Membership of the Joint Dental Faculties (MJDF) Periodontology and Oral Medicine Syllabus

Periodontology and Oral Medicine syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Periodontology and Oral Medicine in Membership of the Joint Dental Faculties (MJDF), not a summary of it.

1. 1

   Periodontal Health and Disease

   4 topics

   • Aetiology of periodontal disease
     • Dental biofilm and host response
     • Risk factors including smoking and diabetes
   • 2017 classification of periodontal and peri-implant diseases
   • Periodontal examination and indices
     • Basic Periodontal Examination (BPE)
     • Pocket charting, bleeding and recession
   • Staging and grading of periodontitis
2. 2

   Periodontal Therapy

   5 topics

   • Non-surgical periodontal treatment and oral hygiene instruction
   • Re-evaluation and supportive periodontal care
   • Indications for periodontal surgery and referral
   • Management of gingival recession and mucogingival problems
   • Necrotising and acute periodontal conditions
3. 3

   Oral Mucosal Disease

   4 topics

   • Oral ulceration
     • Recurrent aphthous stomatitis
     • Ulcers associated with systemic disease
   • White and red patches and lichen planus
   • Vesiculobullous disorders
   • Oral candidal and viral infections
4. 4

   Oral Cancer and Potentially Malignant Disorders

   4 topics

   • Risk factors and epidemiology of oral cancer
   • Recognition of potentially malignant lesions
   • Referral pathways and urgent suspected cancer referral
   • Principles of biopsy and onward management
5. 5

   Orofacial Pain and Salivary Gland Disease

   3 topics

   • Temporomandibular disorders and management
   • Trigeminal neuralgia and neuropathic pain
   • Dry mouth, salivary gland swelling and sialadenitis

Periodontology and Oral Medicine flashcards for Membership of the Joint Dental Faculties (MJDF)

23 of 67 cards from the Periodontology and Oral Medicine deck — real questions with worked answers.

1. What is the primary aetiological factor in periodontal disease, and what role do host factors play?

   The primary aetiological factor is the dysbiotic dental plaque biofilm (microbial). However, disease initiation and progression are modified by the host inflammatory-immune response, with destruction largely mediated by host-derived enzymes (e.g. MMPs) and cytokines rather than directly by bacteria. Plaque is necessary but not sufficient — host susceptibility and risk factors determine outcome.

2. Name the three members of the 'red complex' (Socransky) most strongly associated with periodontitis.

   Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. These late colonisers are strongly associated with deep pockets and progressive periodontal destruction.

3. What is a 'keystone pathogen' in periodontal disease and which organism exemplifies it?

   A keystone pathogen is a low-abundance organism that disproportionately disrupts host homeostasis, converting a symbiotic microbiota into a dysbiotic one that drives disease. Porphyromonas gingivalis is the classic example, manipulating the host immune response (e.g. via gingipains and complement subversion) to promote dysbiosis.

4. List the major modifiable and non-modifiable risk factors for periodontitis.

   Modifiable: smoking, poorly controlled diabetes, plaque/poor oral hygiene, stress, obesity, certain medications. Non-modifiable: genetic susceptibility, age, sex, certain systemic/genetic conditions (e.g. Down syndrome, leukocyte adhesion deficiency). Smoking and diabetes are the two most important modifiable risk factors.

5. What were the main disease categories introduced in the 2017 World Workshop classification of periodontal and peri-implant diseases?

   (1) Periodontal health, gingival diseases/conditions; (2) Periodontitis (staging and grading) — combining old chronic and aggressive into a single entity; (3) Other conditions affecting the periodontium (systemic diseases, periodontal abscesses, endo-perio lesions, mucogingival/developmental conditions, occlusal trauma); and (4) Peri-implant health and diseases (peri-implant mucositis and peri-implantitis).

6. In the 2017 classification, how is 'periodontal health' on an intact periodontium defined in terms of bleeding on probing?

   Periodontal health is defined as bleeding on probing at fewer than 10% of sites, with probing depths $\leq 3$ mm and no attachment or bone loss attributable to periodontitis. Gingivitis on an intact periodontium is BoP $\geq 10\%$ of sites with probing depths $\leq 3$ mm.

7. How does the 2017 classification define a case of periodontitis (the threshold for diagnosis)?

   Periodontitis is diagnosed when there is interdental clinical attachment loss (CAL) detectable at $\geq 2$ non-adjacent teeth, OR buccal/oral CAL $\geq 3$ mm with pocketing $> 3$ mm at $\geq 2$ teeth — provided the attachment loss is not explained by non-periodontitis causes (e.g. recession, caries, fracture).

8. What probing depth defines a peri-implant pocket of concern, and what distinguishes peri-implant mucositis from peri-implantitis?

   Peri-implant mucositis: inflammation (bleeding/suppuration on probing) confined to the soft tissue with NO progressive bone loss beyond initial remodelling. Peri-implantitis: inflammation PLUS progressive crestal bone loss beyond initial remodelling, typically with increased probing depths and BoP/suppuration.

9. Describe the Basic Periodontal Examination (BPE) probe and its measurement bands.

   The BPE uses a WHO probe with a 0.5 mm ball end and a black band from 3.5–5.5 mm (some have a second band 8.5–11.5 mm). The mouth is divided into 6 sextants and the highest score per sextant is recorded.

10. State the BPE codes 0–4 and the asterisk (*).

    0 = healthy, no bleeding, no calculus, black band fully visible. 1 = bleeding on probing, black band fully visible. 2 = calculus/plaque-retentive factor, black band fully visible. 3 = black band partially visible (pocket 3.5–5.5 mm). 4 = black band disappears (pocket $\geq 6$ mm). * = furcation involvement.

