AAP Classification of Periodontal Diseases and Conditions (1999)

1
AAP Classification of Periodontal Diseases and
Conditions (1999)

• Gingival Diseases
• Dental plaque-induced gingival diseases
• Non-plaque induced gingival lesions
• Chronic Periodontitis (Slight 1-2mm CAL
  moderate 3-4mm CAL severe gt5mm CAL)
• Localized
• Generalized (gt30 of sites are involved)
• Aggressive Periodontitis (Slight 1-2mm CAL
  moderate 3-4mm CAL severe gt5mm CAL)
• Localized
• Generalized (gt30 of sites are involved)

2
AAP Classification of Periodontal Diseases and
Conditions (1999)

• Periodontitis as a Manifestation of Systemic
  Diseases
• Associated with hematological disorders
• Associated with genetic disorders
• Not otherwise specified
• Necrotizing Periodontal Diseases
• Necrotizing ulcerative gingivitis
• Necrotizing ulcerative periodontitis
• Abscesses of the Periodontium
• Gingival abscess
• Periodontal abscess
• Pericoronal abscess

3
AAP Classification of Periodontal Diseases and
Conditions (1999)

• Periodontitis Associated with Endodontic Lesions
• Combined periodontic-endodontic lesions
• Developmental or Acquired Deformities and
  Conditions
• Localized tooth-related factors that modify or
  predispose to plaque-induced gingival diseases
  periodontitis
• Mucogingical deformities and conditions around
  teeth
• Mucogingival deformities and conditions on
  edentulous ridges
• Occlusal trauma
• The Periodontal Disease Classification System of
  the American Academy of Periodontology - An
  Update, Journal of Canadian Dental Association,
  2002 66549-7
• Crystal S. Baik

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What is Refractory Periodontal Disease

• Refractory periodontal disease refers to
  destructive periodontal diseases in patients who
  demonstrate continued attachment loss in spite of
  adequate treatment and proper oral hygiene.
• Contributing factors includetype of therapy
  provided, furcation involvement, microflora, and
  smoking history.
• Journal of Canadian Elizabeth Black
• Dental Association, December 2000

5
Periodontal Disease and Diabetes

• The diabetic state is associated with
• Decreased collagen synthesis
• Increased collagenase activity
• Altered neutrophil function
• Elevated blood sugar levels suppress the hosts
  immune response and results in
• Poor wound healing
• Susceptibility to recurrent infections
• Periodontal disease is often considered the 6th
  complication of diabetes and may place the
  individual at risk for future diabetic
  complications

6
Periodontal Disease Diabetes

• BRITTLE DIABETICS
• More susceptible to gingivitis, gingival
  hyperplasias and periodontitis
• More harmful proteins (cytokines) in their
  gingival tissues
• Decreased beneficial proteins (growth factors) ?
  interferes with the healing response
• Increased levels of serum triglycerides may be
  related to greater probing depths and attachment
  loss

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Periodontal Disease and Diabetes

• TREATMENT
• Closely monitor blood glucose levels
• Maintenance of meticulous oral hygiene and strict
  recall appointments
• Short appointments in relaxed, non-stressful
  environment
• Have source of oral glucose available
• Effective treatment of periodontal infection and
  reduction of periodontal inflammation are
  associated with a reduction in the level of
  glycosylated hemoglobin the marker of diabetic
  control

8
Periodontal Treatment and Diabetes

• -The diabetic patient requires special
  precautions prior to periodontal treatment
• -treatment in the uncontrolled diabetic is
  contraindicated
• -treatment in the brittle diabetic requires
  prophylactic antibiotics, started 2 days
  preoperatively (Penicillin VK) and continuing
  through the immediate post-op period
• -treatment of the well-controlled diabetic may
• the same as an ordinary patient

9
Periodontal Treatment and Diabetes

• Protocol for Treatment
• Clinician should make sure that prescribed
  insulin has been taken, followed by a meal
• Morning appointments are appropriate because of
  optimal insulin levels
• Monitor vitals, including blood glucose prior to
  treatment
• Procedures performed may alter the patients
  ability to maintain caloric intake, therefore
  post-op insulin doses should be altered
  accordingly
• Tissues should be handled as atraumatically and
  minimally as possible (less than 2 hrs)
• Epinephrine should not be used in concentration
  greater than 1100,000 due to epinephrine effects
  on insulin
• Diet recommendations should be made to maintain
  proper glucose balance
• Frequent recall and fastidious home oral care
  should be stressed

