Classification Periodontal Disease

8/3/2019 Classification Periodontal Disease

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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

Classification Periodontal Disease

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