Classification of Periodontal Diseases PDF

Dr. Nawal Khalifa Babiker BDS , P.G. Res. M. , MD Periodontics. CLASSIFICATION OF PERIODONTAL DISEASES AND CONDITIONS. Definition & significance: ▪ Classification should be a systematic arrangement of groups that possess common attributes. ▪ This arrangement should provide insight into the...

Dr. Nawal Khalifa Babiker BDS , P.G. Res. M. , MD Periodontics. CLASSIFICATION OF PERIODONTAL DISEASES AND CONDITIONS. Definition & significance: ▪ Classification should be a systematic arrangement of groups that possess common attributes. ▪ This arrangement should provide insight into the relationship between groups and between members of the same group. ▪ Classification of diseases is necessary to separate conditions into distinct categories so as to aid clinical and laboratory diagnosis and specific treatments. PURPOSE OF CLASSIFICATION SYSTEM ▪ 1. Communicating clinical findings accurately to other dental health care providers and to dental insurance providers. ▪ 2. Presenting information to the patient about his or her disease. ▪ 3. Formulating individualized treatment plans. ▪ 4. Predicting treatment outcomes. Paradigms explaining the nature of the periodontal diseases at a given historical period. ▪ 1. Clinical characteristics paradigm(1870- 1920). ▪ 2. Classical Pathology Paradigm ( 1920- 1970). ▪ 3. Infection/Host response paradigm (1970- present ). ▪ Paradigms are models or patterns. AAP 1989 CLASSIFICATION (WORLD WORKSHOP IN CLINICAL PERIODONTICS) ▪ AAP World workshop in clinical periodontics classified periodontal diseases as: ▪ 1. Adult periodontitis. ▪ 2.Early periodontitis (may be prepubertal, juvenile, ▪ rapidly progressive). ▪ 3. Periodontitis associated with systemic disease. ▪ 4. Necrotizing periodontitis ▪ 5. Refractory periodontitis. ▪ Drawbacks: ▪ ( no gingivitis/ gingival diseases ,age categorization and Overlap ) European workshop classification in 1993 ▪ 1. Adult periodontitis ▪ 2. Early onset periodontitis ▪ 3. Necrotizing periodontitis. AAP 1999 CLASSIFICATION (INTERNATIONAl WORKSHOP FOR CLASSIFICATION Of PERIODONTAL DISEASES AND CONDITIONS). ▪ 1. Gingival diseases: ▪ Plaque – induced gingival diseases ▪ Non- plaque – induced gingival diseases ▪ 2. Chronic periodontitis: ▪ Localized ▪ Generalized ▪ 3. Aggressive periodontitis: ▪ Localized ▪ Generalized ▪ 4. Periodontitis as a manifestation of systemic diseases ▪ 5. Necrotizing periodontal diseases: ▪ Necrotizing ulcerative gingivitis (NUG) ▪ Necrotizing ulcerative periodontitis (NUP) ▪ 6. Abscesses of the periodontium: ▪ Gingival abscess ▪ Periodontal abscess ▪ Pericoronal abscess ▪ 7. Periodontitis associated with endodontic lesions: ▪ Endodontic – periodontal lesion ▪ Periodontal – endodontic lesion ▪ Combined lesion ▪ 8. Developmental or acquired deformities and conditions: ▪ Localized tooth – related factors that predispose to plaque– ▪ induced gingival diseases or periodontitis ▪ Mucogingival deformities and conditions around teeth ▪ Mucogingival deformities and conditions on edentulous Ridges. ▪ Occlusal trauma GINGIVAL DISEASES ( Two main categories) ▪ Dental plaque - Induced gingival diseases ▪ These diseases may occur on a periodontium with no attachment loss or on one with attachment loss that is stable and not progressing. ▪ I. Gingivitis associated with dental plaque only: ▪ A. Without local contributing factors ▪ B. With local contributing factors ▪ II. Gingival diseases modified by systemic factors: ▪ A. Associated with 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. Other ▪ III. Gingival diseases modified by medications: ▪ A. Drug – influenced gingival diseases: ▪ 1. Drug – influenced gingival enlargements ▪ 2. Drug – influenced gingivitis: a. Oral contraceptive – associated gingivitis b. Others ▪ IV. Gingival diseases modified by malnutrition: ▪ A. Ascorbic acid deficiency gingivitis ▪ B. Other Non Plaque induced gingival diseases ▪ I. Gingival diseases of specific bacterial origin: ▪ A. Neisseria gonorrhea ▪ B. Treponema pallidum ▪ C. Streptococcal species ▪ D. Other ▪ II. Gingival diseases of viral origin: A. Herpes virus infections B. Primary herpetic gingivostomatitis ▪ C. Recurrent oral herpes ▪ D. Varicella Zoster E. Others ▪ III. Gingival diseases