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Classification of periodontal diseases

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  • 1. Classification of periodontal diseases
  • 2. Periodontium The periodontium consist of the investing & supporting tissues of the teeth which include gingiva . periodontal ligament ,cementum & alveolar bone.
  • 3. 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
  • 4. Systematic collection of data or knowledge & its arrangement in sequential manner in order to facilitate its understanding or knowledge CLASSIFICATION
  • 5. 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
  • 6. HISTORICAL DEVLOPMENT OF CLASSIFICATION SYSTEM
    • CLINICAL CHARACTERISTIC PARADIGM
    • CLASSICAL PATHOLOGY PARADIGM
    • INFECTION / HOST RESPONSE PARADIGM
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. ORBAN CLASSIFICATION (1942)
    • INFLAMMATORY
    • DYSTROPHIC
    • NEOPLASTIC
    • PATHOLOGIC REACTION PRODUCED BY OCCLUSAL TRAUMA
  • 11. 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
  • 12. INFECTION / HOST RESPONSE PARADIGM
    • ROBERT KOCH IN 1876 – GERM THEORY OF DISEASE
    • W. D. MILLER SUGGESTED THAT 3 FACTOR’S ARE CONSIDERRED FOR PYRRHOEA
  • 13. PRITCHARD CLASSIFICATION {1972}
    • INFLAMMATION WITH SURFACE DESTRUCTION
    • DISEASE AFFECTING SURFACE OR GINGIVA
    • DISEASE AFFECTING DEEPAR STRUCTURE
  • 14. RAMFORD & ASH CLASSIFICATION (1979)
    • GINGIVITIS
    • GINGIVAL ATROPHY OR RECESSION
    • TRAUMA FROM OCCLUSION
    • PERIODONTITIS
  • 15. 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
  • 16.
    • FUNTIONALLY INDUCED DISEASES
            • TRAUMATIC OCCLUSION
            • DISEASE ATROPHY
            • TRAUMA
            • ACCIDENTAL
            • HABITS
  • 17. Page & schroeder classification (1982)
    • 1)Prepubertal periodontitis
    • Generalized
    • Localized
    • 2)Juvenile periodontitis
    • 3)Rapidilly progressing periodontitis
    • 4)Adult type periodontitis
  • 18. Topic’s classification (1986)
    • Acute
    • gingivitis
    • specific , non specific
    • Periodontitis
    • periodontal abscess
    • pericoronitis
    • Chronic
    • Gingivitis
    • plaque associated, symptomatic
    • Periodontits
    • recession
  • 19.
    • Periodontitis
    • localized
    • generalized
    • Periodontitis
    • simple
    • complex
    • Rapidlly progressive – type A
    • -- type B
    • Prepubertal
    • Juvenile
    • Post juvenile
    • symptomatic
  • 20. Suzuki classification (1988)
    • Adult periodontitis
    • Early onset periodontitis
    • Juvenile periodontitis
    • Post juvenile periodontitis
    • Prepubertal periodontitis
  • 21. Genco classification (1990)
    • Periodontitis in adult
    • Periodontitis in juvenile
    • localized
    • generalized
    • Periodontitis with systemic involvement
    • Primary neutrophil disorders
    • Secondary neutrophil impairment
    • Misellaneous condition
  • 22. Weatherford classification (1987)
    • Disease affecting surface of gingiva
    • Disease affecting deeper structure
    • Periodontal traumaties
    • Periodontal abscess
  • 23. 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
  • 24. 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.
  • 25. CURRENT CLASSIFICATION
    • INTERNATIONAL WORKSHOP FOR A CLASSIFICATION OF PERIODONTAL DISEASES & CONDITION –(1999)
    • GOAL – “COURSE CORRECTION” OR “FINE TUNING” OF 1989 CLASSIFICATION
  • 26.
    • 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
  • 27.
    • 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
  • 28.
    • 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
  • 29.
    • 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
  • 30.
    • 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
  • 31.
    • 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
  • 32.
    • 6. Traumatic lesions (factitious, iatrogenic,
    • accidental)
    • a. chemical injury
    • b. physical injury
    • c. thermal injury
    • 7. Foreign body reaction
    • 8. Not otherwise specified (NOS)
  • 33.
    • II. Chronic Periodontitis
    • A. Localized
    • B. Generalized
    • III. Aggressive Periodontitis
    • A. Localized
    • B. Generalized
  • 34.
    • IV. Periodontitis as a Manifestation of Systemic Diseases
    • A. Associated with hematological disorders
    • 1. Acquired neutropenia
    • 2. Leukemias
    • 3. Other
  • 35.
    • 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
  • 36.
    • 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
  • 37.
    • 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
  • 38.
    • 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
  • 39.
    • 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
  • 40. 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.
  • 41. 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
  • 42.  

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