10
Periodontal Treatment and Diabetes

• Recent Studies
• -Effective treatment of periodontal infection
  and reduction of periodontal inflammation are
  associated with a reduction in the level of
  glycated hemoglobin
• -Increased serum triglyceride levels in
  uncontrolled diabetics have been shown to be
  related to greater attachment loss and probing
  depths
• -ThereforeControl of periodontal disease should
  be an important part of the overall management of
  the diabetic patient
• Sources
• Carranza and Newman, Clinical Periodontology, 8th
  ed.
• Grossi, et al. Treatment of Periodontal Disease
  in Diabetics Reduces Glycated Hemoglobin. Journal
  of Periodontology, Vol. 68, No. 8
• Chris VanDeven

11
Smoking and Periodontal Disease

• Smoking is a major cause of periodontal disease.
• Smokers are 4x as likely to develop periodontitis
  as non-smokers.
• Smoking may be responsible for more than half of
  the periodontal disease among adults in the U.S.
• Up to 90 of refractory periodontitis patients
  are smokers.

References 1) Tomar, S., Asma, S. J
Periodontol 200071743-751 2) Johnson GK. Slach
NA. Impact of tobacco use on periodontal status.
Review Journal of Dental Education.
65(4)313-21, 2001 Apr.
Graham Smith
12
Smoking and Periodontal Disease

• Smoking may increase levels of certain
  periodontal pathogens.
• Smoking has a negative effect on host response,
  such as neutrophil function and antibody
  production.
• Smoking has been shown to have a cytotoxic effect
  on gingival fibroblasts and could slow down wound
  healing.

References 3) Rota MT. Tobacco smoke in the
development and therapy of periodontal disease
progress and questions. Review Bulletin du
Groupement International Pour la Recherche
Scientifique en Stomatologie et Odontologie.
41(4)116-22, 1999 Oct-Dec. 2) Johnson GK. Slach
NA. Impact of tobacco use on periodontal status.
Review Journal of Dental Education.
65(4)313-21, 2001 Apr.
Graham Smith
13
Smoking and Periodontal Disease

• Smoking may be one parameter to use in deciding
  to treat refractory periodontitis in smokers with
  a systemic antibiotic therapy directed against
  smoking-associated periodontal bacteria.
• Smoking cessation seems to have a beneficial
  effect on periodontal health.

References 4) Lie MA. Smoking as a risk factor
for periodontitis. Review Dutch Nederlands
Tijdschrift voor Tandheelkunde. 106(11)419-23,
1999 Nov. 5) van Winkelhoff AJ. Bosch-Tijhof CJ.
Winkel EG. van der Reijden WA. Smoking affects
the subgingival microflora in periodontitis.
Journal of Periodontology. 72(5)666-71, 2001 May.
Graham Smith
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What is Periostat?

• Doxycycline Hyclate- inhibits collagenase
  activity and reduces the collagenase activity in
  gingival crevicular fluid of patients with adult
  periodontitis
• Indicated for use as an adjunct to scaling and
  root planing to promote attachment level gain and
  to reduce pocket depths
• Periostat is available as a tablet(20mg) to be
  taken orally two times a day (about an hour
  before, or two hours after meals). Should be
  taken with plenty of fluids.
• Typical treatments range from 3months to
  12months.
• www.Periostat.com R.Macnowski

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What is Periostat?

• Clinical studies have shown that the use of
  Periostat, along with SC/RP is more effective at
  regaining attachment level, than treatment with
  SC/RP alone
• Periostat is the first and only therapeutic agent
  designed to modulate the host response and helps
  to slow the progression of periodontal disease.
• Periostat should be used when traditional SC/RP
  treatments alone are ineffective, but before
  surgery is indicated.
• www.Periostat.com R. Macnowski

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What is Periostat?

• Periostat is not an antibiotic- the low dosages
  of periostat have no detectable effect on
  bacteria.
• Periostat should not be used with children,
  expecting mothers, nursing mothers, or anyone
  with a tetracycline hypersensitivity.
• Periostat may cause hypersensitivity to sunlight
• No reports of tooth staining
• May reduce the effect of BCPs
• www.periostat.com R.Macnowski