Everything you need to know about Clinical Periodontology - The Basics!

 Clinical Periodontology:

GENERAL PRINCIPLES:

4 phases:

1 - Assessment and diagnosis

Periogram, prophylaxis, plaque detection, diagnosis and oral hygiene instructions

• 2 - Cause-related therapy
• Scaling and root planing, non-surgical treatments (oral hygiene instructions) 3 - Reevaluation
• 2 scenarios:
  • If the patient has improved, proceed to the 4th phase
  • If the patient has not improved, either return to phase 2 or consider surgical treatment if necessary. 4 - Periodontal support therapy
• Periodic recalls every 1 year or, for more complex cases, every 6 months.

1

Periogram:

Complete mouth probing to identify bleeding points, probing depth (PD), gingival level (GL), calculate clinical attachment level (CAL), plaque index. Probing: North Carolina millimeter probe = Each mark represents 1mm, the first black mark indicates between 4 and 5mm, the second between 9 and 10mm, and the third between 14 and 15mm. Nabers probe: Used when assessing furcation involvement. This curved probe has two dark areas, with the first marking from 3 to 6mm and the second from 9 to 12mm. The North Carolina probe is used to measure both PD and GL. When inserted into the sulcus/gum pocket of the patient, it marks the PD, and the level of recession or swelling is the GL. The GL is calculated as follows: Recession is +mm, and swelling is -mm.

• For example: Recession (GL) of 2mm and pocket depth (PD) of 4mm = 4 + 2 = 6 (CAL)
• If there is gingival swelling (GL) of, for example, 2mm, it becomes: 4 (PD) - 2 (GL) = 2 (CAL)

If CAL is equal to or less than 3mm, it's a sulcus; if greater than 3mm, it's considered a periodontal pocket. Bleeding Index:

• To understand this, we need to know the probed sites: Each tooth should be probed at a minimum of 6 sites (3 on the palatal and 3 on the buccal side).

The formula to calculate the bleeding index is as follows: Number of bleeding sites divided by probed sites times 100. If the index is less than or equal to 10%, it indicates health.

Bleeding Index=(Number of Probed SitesNumber of Bleeding Sites​)×100

Plaque Index:

• To calculate, we need to visualize the plaque.
• Then, use the same formula, but instead of the number of bleeding sites, use the number of surfaces with plaque.
• Dental Plaque Index=(Total Number of Surfaces EvaluatedNumber of Surfaces with Plaque​)×100

Diagnosis:

Gingivitis:

• A condition characterized by gingival inflammation due to biofilm (etiology).
• More than 10% bleeding.
• Can be localized or generalized; if up to 30% of teeth are involved, it's considered localized, and if more than 30%, it's generalized.

Non-biofilm-induced gingival diseases:

• Hereditary/Medicamentous gingival fibromatosis
• Burns
• Systemic diseases
• Fungal diseases: Candidiasis, Histoplasmosis, Aspergillosis
• Viral diseases: Herpes, HPV, Varicella, Hand-foot-mouth disease
• Bacterial diseases: Tuberculosis, Gonorrhea
• Immune-inflammatory conditions
• Neoplasms
• Scurvy
• Reactive processes
• Traumatic injuries
  
  
  

Periodontitis:

• A chronic inflammatory disease, multifactorial, associated with dysbiotic biofilm and characterized by loss of periodontal bone attachment.

CLASSIFICATION: Stages I, II, III, IV, and Grades A, B, C

• Start by assessing clinical attachment loss.
• Followed by radiographic bone loss.
• If complex conditions like furcation lesions and advanced mobility are present, the stage is upgraded, always based on the worst scenario found.
• Staging indicates disease severity.

Stages I, II, III, IV: Loss of less than 15% attachment, 1-2 mm = Stage I

Loss of 15-33% attachment, 3-4 mm = Stage II

Loss of more than 33% attachment (up to the middle third of the root), more than 5 mm with tooth loss of less than 4 teeth (due to periodontitis), possible furcation involvement grade 2 or 3 = Stage III

Bone loss beyond the midpoint of the root, tooth loss of 5 or more teeth due to periodontitis, severe ridge defects, generalized mobility grade 2 or 3, less than 20 remaining teeth = Stage IV

Grades A, B, C

• Grade A: Determining factor: Direct - No progression of attachment loss in the last 5 years; if no evidence from 5 years ago, assess indirectly - Note the percentage of bone loss and divide it by the patient's age; if the result is less than or equal to 0.25mm, it's grade A. High biofilm accumulation and minimal periodontal destruction. Non-smoker and non-diabetic.

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• Grade B: Direct - Progression less than 2mm in 5 years Indirect - If bone loss calculation is between 0.25mm and 1mm = grade B Moderate biofilm accumulation and periodontal destruction, both moderate. Smokes less than 10 cigarettes per day and HbA1c <7% (glycated hemoglobin); not diabetic.

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• Grade C: Direct - Progression equal or greater than 2mm Indirect - If the bone loss calculation per age is more than 1mm Low biofilm for significant periodontal destruction. Smokes more than 10 cigarettes per day and HbA1c >7% (Diabetic).