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Classification of Periodontal DiseasesDr Prateek ShresthaHelps in the development of frameworks to study the aetiology, Pathogenesis & treatment of diseases;

Provides the international healthcare community with a way of communicating in a common language.Why Classification ?

Where were we? juvenile periodontitis (prepubertal, localized and generalized); early-onset periodontitis (formally prepubertal, juvenile and rapidly progressive);adult periodontitis;( This classification system is heavily age dependent: a cut-off point of 35 Years)acute necrotizing ulcerative periodontitis; refractory periodontitis.

Periapical radiographs of a 36-year-old patient, showing severe generalized bone loss.Diagnosis: chronic adult periodontitis or early-onset periodontitis?The following changes were implemented:

Gingival disease category introduced. Adult periodontitis replaced by chronic periodontitis. Refractory disease category removed. Early-onset periodontitis replaced by aggressive periodontitis. The implications of systemic diseases on periodontal status were expanded and more comprehensively defined. Necrotizing periodontal diseases were introduced to cover both necrotizing periodontitis and necrotizing gingivitis. Periodontal abscess and periodontal-endodontic lesions were added. A category for developmental or acquired lesions was introduced.Where are we now?The 1999 International Workshop for the Classification of Gingival Diseases

A. Dental plaque-induced gingival diseasesB. Non-plaque-induced gingival lesionsThe 1999 International Workshop for the Classification of Periodontal Diseases.

A. Chronic periodontitisB. Aggressive periodontitisC. Periodontitis as a manifestation of systemic diseasesD. Necrotizing periodontal diseasesE. Abscesses of the periodontiumF. Periodontitis associated with endodontic lesionsG. Developmental or acquired deformities and conditions

Gingival diseases: A simplified version of the 1999 International Workshop.5Classification of Gingival DiseasesDental plaque-induced gingival diseases

1. Gingivitis associated with dental plaque onlya. Without other local contributing factorsb. With local contributing factorsClassification of Gingival DiseasesDental plaque-induced gingival diseases

2. Gingival diseases modified by systemic factors

a. associated with the endocrine system1) puberty-associated gingivitis2) menstrual cycle-associated gingivitis3) pregnancy-associated a) gingivitis b) pyogenic granuloma4) diabetes mellitus-associated gingivitis

b. associated with blood dyscrasias1) leukaemia-associated gingivitis2) otherClassification of Gingival Diseases3. Gingival diseases modified by medications

1) drug-influenced gingival enlargements2) drug-influenced gingivitis a) oral contraceptive-associated gingivitis b) otherDental plaque-induced gingival diseases4. Gingival diseases modified by malnutritiona. ascorbic acid-deficiency gingivitisb. otherClassification of Gingival DiseasesNon-plaque-induced gingival lesions1. Gingival diseases of specific bacterial origin

a. Neisseria gonorrhoea-associated lesionsb. Treponema pallidum-associated lesionsc. streptococcal species-associated lesionsd. other2. Gingival diseases of viral origin

a. herpesvirus infections 1) primary herpetic gingivostomatitis 2) recurrent oral herpes 3) varicella-zoster infectionsb. otherClassification of Gingival DiseasesNon-plaque-induced gingival lesions3. Gingival diseases of fungal origina. candidal infections 1) generalized gingival candidosisb. linear gingival erythemac. histoplasmosisd. other

4. Gingival lesions of genetic origina. hereditary gingival fibromatosisb. other12Classification of Gingival DiseasesNon-plaque-induced gingival lesions5. Gingival manifestations of systemic conditionsa. mucocutaneous disorders1) lichen planus2) pemphigoid3) pemphigus vulgaris4) erythema multiforme5) lupus erythematosus6) drug-induced7) other

b. allergic reactions1) dental restorative materials a) mercury b) nickel c) acrylic d) other2) reactions attributable to a) toothpastes/dentifrices b) mouthrinses/mouthwashes c) chewing gum additives d) foods and additives3) otherClassification of Gingival DiseasesNon-plaque-induced gingival lesions6. Traumatic lesions (factitious, iatrogenic, accidental) a. chemical injury b. physical injury c. thermal injury

7. Foreign body reactions

8. Not otherwise specified (NOS)

Gingival diseases: A simplified version of the 1999 International Workshop.5The 1999 International Workshop for the Classification of Gingival Diseases

A. Dental plaque-induced gingival diseasesB. Non-plaque-induced gingival lesionsThe 1999 International Workshop for the Classification of Periodontal Diseases.

