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CLASSIFICATION OFCLASSIFICATION OF
DISEASES AFFECTINGDISEASES AFFECTINGTHE PERIODONTIUMTHE PERIODONTIUM
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Gingivitis
Refers to the inflammation of the soft tissues thatsurround the teeth
Compounding Factors for Gingivitis
Lack of proper hygiene
Periods of susceptibility
(puberty, pregnancy(progesterone level),menopause)
Smoking
Diet (poor nutrition)
Medications
Diabetes mellitus
Metal poisoning
Trauma/masticationinjury
Tooth crowding/overlap Mouth breathin
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Contrast Between Healthy &
Diseased Gingiva
Healthy
Coral pink
Stippled
Knife-edge margin
Diseased
Light red red tomagenta
Loss of stippling
Swelling/edema/fibrosis
Margin rolled, blunted,receded or hyperplastic
Bleeding/exudate
Malodor
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CLASSIFICATION OF PERIODONTAL DISEASES AND CONDITIONS(1999 WORLD WORKSHOP CLASSIFICATION BY AAP)
GINGIVAL DISEASES
Plaque induced gingival diseases
Non-plaque induced gingival diseases
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CHRONIC PERIODONTITISLocalized
GeneralizedAGGRESSIVE PERIODONTITIS
LocalizedGeneralized
PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES
NECROTIZING PERIODONTAL DISEASES
Necrotizing ulcerative gingivitis (NUG)
Necrotizing ulcerative periodontitis (NUP)
ABSCESSES OF THE PERIODONTIUM
Gingival abscess
Periodontal abscess
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PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS
Endo perio lesionPerio endo lesion
Combined lesion
DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND CONDITIONS
Localized tooth related factors predisposing to plaque induced gingival diseaseor periodontitis
Mucogingival deformities and conditions around the teeth
Mucogingival deformities and conditions on edentulous ridge
Occlusal trauma
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GINGIVAL DISEASES
DENTAL PLAQUE-INDUCED GINGIVAL DISEASESDisease may occur on a periodontium with no attachment loss
or with attachment loss that is stable and not progressing.
I. GINGIVITIS ASSOCIATED WITH DENTAL PLAQUE ONLY
A. without local factors
B. with local contributing factors
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II. 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 associated gingivitis
B. Associated with blood dyscrasias
1. Leukemia associated gingivitis
2. Others
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III. GINGIVAL DISEASE MODIFIED BY MEDICATIONS
A. Drug influenced gingival disease
1. Drug induced gingival enlargement
2. Drug induced gingivitis
a. oral contraceptive associated
b. others
IV. GINGIVAL DISEASES MODIFIED BY MALNUTRITION
A. Ascorbic acid deficiency gingivitis
B. Others
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NON-PLAQUE INDUCED GINGIVAL LESIONS
I. Gingival disease of specific bacterial origin
a. Neisseria gonorrhea
b. Treponema pallidum
c. Streptococcal sp
d. Others
II. Gingival disease of viral origin
a. Herpes virus infections1. primary herpetic gingivostomatitis
2. recurrent oral herpes
3. varicella zoster
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III GINGIVAL DISEASE OF FUNGAL ORIGIN
A. Candida sp infection gingival candidosis
B. Linear gingival erythema
C. Histoplasmosis
D. Others
IV. GINGIVAL LESIONS OF GENETIC ORIGIN
A. Hereditary gingival fibromatosis
B. Others
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V. GINGIVAL MANIFESTATION OF SYSTEMIC CONDITIONS
A. Mucocutaneous lesions
1. Lichen planus
2. Pemphigoid
3. pemphigus vulgaris
4. Erythema multiforme
5. Lupus erythematosis
6. Drug induced
7. Others
B. Allergic reactions
1. Dental restorative materials ( mercury, acrylic)2. Reactions to toothpaste, mouth rinse, chewing gum additives
food and additives
3. Others
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VI. TRAUMATIC LESIONS ( IATROGENIC ORACCIDENTAL)
A. Chemical injury
B. Physical
C. Thermal
VII. FOREIGN BODY REACTIONS
VIII. NOT OTHERWISE SPECIFIED
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Periodontitis
Defined as an inflammation of the gingiva
with some loss of both attachment of theperiodontal ligament and bony support
Probably related to the specific flora present
in dental plaque and the ability of the host tocounteract the affects of the organismspresent
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CLASSIFICATION OF VARIOUS FORMS OF PERIODONTITIS
AAP WORLD WORKSHOP 1989
Adult Periodontitis Age of onset > 35 years
Slow rate of disease progression
No defect in host defense
Early onset periodontitis - Age of onset < 35 years
(Prepubertal, Juvenile or Rapid rate of disease
