classification of periodontal disease

2. Classification is defined
as the act or method of
distribution into groups

3. Identification of the etiology and
understanding of the pathology.
For diagnosis and treatment planning.
Facts can be filed for future references
Predicting treatment oucomes

4. For logical, systemic separation and
organisation of knowledge about disease.
Facilitates communication among the
clinician, researcher’s educators, students,
epidemiologist

5. CLINICAL CHARACTERISTIC PARADIGM
CLASSICAL PATHOLOGY PARADIGM
INFECTION / HOST RESPONSE
PARADIGM.
Perio 2000 vol 30

6. Classification system in the modern era
represent a blend of all three paradigms
The classification systems should be
viewed as dynamic works in progress that
need to be periodically modified based on
current thinking and new knowledge.

7. The first specific name for
periodontal disease was introduced
by Fauchard in 1723 using the term
“ SCURVY OF THE GUMS”

8. In 1811-1875 John M Riggs lectured on the
treatment of periodontal disease. After that
periodontitis was called “Rigg’s disease”

9. C.G.DAVIS CLASSIFICATION
Gingival recession with minimum or no
inflammation
Periodontal destruction secondary to Lime
deposits
Rigg’s disease

10. G.V. BLACK CLASSIFICATION(1886)
 Constitutional gingivitis
 Painful form of gingivitis
 Simple gingivitis
 Calcic inflammation of the periodontal
membrane
 Phagedenic pericementitis
Dent Rev
1894

11. In the later part of the 19th century,
periodontitis went under different names
Pyorrhea alveolaris
Riggs disease
Calcic inflammation of the periodontal
membrane
Phagedinic pericementitis

12. INFLAMMATORY
NON INFLAMMATORY

13. Gottlieb believed that he had
discovered histological evidence of an
impairment in the continuous deposition of
cementum i.e. ‘cementopathia’
GOTTLIEB CLASSIFICATION (1920):
 schmutz pyorrhoea
Alveolar atrophy
Paradental pyorrhoea
Occlusal trauma

14. McCall & Box introduced the term
periodontitis to denote those inflammatory
diseases in which all three components of
the periodontium, i.e. the gingiva, bone, and
periodontal ligament, were affected.
J Am Dent Assoc 1925:
12

15. Periodontitis was subclassified, on the basis
of presumed etiologic factors, into
1.Simplex periodontitis
2.Complex periodontitis

16.  Becks (1931) made a distinction between
paradentitis and genuine paradentosis.
 Orban & Weinmann (1942) adopted this
nomenclature using the anglicized term
periodontosis to designate this
noninflammatory disease.
J Periodontol 1942: 13

17. I. INFLAMMATION:
GINGIVITIS PERIODONTITIS
1.LOCAL
Calculus
Food impaction
Irritatiting restoration
2.SYSTEMIC
Diabetes
Pregnancy
Tuberculosis
Syphilis
1. SIMPLEX
2. COMPLEX

18. II. DEGENERATION
PERIODONTOSIS
Systemic disturbances
Hereditary
Idiopathic

19. III. ATROPHY:
PERIODONTAL ATROPHY
Local trauma
Presenile
Senile
Disuse
Following inflammation
Idiopathic

20. IV. HYPERTROPHY:
GINGIVAL HYPERTROPHY
Chronic irritation
Drug action
Idiopathic
V. TRAUMATISM:
Occlusal trauma

21. Importance of dental plaque in 1950s
and 1960s by Loe and coworkers
Association between plaque and
gingival inflammation was shown in their
experimental gingivitis

22. Evidence to support the conventional
concept of periodontosis is
unsubstantiated.
 The term periodontosis is eliminated from
periodontal nomenclature.

23. Butler introduced the name juvenile
periodontitis instead of periodontosis when
describing the periodontal condition of
young individuals with severe periodontal
bone loss
J Periodontol 1969

24. Harald Löe and his colleagues studied
on experimental gingivitis and concluded
there is a significant relationship between
plaque flora and development of gingivitis.

