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Classifcation o
Periodontal Diseases
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Helps in the development of frameworks to study theI. aetiology,II. Pathogenesis &III. treatment of diseases;
. Provides the international healthcare community with a wayof communicating in a common language.
Why Classifcation ?
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Where were we?
juvenile periodontitis (prepuertal, locali!ed andgenerali!ed"; early#onset periodontitis (formally prepuertal, juvenile andrapidly progressive";adult periodontitis;( $his classi%cation system is heavily agedependent a cut#o' point of ) *ears"acute necroti!ing ulcerative periodontitis; refractory periodontitis.
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Periapical radiographs of a +#year#old patient, showing severegenerali!ed one loss.iagnosis -chronic adult periodontitis or -early#onsetperiodontitis/
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The ollowing changes were implemented:
0ingival disease category introduced. -1dult periodontitis replaced y -chronic periodontitis. -2efractory disease category removed.
-3arly#onset periodontitis replaced y -aggressiveperiodontitis. $he implications of systemic diseases on periodontal statuswere e4panded and more comprehensively de%ned. -5ecroti!ing periodontal diseases were introduced to cover
oth -necroti!ing periodontitis and -necroti!ing gingivitis. -Periodontal ascess and -periodontal#endodontic lesionswere added. 1 category for developmental or ac6uired lesions wasintroduced.
Where are we now?
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The 1999 International Workshop for the Classication ofGingival Diseases
A. Dental pla!e"ind!ced gingival diseases#. $on"pla!e"ind!ced gingival lesions
The 1999 International Workshop for the Classication of
Periodontal Diseases.
A. Chronic periodontitis#. Aggressive periodontitisC. Periodontitis as a maniestation o systemic diseasesD. $ecroti%ing periodontal diseases
&. A'scesses o the periodonti!m(. Periodontitis associated with endodontic lesionsG. Developmental or ac!ired deormities and conditions
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Gingival diseases: A simplifed version o the 1999 International
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Classication of GingivalDiseases
Dental pla!e"ind!ced gingival diseases
7. 0ingivitis associated with dental pla6ue onlya. 8ithout other local contriuting factors. 8ith local contriuting factors
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Classication of GingivalDiseases
Dental pla!e"ind!ced gingival diseases
9. 0ingival diseases modi%ed y systemic factors
a. associated with the endocrine system7" puerty#associated gingivitis9" menstrual cycle#associated gingivitis
" pregnancy#associated a" gingivitis " pyogenic granuloma:" diaetes mellitus#associated gingivitis
. associated with lood dyscrasias7" leukaemia#associated gingivitis9" other
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Classication of GingivalDiseases
). Gingival diseases modifed 'y medications
7" drug#inuenced gingival enlargements9" drug#inuenced gingivitis a" oral contraceptive#associated gingivitis
" other
Dental pla!e"ind!ced gingival diseases
*. Gingival diseases modifed 'y maln!tritiona. ascoric acid#de%ciency gingivitis
. other
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Classication of GingivalDiseases
$on"pla!e"ind!ced gingivallesions
+. Gingival diseases o specifc 'acterial origin
a. Neisseria gonorrhoea-associated lesions. reponema pallid!m-associated lesionsc. streptococcal species#associated lesions
d. other
,. Gingival diseases o viral origin
a. herpesvir!s inections
7" primary herpetic gingivostomatitis 9" recurrent oral herpes " varicella-"oster inections. other
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Classication of GingivalDiseases
$on"pla!e"ind!ced gingivallesions
). Gingival diseases o !ngal origina. candidal infections 7" generali!ed gingival candidosis
. linear gingival erythemac. histoplasmosisd. other
*. Gingival lesions o genetic origin
a. hereditary gingival %romatosis. other
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Classication of GingivalDiseases$on"pla!e"ind!ced gingival
lesions). 0ingival manifestations of systemic conditions
a. mucocutaneous disorders7" lichen plan!s9" pemphigoid" pemphig!s v!lgaris:" er#thema m!ltiorme
)" l!p!s er#thematos!s+" drug#induced<" other
. allergic reactions7" dental restorative materials
a" mercury " nickel c" acrylic d" other
9" reactions attriutale to
a" toothpastes=dentifrices "mouthrinses=mouthwashes c" chewing gum additives d" foods and additives
" other
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Classication of GingivalDiseases
$on"pla!e"ind!ced gingivallesions
+. $raumatic lesions (factitious, iatrogenic, accidental" a. chemical injury . physical injury c. thermal injury
<. >oreign ody reactions
?. 5ot otherwise speci%ed (5@A"
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Gingival diseases: A simplifed version o the 1999 International
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The 1999 International Workshop for theClassication of Gingival Diseases
A. Dental pla!e"ind!ced gingival diseases#. $on"pla!e"ind!ced gingival lesions
The 1999 International Workshop for the Classication of
Periodontal Diseases.