Rapidly progressive) progression
Defect in host defense
Associated with specific
microflora
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Periodontitis associated - Systemic disease that predisposeto
with systemic disease rapid rate of periodontitis
Diabetes, down syndrome, HIVinfection,
Papillon Lefevre syndrome
Necrotizing ulcerative - Similar to ANUG but with associatedclinical
periodontitis attachment loss
Refractory Periodontitis - Recurrent periodontitis that does notrespond to treatment
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EUROPEAN WORKSHOP ONEUROPEAN WORKSHOP ON
PERIODONTOLOGY 1993PERIODONTOLOGY 1993
Adult periodontitisAdult periodontitis- Age of onset fourth- Age of onset fourth
decade of lifedecade of life
Slow rate of diseaseSlow rate of diseaseprogressionprogression
No defect in host responseNo defect in host responseEarly onsetEarly onset - Age of onset prior to- Age of onset prior to
PeriodontitisPeriodontitis fourth decade of lifefourth decade of life
Rapid rate of diseaseRapid rate of disease
progressionprogression
defect in the host defensedefect in the host defense
NecrotizingNecrotizing - Tissue necrosis with attachment and- Tissue necrosis with attachment and
periodontitis bone lossperiodontitis bone loss
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AAP WORKSHOP FOR CLASSIFICATIONAAP WORKSHOP FOR CLASSIFICATION
OF PERIODONTAL DISEASE 1999OF PERIODONTAL DISEASE 1999
Chronic periodontitisChronic periodontitis
AggressiveAggressive
periodontitisperiodontitis
Periodontitis as aPeriodontitis as a
manifestation ofmanifestation ofsystemic diseasessystemic diseases
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CHRONIC PERIODONTITISCHRONIC PERIODONTITIS
Prevalent in adultsPrevalent in adults
Destruction consistent with local factorsDestruction consistent with local factors
Variable microbial patternVariable microbial pattern
Subgingival calculus presentSubgingival calculus present
Slow to moderate rate of progressionSlow to moderate rate of progression
Modified by systemic diseases like Diabetes, HIVModified by systemic diseases like Diabetes, HIV
Local factors predisposing to periodontitisLocal factors predisposing to periodontitis Smoking and stressSmoking and stress
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Chronic periodontitisChronic periodontitis
Classified intoClassified into
Localized form < 30% of sites involvedLocalized form < 30% of sites involved
Generalized form > 30% of sites involvedGeneralized form > 30% of sites involvedSlightSlight : 1-2mm of CAL: 1-2mm of CAL
ModerateModerate : 3-4mm of CAL: 3-4mm of CAL
SevereSevere :: 5mm of CAL5mm of CAL
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AGGRESSIVE PERIODONTITISAGGRESSIVE PERIODONTITIS
clinically healthy ptclinically healthy pt
Rapid attachment and bone lossRapid attachment and bone loss
Microbial deposits inconsistent with disease severityMicrobial deposits inconsistent with disease severity
Familial aggregationFamilial aggregation Diseased site infected with AaDiseased site infected with Aa
Abnormal phagocyte functionAbnormal phagocyte function
Hyperresponsive macrophageHyperresponsive macrophage
Increased PGE2 and IL-1Increased PGE2 and IL-1 Self arresting disease progressionSelf arresting disease progression
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AGGRESSIVE PERIODONTITISAGGRESSIVE PERIODONTITIS
Classified intoClassified intoLocalized formLocalized form
circumpubertal onsetcircumpubertal onset
first molar or incisor disease with attachmentfirst molar or incisor disease with attachment
loss on two permanent teeth with one first molarloss on two permanent teeth with one first molarRobust serum antibody responseRobust serum antibody response
Generalized formGeneralized form
under 30 years of ageunder 30 years of agegeneralized attachment loss other than 1generalized attachment loss other than 1ststmolars and incisorsmolars and incisors
episodic nature of periodontal destructionepisodic nature of periodontal destruction
poor serum antibody responsepoor serum antibody response
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PERIODONTITIS AS A MANIFESTATIONPERIODONTITIS AS A MANIFESTATION
OF SYSTEMIC DISEASEOF SYSTEMIC DISEASE
1.Hematological disorders1.Hematological disorders
a. Acquired neutropeniaa. Acquired neutropenia
b. Leukemiab. Leukemia
c. Othersc. Others
2. Genetic disorders2. Genetic disordersa. Cyclic neutropeniaa. Cyclic neutropenia
b. Down Syndromeb. Down Syndrome
c. Papillon Lefeverec. Papillon Lefevere
d. Chediak Higashi syndromed. Chediak Higashi syndromee. Leukocyte adhesion deficiencye. Leukocyte adhesion deficiency
f. Hypophosphatasiaf. Hypophosphatasia
3. Not otherwise specified3. Not otherwise specified