Periodontics
This domain tests periodontal diagnosis, risk assessment, nonsurgical and surgical therapy, and maintenance. The exam expects you to distinguish gingivitis from periodontitis and to use clinical attachment level, not pocket depth alone.
Diagnosis
- Gingivitis is plaque-induced inflammation with bleeding and swelling but no attachment loss. Periodontitis requires clinical attachment loss and radiographic bone loss.
- Probing depth plus recession gives clinical attachment level. Bleeding on probing indicates inflammation; suppuration and deep pockets indicate active disease.
- The 2018 classification stages periodontitis by severity and complexity and grades by progression risk. Smoking and diabetes worsen grade.
Treatment
- Initial therapy is oral hygiene instruction, supragingival and subgingival scaling and root planing, risk-factor control and re-evaluation after six to eight weeks.
- Adjunctive antibiotics are not routine; they may be considered in selected aggressive or necrotising cases. Surgery aims to reduce pockets or regenerate defects.
- Maintenance every three to six months is essential; untreated periodontitis is a chronic disease.
Worked example
A 45-year-old smoker has 6 mm pockets, 5 mm clinical attachment loss, bleeding on probing and 30% bone loss. Reasoning: attachment loss and bone loss confirm periodontitis. The severity and complexity place it at least Stage III; smoking raises the grade. Treatment begins with scaling and root planing plus smoking cessation, not immediate surgery.
Traps that cost marks
Pocket depth alone does not diagnose periodontitis. Smoking can mask bleeding. Radiographs show historic bone loss, not current activity. Do not call all redness periodontitis. Peri-implant mucositis and peri-implantitis are separate diagnoses. Antibiotics are adjuncts, not a substitute for debridement.