosis Features TreatmentGingivitis Non-plaque induced Fungal origin-CandidosisFeatures– pseudomembranous candidosismay present as white lesions,chronic erythematous candidosis presentsas redness along the gingival margins.AntifungalOH reinforcementreviewMucocutaneous disorders– Oral LichenPlanus, Benign mucous membranepemphigoid, pemphigus vulgaris, erythemamultiformeTopical ointments, steroidsOH reinforcementReviewFeatures– desquamative lesions, gingivalulcerationsTrauma– traumatic brushing techniqueFeatures– frictional keratosisInstruction on atraumatic brushing techniquePeriodontitis Incidental attachment loss Loss of attachment doesn’t fit into criteriaof aggressive or chronic periodontitisIsolated areas of attachment loss in an otherwisehealthy dentition associated withtrauma, malpositioned tooth, impacted thirdmolars, subginigival caries and endo infectionsMay predispose to periodontitisTreat local defectOH reinforcementReviewIncipient chronic periodontitis Age of onset can be in adolescence (13–14years) Interproximal clinical attachment loss of 1–2 mm (commonly seen on maxillary firstmolars, mandibular incisors), associatedwith presence of plaque, subgingival calculus Pockets of 4–5 mm. Bone loss no more than 0.5 mm over an 18-month period (bite-wing radiographs usuallyshow horizontal bone loss).OH reinforcementNon-surgical rsdReview

Preyesh Patel and Alaa Guni, BDS 4 studentsPeriodontitisDiagnosis Features TreatmentChronic PeriodontitisMild 1-2mm cal, 50% bone lossLocalised 30% sites affectedAggressive periodontitis-Localised: Circumpubertal onset restricted to interproximal areas (IPCAL is >3mm) of first molar andincisors. (arc shaped) involving no more than two teethother than first molar or incisorGeneralised- Generalised Interproximal attachmentloss affecting at least 3 teethother than first molars and incisors(

Preyesh Patel and Alaa Guni, BDS 4 studentsDiagnosis Features TreatmentPeriodontitis Abscesses (periodontal) Forms close to the gingival margin Tender to lateral percussion Pulp vital for true perio lesionsDrainage (to relieve patient!)RSD if allowedCourse of antimicrobials: Metronidazole (preffered aseffective against anaerobic bacteria) or a mix of metronidazoleand amoxicillin if cellulitis presentReviewPerio-endo lesion -Primarily endodontic History of trauma or pulpitisHeavily restoredFracture of tooth?Localised pockets and relatively healthy periodontium generallyNon-vitalTTPExtraction or extirpate the pulp and monitorIf improvement shown (reduction in symptoms and reducedlesion on LCPA) à RCT followed by RSDPerio-endo lesion -Primarily periodontic History of periodontitisVital/non-vital pulp upon testingLack of restoration/fracture or history of traumaNo history of pulpitisTTPExtraction or extirpate the pulp and monitorIf improvement shown (reduction in symptoms and reducedlesion on LCPA) à RCT followed by RSD