25. In 1977– 1979 it was found that
neutrophils from patients with juvenile
periodontitis had defective chemotactic
and phagocytic activities marked the
beginning of the dominance of the
Infection/Host Response paradigm
J Periodontal Res 1979: 14

26. In 1982 Page & Schroeder defined
periodontitis as an inflammatory disease of
the periodontium characterized by the
presence of periodontal pockets and active
bone resorption with acute inflammation.

27. PAGE & SCHROEDER CLASSIFICATION
 Prepubertal
 Juvenile
 Rapidly progressive
 Adult periodontitis
 Acute necrotizing ulcerative gingivo-
periodontitis (ANUG⁄P).

28. I. Juvenile periodontits
 Prepubertal periodontitis
 Localized juvenile periodontitis
 Generalized juvenile periodontitis
II Adult periodontis
III Necrotizing ulcerative gingivo-
periodontitis
IV Refractory periodontitis.

29. I. Childhood periodontitis
II. Juvenile periodontitis:
localized
generalized
III Post-juvenile periodontitis
IV. Adult onset periodontitis:
slowly progressive
rapidly progressive
V. Periodontitis associated with systemic diseases
VI .Traumatic periodontitis
VII. Iatrogenic periodontitis, due to inappropriate
restorations or inappropriate

30. I Adult periodontitis
II Early onset periodontitis
 A Prepubertal periodontits
 B Juvenile periodontitis
 C Rapidly progressive periodontitis
III Periodontitis associated with systemic diseases
IV Necrotizing ulcerative periodontitis
V Refractory periodontitis.

31.  Absence of gingival disease category.
 nonvalidated age
Extensive overlap in the clinical
characteristics of the different categories of
periodontitis

32. Rapidly Progressive
Periodontitis
heterogenous
Refractory Periodontitis’ category
Prepubertal Periodontitis

33. He recommended the elimination of
refractory Periodontitis’
&
‘Periodontitis Associated with Systemic
Disease’

34. Adult periodontitis
Early onset periodontitis
Necrotising ulcerative periodontitis
Periodontal abscess

35. There is insufficient knowledge to
separate truly different diseases (disease
heterogeneity) from differences in the
presentation ⁄ severity of the same disease

36. “The international workshop for a
classification of periodontal diseases and
conditions” was organised and a new
classification was agreed upon.
AAP , october 30- November 2nd
1999,

37. 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

38. 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
 puberty-associated gingivitis
 menstrual cycle-associated gingivitis
 pregnancy-associated
a) gingivitis
b) pyogenic granuloma
 diabetes mellitus-associated gingivitis
b. associated with blood dyscrasias
1) leukaemia-associated gingivitis
2) other

39. Classification of Gingival Diseases
3. Gingival diseases modified by medications
 drug-influenced gingival enlargements
 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

40. 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

41. Classification of Gingival Diseases
Non-plaque-induced gingival lesions
3. Gingival diseases of fungal origin:
generalized gingival candidosis
linear gingival erythema
histoplasmosis
other
4. Gingival lesions of genetic origin
a. hereditary gingival fibromatosis
b. other

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

43. 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)

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

45. 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).

46. C. Periodontitis as a manifestation of systemic diseases
 Associated with haematological disorders
1. Acquired neutropenia
2. Leukaemias
3. Other
 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.

47. 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.

48. 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.

49. G. Developmental or acquired deformities and conditions
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 fraenum/muscle position
5. Gingival excess
a) pseudopocket
b) inconsistent gingival margin
c) excessive gingival display
d) gingival enlargement
6. Abnormal colour
Classification of Periodontal Diseases.

50. 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.

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

52. Van der Velden classification
based on four dimensions
 Extent
 severity
 age
 clinical characteristics

53. The classification proposed by 1999
inernational workshop has corrected the
problems of previous system. It may be
modified in he future if there are sufficien
data to justify revisions.