CLASSIFICATION-OF-GINGIVAL AND PERIODONTALDISEASES.ppt

This ppt is a basic classification of gingival and periodontal diseases

1. CLASSIFICATION OF CLASSIFICATION OF
DISEASES AFFECTING DISEASES AFFECTING
THE PERIODONTIUMTHE PERIODONTIUM

2. CLASSIFICATION OF PERIODONTAL DISEASES AND
CONDITIONS (1999 WORLD WORKSHOP CLASSIFICATION BY
AAP)
GINGIVAL DISEASES
Plaque induced gingival diseases
Non-plaque induced gingival diseases
CHRONIC PERIODONTITIS
Localized
Generalized
AGGRESSIVE PERIODONTITIS
Localized
Generalized

3. 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
Pericoronal abscess
PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS
Endo perio lesion
Perio endo lesion
Combined lesion

4. DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND
CONDITIONS
Localized tooth related factors predisposing to
plaque induced gingival disease or periodontitis
Mucogingival deformities and conditions around the
teeth
Mucogingival deformities and conditions on
edentulous ridge
Occlusal trauma

5. GINGIVAL DISEASES
DENTAL PLAQUE-INDUCED GINGIVAL DISEASES
Disease 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

6. 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

7. 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

8. 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 infections
1. primary herpetic gingivostomatitis
2. recurrent oral herpes
3. varicella zoster
b. Others

9. 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

10. 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

11. VI. TRAUMATIC LESIONS ( IATROGENIC OR
ACCIDENTAL)
A. Chemical injury
B. Physical
C. Thermal
VII. FOREIGN BODY REACTIONS
VIII. NOT OTHERWISE SPECIFIED

12. 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

13. Periodontitis associated - Systemic disease that
predispose to
with systemic disease rapid rate of periodontitis
Diabetes, down syndrome, HIV
infection,
Papillon Lefevre syndrome
Necrotizing ulcerative - Similar to ANUG but with associated
clinical
periodontitis attachment loss
Refractory Periodontitis - Recurrent periodontitis that does
not respond to treatment

14. EUROPEAN WORKSHOP ON EUROPEAN WORKSHOP ON
PERIODONTOLOGY 1993PERIODONTOLOGY 1993

Adult periodontitisAdult periodontitis- Age of onset fourth- Age of onset fourth
decade of lifedecade of life
Slow rate of disease Slow rate of disease progression progression
No defect in host responseNo defect in host response
Early onset Early onset - Age of onset prior to- Age of onset prior to
PeriodontitisPeriodontitis fourth decade of life fourth decade of life
Rapid rate of disease Rapid rate of disease
progressionprogression
defect in the host defensedefect in the host defense
Necrotizing Necrotizing - Tissue necrosis with attachment and- Tissue necrosis with attachment and
periodontitis bone loss periodontitis bone loss

15. AAP WORKSHOP FOR CLASSIFICATION AAP WORKSHOP FOR CLASSIFICATION
OF PERIODONTAL DISEASE 1999OF PERIODONTAL DISEASE 1999

Chronic periodontitisChronic periodontitis

Aggressive Aggressive
periodontitisperiodontitis

Periodontitis as a Periodontitis as a
manifestation of manifestation of
systemic diseasessystemic diseases

16. CHRONIC PERIODONTITISCHRONIC PERIODONTITIS

Prevalent in adults Prevalent 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, Modified by systemic diseases like Diabetes,
HIVHIV

Local factors predisposing to periodontitisLocal factors predisposing to periodontitis

Smoking and stressSmoking and stress

17. 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 involved
SlightSlight : 1-2mm of CAL: 1-2mm of CAL
ModerateModerate : 3-4mm of CAL: 3-4mm of CAL
Severe Severe : :  5mm of CAL 5mm of CAL

18. 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-1ββ

Self arresting disease progressionSelf arresting disease progression

19. AGGRESSIVE PERIODONTITISAGGRESSIVE PERIODONTITIS

Classified intoClassified into
Localized form Localized form
circumpubertal onsetcircumpubertal onset
first molar or incisor disease with attachment first molar or incisor disease with attachment
loss on two permanent teeth with one first loss on two permanent teeth with one first
molarmolar
Robust serum antibody responseRobust serum antibody response
Generalized formGeneralized form
under 30 years of ageunder 30 years of age
generalized attachment loss other than 1generalized attachment loss other than 1
stst

molars and incisorsmolars and incisors
episodic nature of periodontal destructionepisodic nature of periodontal destruction
poor serum antibody responsepoor serum antibody response

20. PERIODONTITIS AS A MANIFESTATION PERIODONTITIS 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 disorders
a. Cyclic neutropeniaa. Cyclic neutropenia
b. Down Syndromeb. Down Syndrome
c. Papillon Lefeverec. Papillon Lefevere
d. Chediak Higashi syndromed. Chediak Higashi syndrome
e. Leukocyte adhesion deficiencye. Leukocyte adhesion deficiency
f. Hypophosphatasiaf. Hypophosphatasia
3. Not otherwise specified3. Not otherwise specified