of fungal origin: ▪ A. Candida - species infections: Generalized gingival candidiasis ▪ B. Linear gingival erythema ▪ C. Histoplasmosis ▪ D. Others ▪ IV. Gingival diseases of genetic origin: ▪ A. Hereditary gingival fibromatosis ▪ B. Other ▪ V. Gingival manifestations of systemic conditions: ▪ A. Mucocutaneous lesions ▪ 1. Lichen planus ▪ 2. Pemphigoid ▪ 3. Pemphigus vulgaris ▪ 4. Erythema multiforme ▪ 5. Lupus erythematosus ▪ 6. Drug induced ▪ 7. Other ▪ B. Allergic reactions ▪ 1. Dental restorative materials: ▪ a. Mercury ▪ b. Nickel ▪ c. Acrylic ▪ d. Other ▪ 2. Reactions attributable to: ▪ a. Toothpastes or dentifrices ▪ b. Mouthrinses or mouthwashes ▪ c. Chewing gum additives ▪ d. Food and additives ▪ 3. Others ▪ VI. Traumatic lesions ( factitious, iatrogenic ,o r accidental) ▪ A. Chemical injury ▪ B. Physical injury ▪ C. Thermal injury ▪ VII. Foreign body reactions ▪ VIII. Not otherwise specified DEVELOPMENTAL/ACQUIRED DEFORMITIES AND CONDITIONS ▪ Developmental or acquired deformities and conditions ▪ Localized tooth related factors that modify or predispose to plaque induced gingival diseases or periodontitis ▪ 1. Tooth anatomic factors ▪ 2. Dental restorations or appliances ▪ 3. Root fractures ▪ 4. Cervical root resorption and cemental tears ▪ Mucogingival deformities and conditions around teeth ▪ 1. Gingival or soft tissue recession ▪ A. Facial or lingual surfaces ▪ B. Interproximal (papillary) ▪ 2. Lack of keratinized gingiva ▪ 3. Decreased vestibular depth ▪ 4. Aberrant frenum or muscle position ▪ 5. Gingival excess ▪ A. Pseudopocket ▪ B. Inconsistent gingival margin ▪ C. Excessive gingival display ▪ D. Gingival enlargement ▪ E. Abnormal color Mucogingival deformities and conditions on edentulous edges ▪ I. Vertical and/ or horizontal ridge deficiency ▪ II. Lack of gingiva or keratinized tissue ▪ III. Gingival or soft tissue enlargements ▪ IV. Aberrant frenum or muscle position ▪ V. Decreased vestibular depth ▪ VI. Abnormal color ▪ Occlusal trauma ▪ 1. Primary occlusal trauma ▪ 2. Secondary occlusal trauma  ▪ But ,,,,,,now we have a new updated classification of periodontal & peri- implant diseases ( released on November 2017) by the AAP & EFP World workshop. The objectives of the new classification system ▪ To create a simple classification system that could be implemented in general dental practice; To create a system that accounts for both current peri-odontal status (assessed by staging periodontal disease) and future susceptibility to periodontal disease (assessed by grading periodontal disease); To create a system that takes into account treatment planning customized to individual patient scenarios; To create a live/dynamic system that can accommodate regular updates and incorporate future knowledge (for example, biomarkers) emerging from research. Main Changes: ▪ 1. BOP is the main indicator for gingivitis. ▪ 2.PD is the main clinical parameter to check for periodontitis. ▪ 3.Always record the greatest reading. ▪ 4. Bleeding is the best( objective) clinical indicator of gingival inflammation. ▪ 5. Changes in terms: ▪ Supra crestal tissues( Biological Width). ▪ Incisor- molar pattern periodontitis ( Aggressive Periodontitis), bear in mind NO separate disease entities, both chronic and aggressive periodontitis share the same etiopathogenesis. The quick and simple periodontal diagnostic flowchart. BOP = full-mouth BOP;CAL = clinical attachment loss; PD = probing depth; RBL = radiographic bone loss. Staging for periodontitis. One stage should be assigned per patient, based on the worst tooth. AL= clinical attachment loss; PD= probing depth; RBL= radiographic bone loss. Grade scoring for periodontitis. (+)= primary criteria, (+/−)= criteria that may or may not present, (−)= criteria that must not present.  References: Newman & Carranza’s : Essentials of Clinical Periodontology.An integrated study companion. Newman & Carranza’s essentials of Clinical Periodontology, thirteenth edition.2019 Periodontics Revisited, Shalu Bathla. Flowcharts for Easy Periodontal Diagnosis Based on the 2018 New Periodontal Classification Pimchanok Sutthiboonyapan,∗ Hom-Lay Wang† and Orawan Charatkulangkun∗, Clinical Advances in Periodontics, Vol. 10, No. 3, September 2020 ▪ Any questions? ▪ The end.