Classification of periodontal diseases

Periodontium The periodontium consist of the investing & supporting tissues of the teeth which include gingiva . periodontal ligament ,cementum & alveolar bone.

DISEASE A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms

Systematic collection of data or knowledge & its arrangement in sequential manner in order to facilitate its understanding or knowledge CLASSIFICATION

USES OF CLASSIFICATION IDENTIFICATION OF THE ETIOLOGY & UNDERSTANDING OF THE PATHOLOGY FOR DIAGNOSIS PROGNOSIS & TREATMENT PLANING FACILITATES COMMUNICATION AMONG THE CLINICIAN , RESEARCHER’S EDUCATORS , STUDENT, EPIDIMIOLOGIST & PUBLIC HEALTH WORKER’S PREDICTING TREATMENT OUTCOMES

HISTORICAL DEVLOPMENT OF CLASSIFICATION SYSTEM CLINICAL CHARACTERISTIC PARADIGM CLASSICAL PATHOLOGY PARADIGM INFECTION / HOST RESPONSE PARADIGM

CLINICAL CHARACTERISTIC PARADIGM Very little to know about the etiology & pathogenesis of periodontal disease C. G. DAVIS CLASSIFICATION(1879) Gingival recession with minimum or no inflammation Periodontal destruction secondary to time deposits “ RIGG’S DISEASE” the hallmark of which was loss of alveolus without loss of gums

G. V. BLACK CLASSIFICATION (1886) CONSTITUTIONAL GINGIVITIS PAINFULL FORM OF GINGIVITIS SIMPLE GINGIVITIS INFLAMMATION OF THE PERIODONTAL MEMBRANE PHAGEDENIC PERIODONTITIS LITTLE OR NO EVIDENCE WAS USED TO SUPPORT THE OPINION OF CLINICIAN OF THE TIME

CLASSICAL PATHOLOGY PARADIGM TWO FORMS OF DESTRUCTIVE PERIODONTAL DISEASES 1. INFLAMMATORY 2. NON INFLAMMATORY GOTTLIB CLASSIFICATION {1928} 1. INFLAMMATORY – SCHMUTZ PYORRHOEA [POOR ORAL HYGINE ] 2. DEGENRATIVE OR ATROPHIC- DIFFUSE ALVEOLAR ATROPHY SYSTEMATIC METABOLIC

ORBAN CLASSIFICATION (1942) INFLAMMATORY DYSTROPHIC NEOPLASTIC PATHOLOGIC REACTION PRODUCED BY OCCLUSAL TRAUMA

W.HO. EXPERT COMMITEE ON DENTAL HEALTH IN 1961 SUGGESTED ETIOLOGY PLAYS SECONDARY & IMPORTANT PART IN CLASSIFICATION CLINICAL ASSESMENT LACK SUFFICIENT PRECISION TO SERVE AS

INFECTION / HOST RESPONSE PARADIGM ROBERT KOCH IN 1876 – GERM THEORY OF DISEASE W. D. MILLER SUGGESTED THAT 3 FACTOR’S ARE CONSIDERRED FOR PYRRHOEA

PRITCHARD CLASSIFICATION {1972} INFLAMMATION WITH SURFACE DESTRUCTION DISEASE AFFECTING SURFACE OR GINGIVA DISEASE AFFECTING DEEPAR STRUCTURE

RAMFORD & ASH CLASSIFICATION (1979) GINGIVITIS GINGIVAL ATROPHY OR RECESSION TRAUMA FROM OCCLUSION PERIODONTITIS

GRANT , STERN & LISTGARTEN CLASSIFICATION {1988} BACTERIAL INDUCED DISEASES GINGIVITIS PERIODONTITIS ADULT TYPE POST JUVENILE EARLY ONSET JUVENILE LOCALIZED GENERALIZED ACUTENECROTIZING ULCERATIVE GINGVITIS ACUTE ABSCESS PERICORONITIS

FUNTIONALLY INDUCED DISEASES TRAUMATIC OCCLUSION DISEASE ATROPHY TRAUMA ACCIDENTAL HABITS

Page & schroeder classification (1982) 1)Prepubertal periodontitis Generalized Localized 2)Juvenile periodontitis 3)Rapidilly progressing periodontitis 4)Adult type periodontitis

Topic’s classification (1986) Acute gingivitis specific , non specific Periodontitis periodontal abscess pericoronitis Chronic Gingivitis plaque associated, symptomatic Periodontits recession

Periodontitis localized generalized Periodontitis simple complex Rapidlly progressive – type A -- type B Prepubertal Juvenile Post juvenile symptomatic

Suzuki classification (1988) Adult periodontitis Early onset periodontitis Juvenile periodontitis Post juvenile periodontitis Prepubertal periodontitis

Genco classification (1990) Periodontitis in adult Periodontitis in juvenile localized generalized Periodontitis with systemic involvement Primary neutrophil disorders Secondary neutrophil impairment Misellaneous condition

Weatherford classification (1987) Disease affecting surface of gingiva Disease affecting deeper structure Periodontal traumaties Periodontal abscess

CLASSIFICATION OF THE WORLD WORKSHOP, 1989 PERIODONTITIS a. Adult periodontitis. b. Early-onset periodontitis: i. Prepubertal periodontitis: 1.1. Localized 2.2. Generalized ii. Juvenile periodontitis 1.1. Localized 2.2. Generalized c. Periodontitis associated with systemic diseases d. Necrotising ulcerative periodontitis e. Refractory periodontitis

EUROPEAN WORKSHOP, CLASSIFICATION 1993 A. PRIMARY DESCRIPTORS a. Adult periodontitis b. Early-onset periodontitis c. Necrotising ulcerative periodontitis B . SECONDARY DESCRIPTORS a. Tooth distribution. b. Rate of progression. c. Treatment response. d. Associated with systemic diseases. e. Microbiological characteristics. f. Ethnicity. g. Other factors.

