Classification of Periodontal Diseases 2017

Attempts at Classification

• Classification of disease is essential for distinct categories to aid clinical and lab diagnosis, and specific treatment.
• Ideally, criteria should be based on etiology, histopathology, and genetics, rather than age of onset or disease progression rates.
• Over the past three decades, there have been four major attempts to classify periodontal disease.
• The 1999 classification of periodontitis was reclassified in 1999 and used for 19 years.
• Reclassified into chronic, aggressive (local and generalized), necrotizing, and as a systemic disease manifestation.
• A 2017 workshop established a classification framework for periodontitis.
• This framework includes a multidimensional staging and grading system that can adapt to new information.

Classification of Periodontal Diseases and Conditions (2017)

• 1. Periodontal health and gingival diseases and conditions:
  • a. Periodontal health and gingival health
  • b. Dental biofilm-induced gingivitis
  • c. Non-dental biofilm-induced gingival disease
• 2. Periodontitis:
  • a. Periodontitis
  • b. Necrotizing periodontal diseases
  • c. Periodontitis as a manifestation of systemic disease
• 3. Other conditions affecting the periodontium:
  • a. Periodontal abscess and endodontic periodontal lesions
  • b. Mucogingival deformity and conditions
  • c. Traumatic occlusal force
  • d. Tooth and prosthetic-related factors
  • e. Peri-implant disease and conditions
    • a. Peri-implant health
    • b. Peri-implant mucositis
    • c. Peri-implantitis
    • d. Peri-implant soft and hard tissue deficiency

Periodontal Health and Gingival Health

• Defined by the absence of clinically detectable inflammation.
• There is a biological level of immune surveillance consistent with clinical gingival health and homeostasis.
• Clinical gingival health can be assessed using a bleeding-on-probing score (BOP%).
• Clinical gingival health on an intact periodontium is characterized by the absence of bleeding on probing (less than 10%), lack of symptoms, and attachment and bone loss ≤3mm probing pocket depth.
• Clinical gingival health on a reduced periodontium includes non-periodontitis patients with recession due to any cause except periodontitis. Characterized by the absence of bleeding on probing (less than 10%), and possible reduced clinical attachment and bone levels with probing pocket depth ≤3mm.

Dental Biofilm-Induced Gingivitis

• Defined at the site level as an inflammatory lesion resulting from interactions between dental plaque biofilm and the host's inflammatory response,
• Contained within the gingiva, does not extend to periodontal attachment.
• Reversible by reducing dental plaque at and apical to the gingival margin.
• Localized gingivitis = BOP score 10% to ≤30%
• Generalized gingivitis = BOP score >30%
• Gingivitis on an intact periodontium characterized by BOP score ≥10%, probing pocket depth ≤3mm, no pseudo pocket, no attachment loss, and no radiographic bone loss.
• Gingivitis on a reduced periodontium is in a non-periodontitis patient characterized by BOP score ≥10%, probing pocket depth ≤3mm, possible presence of attachment loss and/or radiographic bone loss.

Classification of Dental Biofilm-Induced Gingivitis

• A. Associated with bacterial dental biofilm only
• B. Mediated by systemic or local risk factors
  • 1. Systemic conditions
    • a. Sex steroid hormones
    • b. Hyperglycemia
    • c. Leukemia
    • d. Smoking
    • e. Malnutrition
  • 2. Oral factors enhancing plaque accumulation
    • a. Prominent subgingival restoration margins
    • b. Hyposalivation
• C. Drug-influenced gingival enlargements

Dental Plaque-Induced Gingivitis, Associated with Specific Infections

• Genetic/developmental disorders (Hereditary gingival fibromatosis)
• Bacterial infections ( Neisseria gonorrhoeae, Treponema pallidum, Streptococcal species , others)
• Viral infections (Herpes simplex, Varicella-zoster, Epstein-Barr)

Inflammatory and Immune Conditions Gingiva (Hypersensitivity)

• Contact allergy
• Plasma cell gingivitis:
• Erythema multiforme