Periodontology and Community/Preventive Dentistry
Periodontology and community dentistry: staging and grading of periodontal disease, first-line and adjunctive management, and population-level prevention. Expect a chart of probing depths and attachment loss, or a public-health scenario on fluoride and caries prevention.
Core rules
- Gingivitis is plaque-induced inflammation without attachment loss; periodontitis requires interdental clinical attachment loss plus radiographic bone loss.
- Staging (I–IV) describes severity and complexity - attachment loss, bone loss, tooth loss, probing depth. Grading (A–C) describes rate of progression and risk, using smoking, diabetes and the bone-loss-to-age ratio.
- Record six sites per tooth: probing depth, recession, CAL and bleeding on probing, plus mobility and furcation involvement.
- Nonsurgical therapy - hygiene instruction plus scaling and root planing - is first line. Adjunctive systemic amoxicillin with metronidazole is reserved for grade C disease, not routine periodontitis.
- Diabetes and periodontitis interact bidirectionally; smoking is the strongest modifiable risk factor.
- Fluoride acts topically by enhancing remineralisation and forming fluorapatite. Water fluoridation is typically 1 ppm; 5% sodium fluoride varnish (22,600 ppm) is applied at least twice yearly in high-risk patients; toothpaste of 1,000–1,500 ppm is used from eruption of the first tooth.
- Epidemiology uses DMFT scores and WHO simplified oral health survey methods.
Worked example
A 40-year-old non-smoker with HbA1c 8.5% has a molar with 6 mm probing depth, 5 mm CAL and 40% bone loss to the middle third of the root. That is stage III (CAL ≥5 mm, bone loss beyond the coronal third), and grading is B or C driven by glycaemic control. Treatment begins with scaling and root planing, oral hygiene instruction and liaison with the physician, then reassessment at 8–12 weeks - not immediate surgery and not antibiotics alone.
Traps
- Calling radiographic bone loss 'gingivitis' because the gingiva looks mildly inflamed.
- Using antibiotics as a substitute for debridement.
- Missing pregnancy: manage with scaling and hygiene, and defer elective care to the second trimester.
- Believing fluoride works only systemically; the dominant effect is topical.