CURRENT CLASSIFICATION INTERNATIONAL WORKSHOP FOR A CLASSIFICATION OF PERIODONTAL DISEASES & CONDITION –(1999) GOAL – “COURSE CORRECTION” OR “FINE TUNING” OF 1989 CLASSIFICATION

I. Gingival Diseases A. Dental plaque-induced gingival diseases * 1. Gingivitis associated with dental plaque only a. without other local contributing factors b. with local contributing factors 2. 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) other 3. Gingival diseases modified by medications a. drug-influenced gingival diseases 1) drug-influenced gingival enlargements 2) drug-influenced gingivitis a) oral contraceptive-associated gingivitis 4. Gingival diseases modified by malnutrition a. ascorbic acid-deficiency gingivitis b. other

B. Non-plaque-induced gingival lesions 1. Gingival diseases of specific bacterial origin a. Neisseria gonorrhea -associated lesions b. Treponema pallidum -associated lesions c. streptococcal species-associated lesions d. other 2. Gingival diseases of viral origin a. herpesvirus infections 1) primary herpetic gingivostomatitis 2) recurrent oral herpes 3) varicella-zoster infections b. other

3. Gingival diseases of fungal origin a. Candida -species infections 1) generalized gingival candidosis b. linear gingival erythema c. histoplasmosis d. other 4. Gingival lesions of genetic origin a. hereditary gingival fibromatosis b. other

5. Gingival manifestations of systemic conditions a. mucocutaneous disorders 1) lichen planus 2) pemphigoid 3) pemphigus vulgaris 4) erythema multiforme 5) lupus erythematosus 6) drug-induced

b. allergic reactions 1) dental restorative materials a) mercury b) nickel c) acrylic d) other 2) Reaction attributable to a)toothpastes/dentifrices b)Mouthrinses / mouthwashes c)Chewing bum additives

6. Traumatic lesions (factitious, iatrogenic, accidental) a. chemical injury b. physical injury c. thermal injury 7. Foreign body reaction 8. Not otherwise specified (NOS)

II. Chronic Periodontitis A. Localized B. Generalized III. Aggressive Periodontitis A. Localized B. Generalized

IV. Periodontitis as a Manifestation of Systemic Diseases A. Associated with hematological disorders 1. Acquired neutropenia 2. Leukemias 3. Other

B. Associated with genetic disorders 1.Familial and cyclic neutropenia 2 Down syndrome 3. Leukocyte adhesion deficiency syndromes 4. Papillon-Lefèvre syndrome 5. Chediak-Higashi syndrome 6. Histiocytosis syndromes 7. Glycogen storage disease 8. Infantile genetic agranulocytosis 9. Cohen syndrome 10. Ehlers-Danlos syndrome (Types IV and VIII) 11. Hypophosphatasia

V. Necrotizing Periodontal Diseases A. Necrotizing ulcerative gingivitis (NUG) B. Necrotizing ulcerative periodontitis (NUP) VI. Abscesses of the Periodontium A. Gingival abscess B. Periodontal abscess C. Pericoronal abscess

VII. Periodontitis Associated With Endodontic Lesions A. Combined periodontic-endodontic lesions VIII. Developmental or Acquired Deformities and Conditions A. Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis 1. Tooth anatomic factors 2. Dental restorations/appliances 3. Root fractures and cemental tears

B. Mucogingival deformities and conditions around teeth 1. Gingival/soft tissue recession a. facial or lingual surfaces b. interproximal (papillary) 2. Lack of keratinized gingiva 3. Decreased vestibular depth 4. Aberrant frenum/muscle position 5. Gingival excess a. pseudopocket b. inconsistent gingival margin c. excessive gingival display d. gingival enlargement

C. Mucogingival deformities and conditions on edentulous ridges 1. Vertical and/or horizontal ridge deficiency 2. Lack of gingiva/keratinized tissue 3. Gingival/soft tissue enlargement 4. Aberrant frenum/muscle position 5. Decreased vestibular depth 6. Abnormal color D. Occlusal trauma 1. Primary occlusal trauma 2. Secondary occlusal trauma

Conclusion The 1999 classification system has been approved by the AAP, is now official terminology for that organization, and will be used in accredited graduate periodontal programs and board examinations. The Parameters of Care4 approved by the AAP have adopted the new classification and future publications will use it as their standard.

Referances Clinical periodontology Carranza, Newman 8 th edition & 9 th edition Periodontal therapy Nabers & Stalker Foundation of periodontic for dental hygienist Jill’s Nield – gehrig, Donald E.william www.perio.org/resources-products/ classification .pdf www.uic.edu/classes/peri/peri323/syallbus/class/index.htm www.odont.lu.se/depts/par/eaop/currclas.html

Classification of periodontal diseases

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Classification of periodontal diseases