11. What is the gingival recession formula for distance and how is clinical attachment loss (CAL) calculated relative to probing pocket depth?

    $\text{CAL} = \text{Probing pocket depth} + \text{Gingival recession}$ (when the gingival margin is apical to the CEJ). If the gingival margin is coronal to the CEJ (e.g. swelling/overgrowth), $\text{CAL} = \text{Probing pocket depth} - \text{distance from CEJ to gingival margin}$.

12. What does the Plaque Index / O'Leary plaque score measure and what is the target?

    The O'Leary plaque control record records the percentage of tooth surfaces (4 per tooth: mesial, distal, buccal, lingual) with disclosed plaque at the gingival margin. $\text{Plaque score} = \frac{\text{surfaces with plaque}}{\text{total surfaces examined}} \times 100\%$. A target of $\leq 15$–$20\%$ is generally considered compatible with periodontal health/stability.

13. What does the gingival bleeding/marginal bleeding index assess, and what full-mouth bleeding score is the target for periodontal stability?

    It records the percentage of sites that bleed on gentle probing of the gingival margin. A full-mouth bleeding score of $\leq 10\%$ is the target associated with periodontal stability and reduced risk of recurrent disease.

14. Describe the three components used to STAGE periodontitis in the 2017 classification.

    Staging is based on severity and complexity. Primary determinant is interdental CAL at the worst site (and radiographic bone loss); secondary determinants include tooth loss due to periodontitis and complexity factors (probing depth, furcation, vertical defects, ridge defects, masticatory dysfunction). Severity bands: Stage I CAL 1–2 mm; Stage II 3–4 mm; Stage III $\geq 5$ mm; Stage IV $\geq 5$ mm with additional complexity (tooth loss $\geq 5$ teeth, bite collapse).

15. How is bone loss extent used to assign periodontitis stage radiographically?

    Stage I: coronal third bone loss (<15% of root length). Stage II: coronal third (15–33%). Stage III & IV: bone loss extending to the middle or apical third of the root. Stage IV adds complexity such as masticatory dysfunction, secondary occlusal trauma, drifting/flaring, and <20 remaining teeth.

16. How is periodontitis GRADED, including the bone-loss-to-age formula?

    Grading estimates the rate of progression and future risk. Primary index = $\frac{\% \text{ radiographic bone loss}}{\text{age}}$. Grade A (slow): ratio $< 0.25$. Grade B (moderate): ratio $0.25$–$1.0$. Grade C (rapid): ratio $> 1.0$. Grade is then modified upward by risk factors (smoking, diabetes).

17. How do smoking and diabetes act as grade modifiers in periodontitis grading?

    Smoking: <10 cigarettes/day moves to Grade B, $\geq 10$/day moves to Grade C. Diabetes: HbA1c $< 7.0\%$ in a diabetic patient = Grade B, HbA1c $\geq 7.0\%$ = Grade C. The presence of these risk factors can elevate the grade regardless of the bone-loss/age ratio.

18. What additional descriptors complete a full 2017 periodontitis diagnosis besides stage and grade?

    Extent and distribution: localised (<30% of teeth involved), generalised ($\geq 30\%$ of teeth), or molar-incisor pattern. Plus current periodontal status (stable, in remission, or unstable). Example diagnosis: 'Generalised periodontitis, Stage III, Grade B, currently unstable'.

19. What defines periodontal 'stability', 'remission', and 'currently unstable' (treated periodontitis status)?

    Stable: BoP <10%, probing depths $\leq 4$ mm, no $\geq 4$ mm site with BoP, and minimal bone loss progression. Remission/controlled: reduced inflammation/improvement but with persisting risk (e.g. ongoing smoking). Unstable: presence of probing depths $\geq 5$ mm OR $\geq 4$ mm sites with BoP — indicating active disease requiring further treatment.

20. What are the core components of Step 1 (initial) periodontal therapy in the EFP S3 stepwise approach?

    Step 1: building motivation and adherence — oral hygiene instruction, risk factor control (smoking cessation, diabetes control), professional mechanical plaque removal (supragingival), and removal of plaque-retentive factors. This is done for all patients before subgingival instrumentation.

21. What does Step 2 of periodontal therapy involve?

    Step 2 (cause-related/subgingival): subgingival instrumentation (root surface debridement / scaling and root planing) to remove subgingival biofilm and calculus, with or without adjuncts (e.g. local/systemic antimicrobials in selected cases). Performed at sites with pockets, after Step 1.

22. What is the recommended toothbrushing technique and interdental cleaning advice in standard oral hygiene instruction?

    Modified Bass technique: bristles angled at $45^{\circ}$ to the gingival margin, small vibratory/circular motions, twice daily for 2 minutes with fluoride toothpaste. Daily interdental cleaning: interdental brushes (TePe) where spaces allow are more effective than floss for plaque removal; floss for tight contacts. Spit, don't rinse, after brushing.

23. In non-surgical periodontal treatment, when is systemic antibiotic adjunctive therapy generally indicated, and what is a commonly cited regimen?

    Systemic antibiotics are generally reserved for younger patients with Grade C (rapidly progressing/Stage III–IV molar-incisor) periodontitis, not as routine adjuncts. A commonly cited regimen is amoxicillin 500 mg + metronidazole 400 mg three times daily for 7 days alongside subgingival instrumentation. Routine use is discouraged due to antimicrobial resistance.

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