Periodontal Disease Classification

• What is the process to diagnosing periodontal disease?

  • history
  • examination
  • special tests
  • diagnosis
  • treatment plan
  • explanation
  • RF and motivation
  • non-surgical tx
  • Review
  • Mantainance/retreatment
• What type of questions are asked when history taking?

  • bleeding on brushing/eating/spontaneous
  • unpleasant taste
  • halitosis
  • mobility/drifting teeth
  • OH regime
  • smoking
  • FH
  • MH
  • perio history
  • stress levels
  • diet
• What is checked on an extra - oral examination?

  • general systemic review
  • facial skin, perioral tissues
  • lymph nodes
  • TMJ
  • muscles of mastication
• What is checked on an intra-oral examination?

  • soft tissue exam
  • gingival inflammation and bleeding
  • pocketing, conduct and document BPE
  • gingival recession
  • tooth mobility/migration
  • attachment loss
  • occlusion
• What instrument is used to measure the BPE?

  • who - c
  • 0.5 mm ball end
  • double black band
  • first black band 3.5 - 5.5 mm
  • second band 8.5 - 11.5 mm
  • use 20 - 25G force
• What are the BPE codes?

  • 0: no tx required
  • 1: ohi
  • 2: ohi and pmpr, removal of pfr
  • 3: ohi, pmpr, removal of pfr, rsd, monitor pi/bi, dpc of sextant
  • 4: ohi, pmpr, removal of pfr, rsd, monitor pi/bi, dpc full mouth, review 3/12
• What are examples of special tests?

  • radiographic exam
  • vitality test
  • mobility, dpc, furcation, recession
• Why do we need to classify?

  • help clinicians design appropriate therapeutic strategies for their patients
  • provide international healthcare community a way of communicating in a common language
  • help in study of periodontal disease
• Why cant periodontal disease be classified by Aetiology?

  complex disease with multiple aetiological factors, which includes bacterial challenge along with the hosts response to that challenge
• Why is there a new classification for periodontal disease?

  • evidence based changed since 1999 classification
  • designed to be used regularly in practice
  • aim to capture extent and severity of disease
  • capture patient susceptibility
  • indicate current disease
  • conflicting literature on Aggresive Perio
  • clear definitions of perio health and gingivitis
• What do codes 0,1,2 indicate?

  • with no evidence of id recession
  • <10% bi = clinical gingival health
  • 10-30% = localised gingivitis
  • >30% = generalised gingivitis
• What does code 3 indicate?

  • with no evidence of id recession
  • + radiograph assessment
  • initial perio tx, review at 3/12 with dpc
  • tx on pockets </= 4mm no bone loss go to code 0/1/2 pathway
  • tx on pockets >/= 4mm or radiographic bone loss go to code 4 pathway
• What does code 4 indicate?

  • and/or obvious evidence of id recession
  • radiographic assessment
  • dpc
  • MI pattern = periodontitis MI pattern
  • <30% teeth = localised perio
  • >30% teeth = generalised perio
• What are the four stages of periodontal disease?

  • stage 1: <15% bone loss or 2<2mm LOA from CEJ
  • stage 2: coronal third of root
  • stage 3: mid third of root
  • stage 4: apical third of root
• But what if you have a code 0, 1 or 2 BPE with interproximal attachment loss and no radiographs??

  You use recession, pocket depth and biological width, average root length to calculate bone level and where on the root there is bone loss to establish a grade
• How is grading determined?

  • % BONE LOSS divided by the PATIENT AGE
  • use worse site
  • <0.5 grade A
  • 0.5-1.0 grade B
  • >1.0 grade c
  • include RF
• How is stability determined?

  • stable: BOP < 10%. PPD </= 4mm No BOP at 4mm sites
  • remission: BOP > 10%, PPD < 4mm no BOP at 4mm sites
  • unstable: PPD > 5mm or PPD >4mm and BOP
• What are examples of risk factors?

  Smoking, poorly controlled diabetes, plaque retentive factors