Periodontal Classification Edit

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Periodontal Classification

The original, current and

update



Why classify?

• Up to date classification allowsclinicians to be aware of the full rangeof periodontal diseases and conditionwhich can effect the patient.

•

• Knowledge of current classificationhelps provide a basis for subsequent

diagnosis and management.•

• This classification can help to developframeworks to study aetiology,

pathogenesis and treatment.



HistoricallyYear proposed Body responsible Classification

1806 Joseph Fox Record of gum disease

1942 Orban First classification recognised by AAP

1966 AAP Chronic marginal periodontitis

1977 AAP Juvenile periodontitis

1986 AAP Prepubertal periodontitisLocalised juvenileGeneralised juvenileAdult periodontitis

Necrotizing ulcerative periodontitisRefractory peridontitis

1989 Nyman & Lindhe Periodontitis levisPeriodontitis gravis

1989 AAP Early onset periodontitisPeriodontitis associated with systemic diseaseRefractory periodontitis

1993 European Workshop Early onset periodontitisAdult periodontitis

Necrotizing ulcerative peridontitis

1999 International Workshop New classification



International workshop forclassification of periodontal

disease• In 1999 the classification was

changed due to previous lack of consensus.

• New categories added were – Gingival disease

– Necrotising periodontal disease

– Abscesses – Periodontitis with endodontic lesions

– Developmental or acquireddeformities and conditions



What changed in 1999?

Adapted categories

• Chronic periodontitis –

Used to be ‘adult periodontitis’ – Addition descriptions added depending on

extent and severity

–

•

Aggressive periodontitis – Replaced ‘early onset periodontitis’ – Distinction made from chronic periodontitis

and managed differently – Features to separate from generalised and

localised form




Excluded categories

• Refractory periodontitis –

The term can be a descriptor and applied toany disease non-responsive to treatment

–

• Recurrent periodontitis –

Denotes return of disease not a separateentity

–

• Poorly controlled diabetes and tobaccosmoking

– Both are significant modifiers of all forms of




Categories added

• Gingival disease categories introduced

•

• Systemic disease of periodontal status

•

• Necrotizing periodontal disease

•

• Periodontal abscesses

•

• Development or acquired lesions



New classification gingivaldiseases

Dental plaque-induced gingival diseases

1. Gingivitis associated with dental plaque only

a. Without other local contributing factors

b. With local contributing factors

2. Gingival diseases modified by systemic factors

a. associated with the endocrine system

1) puberty-associated gingivitis

2) menstrual cycle-associated gingivitis

3) pregnancy-associated

a) gingivitis

b) pyogenic granuloma

4) diabetes mellitus-associatedgingivitis

b. associated with blood dyscrasias

1) leukaemia-associated gingivitis 2) other

3. Gingival diseases modified by medications

1) drug-influenced gingival enlargements

2) drug-influenced gingivitis

a) oral contraceptive-associatedgingivitis

b) other

4. Gingival diseases modified by malnutrition

a. ascorbic acid-deficiency gingivitis



New classification gingivaldiseasesNon-plaque-induced gingival lesions

1. Gingival diseases of specific bacterial origin a. Neisseria gonorrhoea-associated lesions b. Treponema pallidum-associated lesions c. streptococcal species-associated lesions d. other2. Gingival diseases of viral origin a. herpesvirus infections 1) primary herpetic gingivostomatitis

2) recurrent oral herpes 3) varicella-zoster infections b. other3. Gingival diseases of fungal origin a. candidal infections 1) generalized gingival candidosis b. linear gingival erythema c. histoplasmosis

d. other4. Gingival lesions of genetic origin a. hereditary gingival fibromatosis b. other

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New classification periodontaldiseases

A. Chronic periodontitis a. Localized b. Generalized

B. Aggressive periodontitis a. Localized

b. Generalized

C. Periodontitis as a manifestation of systemicdiseases

a. Associated with haematological disorders 1. Acquired neutropenia 2. Leukaemias 3. Other b. Associated with genetic disorders

1. Familial and cyclic neutropenia 2. Down’s syndrome 3. Leukocyte adhesion deficiency syndromes 4. Papillon–Lefèvre syndrome 5. Chediak–Higashi syndrome 6. Histiocytosis syndromes 7. Glycogen storage disease 8. Infantile genetic agranulocytosis 9. Cohen syndrome 10. Ehlers–Danlos syndrome (Types IV and VIII)

11. Hypophosphatasia 12. Other c. Not otherwise specified (NOS)

D. Necrotizing periodontal diseases a. Necrotizing ulcerative gingivitis (NUG) b. Necrotizing ulcerative periodontitis (NUP)

E. Abscesses of the periodontium a. Gingival abscess b. Periodontal abscess

c. Pericoronal abscess

F. Periodontitis associated with endodontic lesions Combined periodontic-endodontic lesions

G. Developmental or acquired deformities and conditions a. Localized tooth-related factors that modify or

predispose to plaque-induced gingival diseases/periodontitis 1. Tooth anatomic factors 2. Dental restorations/appliances 3. Root fractures 4. Cervical root resorption and cemental tears b. Mucogingival deformities and conditions around

teeth 1. Gingival/soft tissue recession a. facial or lingual surfaces

b. interproximal (papillary) 2. Lack of keratinized gingiva 3. Decreased vestibular depth 4. Aberrant fraenum/muscle position 5. Gingival excess a. pseudopocket b. inconsistent gingival margin c. excessive gingival display d. gingival enlargement

6. Abnormal colour

c. Mucogingival deformities and conditions of edentulous ridges

1. Vertical and/or horizontal ridge deficiency 2. Lack of gingiva/keratinized tissue 3. Gingival/soft tissue enlargement 4. Aberrant fraenum/muscle position 5. Decreased vestibular depth 6. Abnormal colour d. Occlusal trauma 1. Primary occlusal trauma

2. Secondary occlusal trauma



Chronic periodontitis• Commonly seen in adults (can be seen in children and

adolesants)• Subgingival calulus is usually present

• Slow to moderate rate of progression

• Can be associated with local factors – Tooth shape and form

– Iatrogenic cause

• Can be modified by systemic disease – Diabetes mellitus

• Can be modified by other factors – Smoking

– Emotional stress• Localised form – up to 30% of sites

• Generalized form – greater then 30% of sites

• Degree of disease – Slight: 1-2mm clinical attachment loss

– Moderate: 2-4mm CAL – Severe: >=5mm CAL



Comparison of chronic and aggressive forms of Periodontitis

Chronic Localised aggressive Generalised aggressive

Mostly seen in adults(can occur inchildren)

Usually occurs inadolescents,circumpubertal onset.

Usually affects < 30yrs of age(pt’s maybe older)

Slow to moderaterates of progression

Rapid rate of progression

Rapid rate of progression (episodic

periods of progression)Microbial depositsconsistent withseverity of destruction

Microbial depositsnot consistent withseverity of destruction

Microbial depositssometimes consistentwith severity of destructionVariable distribution

of periodontaldestruction

Frequent subgingivalcalculus

Periodontal

destruction localisedto permanent firstmolars and incisors

Subgingival calculus

Periodontal

destruction affects atleast 3 permanentteeth in addition to

permanent firstmolars and incisors

Subgingival calculus



Problems and changes for thefuture

• Complicated classification which may discourage itsuse.

• No categories for historical/previous disease

• Removal of localised juvenile Periodontitis – Strong association with AA – Marked effect on polymorphonuclear cells –

Strong family history –

• Only based on the disease visible. – Host related effects – Bacterial infection – Possibilities of gene therapy

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Periodontal Classification Edit

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