Plaque-induced periodontal disease diagnoses

Definitions & Key takeaways

Plaque-induced periodontal disease is a type of gum disease caused by the buildup of plaque, a sticky film of bacteria, on the teeth and gums. The disease is characterized by inflammation and infection of the gums, which can lead to the destruction of the supporting tissues of the teeth, including the bone. The diagnosis of periodontal conditions may involve a physical exam, periodontal probing, X-rays, and lab exams.

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The most recent classification of periodontal and peri implant diseases and condition is from 2017. This newer system is broken down into groups with subcategories and this video will focus on plaque induced peridontal diseases, namely periodontal health, gingivitis and Pati.
Periodontal health really refers to clinical periodontal health and this means absence of clinically detectable inflammation.
How do we measure that bleeding? Improving the bleeding?
Improving score is based on all possible sites, pertus on all present teeth. Clinical periodontal health may be found in either on an anatomically intact period which is without clinical attachment loss or bone loss or on a reduced period.
For this video, we are focusing on patients with history of Pati. So when we talk about reduced periodontium in periodontal health or gingivitis, these patients have gone through and completed successful treatment of periodontitis and now stable.
And a plaque induced gingivitis is gingival inflammation defined by bleeding and probing of 10% or more without active underlying destruction.
And gingivitis can be further described as localized more than 10% but less than 30% or generalized, which is more than 30%.
It can be on intake paradigm or on a reduced paradigm. Patient that have gingivitis on a reduced paradigm, have higher risk of recurrent Pati.
And next is a parentis. In the older classification parentis was categorized as chronic or aggressive, but now they're group in a single category of parentis parentis is then further classified by staging extent.
And grading system staging is based on the severity of disease and the complexity of the long term case or patient management.
So stage should be determined using the interdental or interproximal clinical attachment loss initially. And there are other factors you have to consider to move from either higher or lower staging grade is about rate of parentis progression.
The primary criteria should be direct evidence or observation on bone loss or clinical attachment loss over time. If possible.
If not, then use indirect evidence, which is the percentage of bone loss divided by age at the most affected most severe tooth.
You should assume grade B as a default unless there is evidence to support towards slower rate, which is grade A or rapid rate, which is a grade c extent refers to generalized localized and molar incisor pattern and generalizes 30% or more teeth involved, localizes less than 30%.
The molar incisor pattern describes what it used to be called aggressive parotitis. Aggressive parotitis is not a separate diagnosis anymore and but it's combined in the same category of parentis.
So by designating as a molar incisor pattern, which is very specific, unique pattern of bone loss or uncertain teeth. This gives information to practitioner and patients about this very specific who biofilm interaction.
So let's take a look at this flow diagram. Before you use this flow chart, you have to first rule out any non periodontitis cause of attachment loss because this guideline will not work.
For those first question you want to be asking is is there gingival inflammation defined by bleeding or probing of 10% or more?
If the answer is no, then there is minimal inflammation. Then you have parodontal health and based on the attachment loss and bone loss, you could further classify as paradontal health on an intake paradigm or on a reduced paradigm and again, reduced paradigm refers to successfully treated stable patients.
The reason probing depth for reduced paradigm is set at four millimeter or less or because probing depth set at three millimeter or less will be very difficult to achieve after treatment.
If there's a bleeding approving of 10% or more. That that means you have gingival inflammation and then you could either be gingivitis or parentis at that point.
Presence of attachment loss, improving depth will help you guide the next step. If there is no attachment loss, then you have gingivitis on an intact paradigm.
And you get to the other decision point where there are both inflammation and attachment and the parameter to differentiate between gingivitis and parotitis at this point would be the probing depth.
If the probing depth is three millimeter or less, then you have gingivitis on a reduced paradigm. Remember, these patients are at high risk of disease recurrence and of progressive attachment loss.
Therefore, this is defined as bleeding at a shallow side of three millimeter or less rather than four millimeter or less.
And if there's a probing depth of one millimeter or higher wet bleeding, this is no longer a gingivitis case. This is a parodontitis case.
Once you arrive at the diagnosis of parotitis, then you have stage grade and extent to describe further staging is from 1 to 4 and grading is from A to C and extent includes generalized, localized and molar incisor pattern.
In this video, we went over plaque induced peridontal diagnosis. These are guidelines and case description.
Your patient case might not fit exactly. There might be pseudo pocket active smokers who have minimal bleeding on probing.
You might have attachment loss, we might be too difficult to detect or there might be a mixture of titi and non peridontal cause of attachment loss.
Remember to step back and take a look at the big picture right along with the patient information and the clinical data you gather, you will have to use your clinical judgment to really make the most appropriate diagnosis.
Thank you.