Periodontal Diesase Classification (presentation)

Current Classification of Periodontal Disease

1. Classification of Periodontal Diseases Dr Prateek Shrestha

2. H elps in the development of frameworks to study the aetiology , Pathogenesis & treatment of diseases; P rovides the international healthcare community with a way of communicating in a common language. Why Classification ?

3. 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 .

4. Periapical radiographs of a 36-year-old patient, showing severe generalized bone loss. Diagnosis: ‘chronic adult periodontitis ’ or ‘early-onset periodontitis ’?

5. 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?

6. The 1999 International Workshop for the Classification of Gingival Diseases A. Dental plaque-induced gingival diseases B. Non-plaque-induced gingival lesions The 1999 International Workshop for the Classification of Periodontal Diseases. A. Chronic periodontitis B. Aggressive periodontitis C. Periodontitis as a manifestation of systemic diseases D. Necrotizing periodontal diseases E. Abscesses of the periodontium F. Periodontitis associated with endodontic lesions G. Developmental or acquired deformities and conditions

7. Gingival diseases: A simplified version of the 1999 International Workshop.5

8. Classification of Gingival Diseases Dental plaque-induced gingival diseases 1. Gingivitis associated with dental plaque only a. Without other local contributing factors b. With local contributing factors

9. Classification of Gingival Diseases Dental plaque-induced gingival diseases 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) leukaemia -associated gingivitis 2) other

10. Classification of Gingival Diseases 3. Gingival diseases modified by medications 1) drug-influenced gingival enlargements 2) drug-influenced gingivitis a) oral contraceptive-associated gingivitis b) other Dental plaque-induced gingival diseases 4. Gingival diseases modified by malnutrition a. ascorbic acid-deficiency gingivitis b. other

11. Classification of Gingival Diseases Non-plaque-induced gingival lesions 1. Gingival diseases of specific bacterial origin a. Neisseria gonorrhoea -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

12. Classification of Gingival Diseases Non-plaque-induced gingival lesions 3. Gingival diseases of fungal origin a. candidal 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

13. Classification of Gingival Diseases Non-plaque-induced gingival lesions 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 7) other b. allergic reactions 1) dental restorative materials a) mercury b) nickel c) acrylic d) other 2) reactions attributable to a) toothpastes/dentifrices b) mouthrinses /mouthwashes c) chewing gum additives d) foods and additives 3) other

14. Classification of Gingival Diseases Non-plaque-induced gingival lesions 6. Traumatic lesions (factitious, iatrogenic, accidental) a. chemical injury b. physical injury c. thermal injury 7. Foreign body reactions 8. Not otherwise specified (NOS)

15. Gingival diseases: A simplified version of the 1999 International Workshop.5

16. The 1999 International Workshop for the Classification of Gingival Diseases A. Dental plaque-induced gingival diseases B. Non-plaque-induced gingival lesions The 1999 International Workshop for the Classification of Periodontal Diseases. A. Chronic periodontitis B. Aggressive periodontitis C. Periodontitis as a manifestation of systemic diseases D. Necrotizing periodontal diseases E. Abscesses of the periodontium F. Periodontitis associated with endodontic lesions G. Developmental or acquired deformities and conditions

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

18. A. Chronic periodontitis Localized b. Generalized : up to 30% of sites : more than 30% of sites Slight: CAL 1–2 mm. Moderate: CAL 3–4 mm. Severe: CAL 5 mm or more. [clinical attachment loss (CAL)]: Severity of the disease Classification of Periodontal Diseases .

19. 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.

20. 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 than first molars and incisors).

21. C. Periodontitis as a manifestation of systemic diseases a. Associated with haematological disorders 1. Acquired neutropenia 2. Leukaemias 3. Other b. Associated with genetic disorders 1. Familial and cyclic neutropenia 2. Down’s 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 12. Other c. Not otherwise specified (NOS) Classification of Periodontal Diseases.

22. D. Necrotizing periodontal diseases a. Necrotizing ulcerative gingivitis (NUG) b. Necrotizing ulcerative periodontitis (NUP) E. Abscesses of the periodontium a. Gingival abscess b. Periodontal abscess c. Pericoronal abscess F. Periodontitis associated with endodontic lesions Combined periodontic -endodontic lesions Classification of Periodontal Diseases.

23. 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 factors 2. Dental restorations/appliances 3. Root fractures 4. Cervical root resorption and cemental tears Classification of Periodontal Diseases.

24. G. Developmental or acquired deformities and conditions b. Mucogingival deformities and conditions around teeth 1. Gingival/soft tissue recession facial or lingual surfaces interproximal (papillary) 2. Lack of keratinized gingiva 3. Decreased vestibular depth 4. Aberrant fraenum /muscle position 5. Gingival excess pseudopocket inconsistent gingival margin excessive gingival display gingival enlargement 6. Abnormal colour Classification of Periodontal Diseases.

25. G. Developmental or acquired deformities and conditions 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 fraenum /muscle position 5. Decreased vestibular depth 6. Abnormal colour Classification of Periodontal Diseases.

26. G. Developmental or acquired deformities and conditions d. Occlusal trauma 1. Primary occlusal trauma 2. Secondary occlusal trauma Classification of Periodontal Diseases.

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

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