MJDF Part 1 - Membership of Joint Dental Faculties Periodontology and Gum Health Questions and Answers — Questions and Answers
Question 1: A 48-year-old patient, who smokes 15 cigarettes per day, presents for a routine examination. The Basic Periodontal Examination (BPE) reveals a highest score of 4 in one sextant. According to the 2017 Classification of Periodontal and Peri-Implant Diseases and Conditions as implemented by the British Society of Periodontology (BSP), what would be the most appropriate initial Grade to assign to this patient?
- Grade A: Slow rate of progression
- Grade B: Moderate rate of progression
- Grade C: Rapid rate of progression (Correct answer)
- The Grade cannot be determined from BPE scores alone
Correct answer: Grade C: Rapid rate of progression
According to the BSP implementation of the 2017 classification, the Grade is initially assumed to be B (moderate progression). However, this is then modified by risk factors. Smoking 10 or more cigarettes per day is a key risk factor that automatically moves the patient to Grade C, indicating a rapid rate of progression and an anticipated poorer response to treatment. The BPE score indicates the presence of periodontitis, which necessitates staging and grading.
Question 2: A dentist in the UK performs a Basic Periodontal Examination (BPE) on a new adult patient. The scores recorded are 2, 1, 3, 1, 2, 1. According to the British Society of Periodontology (BSP) guidelines, what is the next most appropriate step in this patient's periodontal management?
- Arrange for a six-point pocket charting in all sextants.
- Discharge the patient with oral hygiene instruction (OHI) only.
- Provide Professional Mechanical Plaque Removal (PMPR) and OHI, then reassess. (Correct answer)
- Immediately refer the patient to a specialist periodontist.
Correct answer: Provide Professional Mechanical Plaque Removal (PMPR) and OHI, then reassess.
A BPE code of 3 in any sextant indicates a probing depth of 3.5-5.5 mm. The BSP guidance states that for a Code 3, initial therapy is required, which consists of oral hygiene instruction (OHI) and Professional Mechanical Plaque Removal (PMPR), formerly known as scale and polish. A six-point pocket chart is only required for the sextant(s) scoring Code 3 initially, and for all sextants if scores of 4 are present. Referral is not indicated at this stage, and discharge with OHI alone is insufficient.
Question 3: Which of the following was a key change introduced in the 2017 World Workshop Classification of Periodontal Diseases, which has been adopted for use in the United Kingdom?
- The introduction of the Basic Periodontal Examination (BPE) as a primary diagnostic tool.
- The creation of a new category for 'refractory periodontitis'.
- The replacement of the 'chronic' and 'aggressive' periodontitis classifications with a staging and grading system. (Correct answer)
- The recommendation to use antibiotics as a first-line treatment for all BPE scores of 4.
Correct answer: The replacement of the 'chronic' and 'aggressive' periodontitis classifications with a staging and grading system.
A principal change in the 2017 classification was the elimination of the distinction between 'chronic' and 'aggressive' periodontitis. These were replaced by a single diagnosis of 'Periodontitis', which is then further described by a Stage (I-IV, based on severity and complexity) and a Grade (A-C, based on rate of progression and risk factors). The BPE is a screening tool, not a new diagnostic tool from this classification. 'Refractory periodontitis' is not a new category, and antibiotics are not a first-line treatment.
Question 4: A 29-year-old patient presents with generalised, severe gingival inflammation and reports that their gums have been getting progressively worse over the last few months. Radiographs reveal significant vertical bone loss affecting the first molars and incisors, which is inconsistent with the level of plaque deposits. The patient is otherwise medically fit and well. Under the pre-2017 classification, this might have been termed 'aggressive periodontitis'. How would this now be classified using the current Staging and Grading system in the UK?
- Stage I, Grade A Periodontitis
- Stage II, Grade B Periodontitis
- Necrotising Periodontitis
- Stage III or IV, Grade C Periodontitis (Correct answer)
Correct answer: Stage III or IV, Grade C Periodontitis
The clinical presentation of severe bone loss, particularly a molar-incisor pattern in a young adult, points towards rapid disease progression. Under the current system, this would be classified with a high Stage (III or IV) due to the severity and complexity (e.g., vertical bone loss, potential for tooth loss). The rapid progression, indicated by the amount of bone loss relative to the patient's age, would lead to a Grade C classification. The former term 'aggressive periodontitis' is now encompassed within this Staging and Grading framework.
Question 5: According to the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, 'Prevention and Treatment of Periodontal Diseases in Primary Care', what is the primary goal of the initial phase of periodontal therapy?
- To perform definitive periodontal surgery to eliminate all pockets.
- To control the local and systemic risk factors and establish good patient self-care. (Correct answer)
- To extract all teeth with a probing depth greater than 6mm.
- To prescribe a long-term course of systemic doxycycline.
Correct answer: To control the local and systemic risk factors and establish good patient self-care.
UK guidelines, including the widely recognised SDCEP guidance, emphasise a conservative, stepwise approach. The initial phase of therapy (Step 1) is foundational and focuses on patient education, motivation, establishing effective daily plaque control (self-care), and managing risk factors like smoking and poor diabetic control. Surgical intervention and extractions are considered in later steps, only after the response to initial therapy has been assessed.
Question 6: A patient has successfully undergone initial non-surgical periodontal therapy. On review, their periodontal status is defined as: Bleeding on Probing (BoP) is 8%, all probing pocket depths (PPD) are ≤4mm, and there is no bleeding on probing at any of the 4mm sites. According to the British Society of Periodontology (BSP) guidance on the outcomes of therapy, how would this patient's periodontal status be best described?
- Currently Unstable
- Currently in Remission
- Refractory Periodontitis
- Currently Stable (Correct answer)
Correct answer: Currently Stable
The BSP implementation guidance defines specific criteria for post-treatment periodontal status. A 'Stable' case is characterised by a low level of inflammation (BoP <10%), no deep pockets (PPD ≤4mm), and no bleeding at the deeper sites (no BoP at 4mm sites). This patient's clinical parameters exactly match the definition of a stable periodontal condition following treatment.
MJDF Part 1 - Membership of Joint Dental Faculties Periodontology and Gum Health Questions and Answers
A 48-year-old patient, who smokes 15 cigarettes per day, presents for a routine examination.
The Basic Periodontal Examination (BPE) reveals a highest score of 4 in one sextant.
According to the 2017 Classification of Periodontal and Peri-Implant Diseases and Conditions as implemented by the British Society of Periodontology (BSP), what would be the most appropriate initial Grade to assign to this patient?