A. Chronic periodontitisB. Aggressive periodontitisC. Periodontitis as a manifestation of systemic diseasesD. Necrotizing periodontal diseasesE. Abscesses of the periodontiumF. Periodontitis associated with endodontic lesionsG. Developmental or acquired deformities and conditions

Periodontal diseases: A simplified version of the 1999 International Workshop.5A. Chronic periodontitis

Localized

b. Generalized

: up to 30% of sites : more than 30% of sites Slight: CAL 12 mm. Moderate: CAL 34 mm. Severe: CAL 5 mm or more. [clinical attachment loss (CAL)]:Severity of the diseaseClassification of Periodontal Diseases.Clinical features and characteristics of Chronic Periodontitis:

Most prevalent in adults (but can occur in children and adolescents). Amount of destruction of the periodontium is consistent with the presence of local risk factors. Subgingival calculus is a frequent finding. Slow to moderate rate of progression (but can have periods of rapid attachment loss). May be modified by systemic disease. Can be modified by factors such as smoking and stress.B. Aggressive periodontitis

a.Localized.

b. Generalized :

:Classification of Periodontal Diseases. Onset around puberty. First molar and incisor involvement. Raised serum antibody response to pathogens. Usually under 30 years, but does occur in older patients. Poor antibody response to pathogens. Pronounced episodic nature of loss of attachment and alveolar bone. Generalized interproximal attachment loss affecting at least three permanent teeth (other thanfirst molars and incisors).C. Periodontitis as a manifestation of systemic diseasesa. Associated with haematological disorders1. Acquired neutropenia2. Leukaemias3. Otherb. Associated with genetic disorders1. Familial and cyclic neutropenia2. Downs syndrome3. Leukocyte adhesion deficiency syndromes4. PapillonLefvre syndrome5. ChediakHigashi syndrome6. Histiocytosis syndromes7. Glycogen storage disease8. Infantile genetic agranulocytosis9. Cohen syndrome10. EhlersDanlos syndrome (Types IV and VIII)11. Hypophosphatasia12. Otherc. Not otherwise specified (NOS)Classification of Periodontal Diseases.D. Necrotizing periodontal diseases

a. Necrotizing ulcerative gingivitis (NUG)b. Necrotizing ulcerative periodontitis (NUP)E. Abscesses of the periodontium

a. Gingival abscessb. Periodontal abscessc. Pericoronal abscessF. Periodontitis associated with endodontic lesions

Combined periodontic-endodontic lesionsClassification of Periodontal Diseases.G. Developmental or acquired deformities and conditions

a. Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis

1. Tooth anatomic factors2. Dental restorations/appliances3. Root fractures4. Cervical root resorption and cemental tearsClassification of Periodontal Diseases.G. Developmental or acquired deformities and conditions

b. Mucogingival deformities and conditions around teeth

1. Gingival/soft tissue recessionfacial or lingual surfaces interproximal (papillary)2. Lack of keratinized gingiva3. Decreased vestibular depth4. Aberrant fraenum/muscle position5. Gingival excess pseudopocket inconsistent gingival marginexcessive gingival display gingival enlargement6. Abnormal colourClassification of Periodontal Diseases.G. Developmental or acquired deformities and conditions

c. Mucogingival deformities and conditions on edentulous ridges

1. Vertical and/or horizontal ridge deficiency2. Lack of gingiva/keratinized tissue3. Gingival/soft tissue enlargement4. Aberrant fraenum/muscle position5. Decreased vestibular depth6. Abnormal colourClassification of Periodontal Diseases.G. Developmental or acquired deformities and conditions

d. Occlusal trauma

1. Primary occlusal trauma2. Secondary occlusal traumaClassification of Periodontal Diseases.