History Why we need to classify?

Transcription

1 Aiming to Cover: MSc ADVANCED GENERAL DENTAL PRACTICE Classification & Recognition of Periodontal Disease Classification of periodontal disease Recognition of Disease DR MIKE MILWARD BDS (Birmingham), MFGDP (London), MFDS RCPS (Glasgow), FHEA (UK), PhD (Birmingham), GDC Specialist in Periodontology Senior Lecturer / Honorary Consultant in Periodontology The School of Dentistry University of Birmingham Introduction Classification of A number of classification schemes have been proposed and modified as the aetiology of periodontal disease has become clearer. Such changes can confuse and frustrate practitioners in diagnosing their patients. History Why we need to classify? To help clinicians design appropriate therapeutic strategies for their patients Provides international healthcare community a way of communicating in a common language Helps in the study of periodontal diseases 1

2 The ideal classification The 1999 scheme Is to use the name of the aetiological agent which causes the disease for example Tuberculosis is so called because it is a mono-infection caused by the bacterium Mycobacterium tuberculosis. But periodontal diseases cannot be classified in this way as they are complex diseases with multiple aetiological factors, which includes bacterial challenge along with the hosts response to that challenge. This current classification scheme was proposed by The International Workshop for Classification of s It aimed to address issues that were felt lacking in the 1989, 1993 schemes The 1999 scheme Gingival Disease Classification Classification The main features of the 1999 classification A gingival disease classification introduced Adult periodontitis replaced by Chronic periodontitis Refractory disease lost Early onset disease replaced by aggressive disease The implications of systemic diseases on periodontal status were expanded and more comprehensively defined The main features of the 1999 classification - continued Necrotizing periodontal diseases were introduced to cover ANUG, and ANUP Periodontal abscess added Perio-endo category included A category of developmental or acquired lesions was introduced 2

3 Localised (<30% sites) Generalised (>30% sites) Dental Plaque Induced Gingival Diseases Gingivitis associated with dental plaque only. Gingival diseases modified by systemic factors. Gingival diseases modified by medications. Gingival diseases modified by malnutrition. Aggressive Periodontitis Periodontitis as a manifestation of Systemic Disease Localised Generalised Associated with genetic disorders Not otherwise specified Gingival diseases of specific bacterial origin. Gingival diseases of viral origin. Nectrotizing Necrotising Ulcerative Gingivitis Necrotising Ulcerative Periodontitis Non Plaque Induced Gingival Lesions Gingival diseases of fungal origin. Gingival diseases of genetic origin. Gingival manifestations of systemic conditions. Abscesses of the Periodontium Gingival Abscess Periodontal Abscess Pericoronal Abscess Traumatic lesions Foreign body reactions Not otherwise specified Periodontal Lesions associated with Endodontic Lesions Combined periodontal-endodontic lesions Localised tooth related factors that modify or predispose to plaque-induced gingival disease/periodontitis Gingival Diseases A simplified scheme of the 1999 International Workshop (4) Developmental or Acquired Deformities or Conditions Mucogingival deformities & conditions around teeth Mucogingival deformities & conditions on edentulous ridges Occlusal Trauma Replaces Chronic Adult Periodontitis Localised (up to 30% sites) Generalised (>30% sites) Most prevalent in adults Amount destruction consistent with local risk factors Subgingival calculus frequent finding Moderate to slow rate of progression May be modified by systemic disease Severity of disease can be recorded as: Slight: CAL 1-2mm Moderate: CAL 3-4mm Severe: CAL 5mm or more (Old classification had 35 yrs as cut off between early onset diseases and Chronic adult disease) Can be modified by smoking and stress Poor oral hygiene Bone loss consistent with local risk factors Probable smoker Will tend to be older CHRONIC PERIODONTITIS Aggressive disease Replaced early onset in old classification Disease that occurs in patients that are:- 1. Systemically healthy 2. Rapid loss of attachment 3. Level of disease inconsistent with local risk factors 4. High incidence of familial link 3

4 Localised Aggressive Disease: Generalised Aggressive Disease: Onset around puberty Usually people less than 30 years old, but can be seen in older subjects First molar and incisor involvement Generalized interproximal attachment loss affecting at least 3 permanent teeth (other than first molars and incisors) Pronounced episodic nature of bone loss Good oral hygiene Bone loss not consistent with local risk factors non smoker Will tend to be younger AGGRESSIVE PERIODONTITIS Long cone periapicals of 36 year female patient Early onset disease or Chronic Adult? Aggressive disease a better classification! Recognition of 4

5 History key points which may indicate periodontal disease o Bleeding on brushing/eating/spontaneous o Unpleasant taste o Halitosis o Mobility o Drifting teeth o Halitosis History continued OH regime Smoking Family history Systemic disease (especially Diabetes) Medication Examination WHO Probe (BPE probe) type C ( mm) Gingival inflammation & bleeding Pocketing Gingival recession Tooth mobility / migration Attachment loss Conduct and document BPE Examine the occlusion ( mm) (0.5mm diameter) Force of 20-25g Basic Periodontal Examination CODE MANAGEMENT 0 No treatment required 1 Oral hygiene instruction 1 st Black band partially obscured Code OHI plus calculus removal, correct plaque retentive factors OHI, scaling, correct plaque retentive factors, monitor plaque/bleeding, detailed chart at review post treatment OHI, scaling, correct plaque retentive factors, RSD of sites >5mm as identified by DPC, review at 3/12 5

6 Examination special tests Appropriate radiographs Vitality testing Diagnosis & Treatment Plan Improve OH, remove supra gingival deposits, plaque retentive factors. RSD sites of > 5mm Review pocket depths, oral hygiene, Repeat RSD on non healing sites Allow 3 months for healing Allow 3 months for healing Review pocket depths, oral hygiene, Repeat RSD on non healing sites Allow 3 months for healing 6