Periodontal Diesase Classification (presentation)

Classification of Periodontal Diseases
Dr PrateekShrestha

Why Classification ?
Helps 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.

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’?

Where are we now?
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.

The 1999 International Workshop for the Classification of
Gingival Diseases
A. Dental plaque-induced gingival diseases
B. Non-plaque-induced gingival lesions
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

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

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

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) pyogenicgranuloma
4) diabetes mellitus-associated gingivitis
b. associated with blood dyscrasias
1) leukaemia-associated gingivitis
2) other

3. Gingival diseases modified by medications
1) drug-influenced gingival enlargements
2) drug-influenced gingivitis
a) oral contraceptive-associated gingivitis
b) other
4. Gingival diseases modified by malnutrition
a. ascorbic acid-deficiency gingivitis
b. other

Non-plaque-induced gingival lesions
1. Gingival diseases of specific bacterial origin
a. Neisseriagonorrhoea-associated lesions
b. Treponemapallidum-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. 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

5. Gingival manifestations of systemic conditions
a. mucocutaneous disorders
1) lichen planus
2) pemphigoid
3) pemphigusvulgaris
4) erythemamultiforme
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

6. 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.5

The 1999 International Workshop for the
A. Dental plaque-induced gingival diseases
B. Non-plaque-induced gingival lesions
Periodontal Diseases.

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

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

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.

a.Localized.
b. Generalized :
:
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).

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)

a. Necrotizing ulcerative gingivitis (NUG)
b. Necrotizing ulcerative periodontitis (NUP)
a. Gingival abscess
b. Periodontal abscess
c. Pericoronal abscess
Combined periodontic-endodontic lesions

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

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

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

d. Occlusal trauma
1. Primary occlusal trauma
2. Secondary occlusal trauma

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

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Periodontal Diesase Classification (presentation)

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