Periodontitis Lecture Notes

Introduction

• Periodontitis is a chronic, slowly progressing inflammatory disease that results in the destruction of the tooth-supporting apparatus.
• Historically classified as Chronic and Aggressive periodontitis.
• 2017 Classification divides periodontitis into 4 stages and 3 grades.
• Risk Factors: Smoking and diabetes are validated risk factors.

Definition and Clinical Features

• Periodontitis is characterized by:
  • Loss of periodontal-tissue support (Clinical Attachment Loss - CAL)
  • Radiographically assessed alveolar bone loss
  • Periodontal pocketing
  • Gingival bleeding

Signs and Symptoms

• Swollen or puffy gums
• Bright red, dusky red, or purplish gums
• Tender gums that bleed easily
• Pink-tinged toothbrush after brushing
• Bad breath
• Pus between teeth and gums

Classification of Periodontitis

1999 Classification (Armitage)

• Chronic Periodontitis
  • Localized: Involves <30% of sites
  • Generalized: >30% of sites
• Aggressive Periodontitis
  • Localized
  • Generalized (>30% of sites)
• Periodontitis as a manifestation of systemic diseases
• Necrotizing Periodontal Diseases
• Periodontitis Associated With Endodontic Lesions

2017 New Classification

• No distinct pathophysiology differentiating aggressive from chronic periodontitis.
• Classified by stages (severity) and grades (progression rate).

Stages of Periodontitis

• Stage I: Early stages of attachment loss, challenging early diagnosis.
• Stage II: Established periodontitis with characteristic damage to tooth support.
• Stage III: Significant damage to attachment apparatus; potential tooth loss.
• Stage IV: Considerable damage, tooth loss, loss of masticatory function.

Grading of Periodontitis

• Grade A: Slow progression
• Grade B: Moderate progression
• Grade C: Rapid progression

Diagnosis

• Based on CAL detectable at two nonadjacent teeth.
• Determination of form (e.g., necrotizing, systemic manifestation).
• Description of stage and grade.

Risk Factors

• Smoking and diabetes as grade modifiers.
• Emerging factors: obesity, genetic factors, physical activity, nutrition.

Differential Diagnosis

• Differentiation from acute periodontal lesions, necrotizing periodontal diseases, and endoperiodontal lesions.

References

• Cites works such as Carranza's Clinical Periodontology and reports from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.