Periodontics
What this domain tests
Periodontics tests the 2017 classification, risk assessment, non-surgical and surgical therapy, and maintenance. Candidates should be able to stage and grade a case and justify treatment.
Core rules
- Gingivitis is plaque-induced inflammation without attachment loss. Periodontitis involves clinical attachment loss and alveolar bone loss.
- Staging uses severity (CAL, bone loss, tooth loss) and complexity. Grading uses progression rate, smoking and diabetes.
- Stage I: CAL 1-2 mm. Stage II: CAL 3-4 mm. Stage III: CAL 5 mm or more with tooth loss of 4 or fewer. Stage IV: CAL 5 mm or more with tooth loss of 5 or more and complex needs.
- Grade A is slow, Grade B moderate and Grade C rapid. Bone loss divided by age greater than 1.0 suggests Grade C; smoking and HbA1c modify grade.
- Probing depth is not attachment loss; recession and pseudopockets can mislead.
- Cause-related therapy includes oral hygiene instruction and supragingival and subgingival scaling and root planing, with re-evaluation at 6-8 weeks.
- Adjunctive antibiotics are not routine; consider them in necrotising disease, aggressive periodontitis or systemic involvement.
- Maintenance is risk-based and monitors bleeding on probing and pocket depth.
Worked example
A 45-year-old smoker has CAL of 6 mm on several molars, 60% bone loss, has lost 2 teeth and has HbA1c 7.8%. This is Stage III, Grade C: severity is Stage III because CAL is 5 mm or more and tooth loss is 4 or fewer; grade is C because of rapid bone loss plus smoking and diabetes. Treatment starts with cause-related therapy, not immediate surgery.
Traps
- Do not call a pseudopocket periodontitis; check the cemento-enamel junction.
- Drug-induced gingival enlargement is not attachment loss.
- Pregnancy gingivitis usually resolves after delivery; avoid unnecessary surgery.
- Smoking masks bleeding; absence of bleeding does not mean absence of disease.