A. Chronic periodontitis#. Aggressive periodontitisC. Periodontitis as a maniestation o systemic diseasesD. $ecroti%ing periodontal diseases
&. A'scesses o the periodonti!m(. Periodontitis associated with endodontic lesionsG. Developmental or ac!ired deormities and conditions
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$eriodontal diseases: A simplifed version o the 1999 InternationalWorkshop.5
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A. Chronic periodontitis
a. -ocali%ed
'. Generali%ed
up to BC of sites
more than BC of sites
I. Alight D1E 7F9 mm.II. Goderate D1E F: mm.III. Aevere D1E ) mm or more.
clinical attachment loss (D1E"
everity o the disease
Classication of Periodontal Diseases.
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Clinical eat!res and characteristics oChronic Periodontitis:
Gost prevalent in adults (ut can occur in children andadolescents". 1mount of destruction of the periodontium is consistent with thepresence of local risk factors. Augingival calculus is a fre6uent %nding. Alow to moderate rate of progression (ut can have periods ofrapid attachment loss". Gay e modi%ed y systemic disease. Dan e modi%ed y factors such as smoking and stress.
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J. Aggressive periodontitis
a.-ocali%ed.
'. Generali%ed :
Classication of Periodontal Diseases.
@nset around puerty. >irst molar and incisor involvement. 2aised serum antiody response topathogens.
Ksually under B years, ut does occur in olderpatients. Poor antiody response to pathogens. Pronounced episodic nature of loss ofattachment and alveolar one. 0enerali!ed interpro4imal attachment lossa'ecting at least three permanent teeth (other
than%rst molars and incisors".
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C. Periodontitis as a maniestation o systemicdiseases
a. Associated with haematological disorders7. 1c6uired neutropenia9. Eeukaemias. @ther'. Associated with genetic disorders
7. >amilial and cyclic neutropenia9. owns syndrome. Eeukocyte adhesion de%ciency syndromes:. PapillonFEefLvre syndrome). DhediakFHigashi syndrome+. Histiocytosis syndromes<. 0lycogen storage disease?. Infantile genetic agranulocytosisM. Dohen syndrome7B. 3hlersFanlos syndrome ($ypes IN and NIII"77. Hypophosphatasia
79. @ther
Classication of PeriodontalDiseases.
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D. $ecroti%ing periodontal diseases
a. 5ecroti!ing ulcerative gingivitis (5K0". 5ecroti!ing ulcerative periodontitis (5KP"
&. A'scesses o the periodonti!m
a. 0ingival ascess. Periodontal ascessc. Pericoronal ascess
(. Periodontitis associated with endodonticlesions
Domined periodontic#endodontic lesions
Classication of PeriodontalDiseases.
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G. Developmental or ac!ired deormities andconditions
a. -ocali%ed tooth"related actors that modiy orpredispose to pla!e"ind!ced gingival
diseases2periodontitis
7. $ooth anatomic factors9. ental restorations=appliances. 2oot fractures:. Dervical root resorption and cemental tears
Classication of PeriodontalDiseases.
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G. Developmental or ac!ired deormities and
conditions
'. 3!cogingival deormities and conditions aro!nd teeth
7. 0ingival=soft tissue recession
a" facial or lingual surfaces" interpro4imal (papillary"9. Eack of keratini!ed gingiva. ecreased vestiular depth:. 1errant fraenum=muscle position
). 0ingival e4cessc" pseudopocketd" inconsistent gingival margine" e4cessive gingival displayf" gingival enlargement+. 1normal colour
Classication of PeriodontalDiseases.
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G. Developmental or ac!ired deormities andconditions
c. 3!cogingival deormities and conditions on edent!lo!sridges
7. Nertical and=or hori!ontal ridge de%ciency9. Eack of gingiva=keratini!ed tissue. 0ingival=soft tissue enlargement:. 1errant fraenum=muscle position). ecreased vestiular depth+. 1normal colour
Classication of PeriodontalDiseases.
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G. Developmental or ac!ired deormities andconditions
d. 0ccl!sal tra!ma
7. Primary occlusal trauma9. Aecondary occlusal trauma
Classication of PeriodontalDiseases.
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$eriodontal diseases: A simplifed version o the 1999 InternationalWorkshop.5
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