Periodontal Systemic Interrelationships

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Eastman Dental Center Rochester, NY
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Downtown Houston, Texas
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Houston Medical Center
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University of Texas Health Science Center Houston
Dental Branch
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TOPICS

• Diagnosis of Periodontal Diseases
• Periodontal-Systemic Interrelationship
• Modulation of Host Response
• Antimicrobials in Periodontics
• Dentin Hypersensitivity
• Halitosis
• Endogain/PepGen P15

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Classification Diagnosis of Periodontal
Diseases

• Antonio J. Moretti, DDS, MS

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Definitions

• Classify
• to arrange or place into classes
• Diagnose
• to discover the nature (of a disease)

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Definitions

• Gingivitis
• Inflammation of the gingiva
• Periodontitis
• Inflammation of the supporting tissues of the
  teeth with a progressive destructive change
  leading to loss of bone and periodontal ligament

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Healthy Periodontium
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Gingival Assessment
Generalized Gingivitis
Localized Gingivitis
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Gingival Assessment
Chronic Inflammation - dark red to blue -
Acute Inflammation - bright red -
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Periodontal Histopathologic Events(Page
Schroeder, 1976)

• Gingivitis
• Initial
• Early
• Established
• Periodontitis
• Advanced

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Gingivitis

• Initial Lesion
• Acute inflammatory reaction (PMNs)
• Four days after plaque accumulation
• Not clinically visible
• 5 to 10 collagen loss

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Gingivitis

• Early Lesion
• Lymphocytes and macrophages
• 7 to 21 days or longer, after plaque accumulation
• Clinically visible
• 60 to 70 collagen loss

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Gingivitis

• Established Lesion
• Plasma cells and B cells
• From 21 days to months or years after plaque
  accumulation
• Can have severe gingival inflammation

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Periodontitis

• Advanced Lesion
• All features of established lesion, but more
  severe
• Destruction of connective tissue attachment
• Apical migration of junctional epithelium

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Diagnoses/Classifications

• PSR - Periodontal Screening Record
• AAP Case type
• World Workshop in Periodontics (1989)
• International Workshop for a Classification of
  Periodontal Diseases and Conditions (1999)

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The American Academy of Periodontology Case
Type Classification of Periodontal Diseases

• I - Gingivitis
• II - Incipient Periodontitis
• III - Moderate Periodontitis
• IV - Advanced Periodontitis
• V - Refractory Periodontitis

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AAP Case Type Classification

• Dental insurance companies requirement
• Based on disease severity
• Diagnosis based on most severe site(s)
• Serves as a guideline only
• Does not dictate treatment plan

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Type I Gingivitis (04500)

• Inflammation of the gingiva characterized by
• Clinical signs changes in color, form, position,
  consistency, surface appearance, bleeding and
  exudate. No attachment loss present.
• No radiographic bone loss.

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Type II Incipient Periodontitis (04600)

• Progression of gingival inflammation
  characterized by
• Clinical signs same as gingivitis except for
  probing depth up to 3 or 4 mm.
• Attachment loss of no more than 2 mm.
• Radiographic evidence of slight crestal bone loss
  ( 1mm).

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Type III Moderate Periodontitis (04700)

• Clinical signs same as gingivitis except for
  probing depth between 4 to 6 mm.
• Attachment loss between 3 to 4 mm.
• Furcation involvement class I may be present.
• Tooth mobility may be present.
• Radiographic evidence of bone loss (1/3).

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Type IV Advanced Periodontitis (04800)

• Clinical signs same as gingivitis except for
  probing depth gt 6mm.
• Attachment loss gt 5mm.
• Furcation involvement class II or III.
• Increased tooth mobility.
• Radiographic evidence of 50 or more of bone
  loss. Vertical defects.

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Type V Refractory Periodontitis (04900)

• Destructive periodontal disease in patients who,
  when longitudinally monitored, demonstrate
  additional attachment loss at one or more sites,
  despite well-executed treatment and patient
  efforts to stop the disease progression.

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