MJDF Part 1 - Membership of Joint Dental Faculties Periodontology and Gum Health 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?

Accepted Answer

Grade C: Rapid rate of progression

Answer

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?

Accepted Answer

Provide Professional Mechanical Plaque Removal (PMPR) and OHI, then reassess.

Answer

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?

Accepted Answer

The replacement of the 'chronic' and 'aggressive' periodontitis classifications with a staging and grading system.

Answer

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?

Accepted Answer

Stage III or IV, Grade C Periodontitis

Answer

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?

Accepted Answer

To control the local and systemic risk factors and establish good patient self-care.

Answer

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.

MJDF Part 1 Practice Test

MJDF Part 1 Practice Test

MJDF Part 1 - Membership of Joint Dental Faculties Periodontology and Gum Health Questions and Answers