Classification of periodontal diseases

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Classification of periodontal diseases

  1. 1. Classification of periodontal diseasesPeriodontiumThe periodontium consist of the investing & supporting tissues of the teeth which include gingiva .periodontal ligament ,cementum & alveolar bone.DISEASEA pathological condition of a part, organ, or system of an organism resulting from various causes, suchas infection, genetic defect, or environmental stress, and characterized by an identifiable group of signsor symptomsCLASSIFICATIONSystematic collection of data or knowledge & its arrangement in sequential manner in order to facilitateits understanding or knowledgeUSES 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 OUTCOMESHISTORICAL DEVLOPMENT OF CLASSIFICATION SYSTEM CLINICAL CHARACTERISTIC PARADIGM CLASSICAL PATHOLOGY PARADIGM INFECTION / HOST RESPONSE PARADIGMCLINICAL CHARACTERISTIC PARADIGM Very little to know about the etiology & pathogenesis of periodontal diseaseC. 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
  2. 2. G. V. BLACK CLASSIFICATION (1886) CONSTITUTIONAL GINGIVITIS PAINFULL FORM OF GINGIVITIS SIMPLE GINGIVITIS INFLAMMATION OF THE PERIODONTAL MEMBRANE PHAGEDENIC PERIODONTITISLITTLE OR NO EVIDENCE WAS USED TO SUPPORT THE OPINION OF CLINICIAN OF THE TIMECLASSICAL 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 METABOLICORBAN CLASSIFICATION (1942) 1. INFLAMMATORY 2. DYSTROPHIC 3. NEOPLASTIC 4. PATHOLOGIC REACTION PRODUCED BY OCCLUSAL TRAUMA
  3. 3. W.HO. EXPERT COMMITEE ON DENTAL HEALTH IN 1961 SUGGESTED ETIOLOGY PLAYS SECONDARY & IMPORTANT PART IN CLASSIFICATION CLINICAL ASSESMENT LACK SUFFICIENT PRECISION TO SERVE ASINFECTION / HOST RESPONSE PARADIGM ROBERT KOCH IN 1876 – GERM THEORY OF DISEASE W. D. MILLER SUGGESTED THAT 3 FACTOR’S ARE CONSIDERRED FOR PYRRHOEAPRITCHARD CLASSIFICATION {1972} INFLAMMATION WITH SURFACE DESTRUCTION DISEASE AFFECTING SURFACE OR GINGIVA DISEASE AFFECTING DEEPAR STRUCTURERAMFORD & ASH CLASSIFICATION (1979) 1. GINGIVITIS 2. GINGIVAL ATROPHY OR RECESSION 3. TRAUMA FROM OCCLUSION 4. PERIODONTITISGRANT , STERN & LISTGARTEN CLASSIFICATION {1988} BACTERIAL INDUCED DISEASES GINGIVITIS PERIODONTITIS ADULT TYPE POST JUVENILE EARLY ONSET JUVENILE LOCALIZED GENERALIZED ACUTE NECROTIZING ULCERATIVE GINGVITIS ACUTE ABSCESS PERICORONITIS
  4. 4. FUNTIONALLY INDUCED DISEASES TRAUMATIC OCCLUSION DISEASE ATROPHY TRAUMA ACCIDENTAL HABITSPage & Schroeder classification (1982)1) Prepubertal periodontitis Generalized Localized2) Juvenile periodontitis3) Rapidly progressing periodontitis4) Adult type periodontitisTopic’s classification (1986) Acute gingivitis specific , non specific Periodontitis periodontal abscess pericoronitis Chronic Gingivitis plaque associated, symptomatic Periodontits recession Periodontitis localized generalized Periodontitis simple complex Rapidlly progressive
  5. 5. type A type B Prepubertal Juvenile Post juvenile SymptomaticSuzuki classification (1988) Adult periodontitis Early onset periodontitis Juvenile periodontitis Post juvenile periodontitis Prepubertal periodontitisGenco classification (1990) Periodontitis in adult Periodontitis in juvenile localized generalized Periodontitis with systemic involvement Primary neutrophil disorders Secondary neutrophil impairment Misellaneous conditionWeatherford classification (1987) Disease affecting surface of gingiva Disease affecting deeper structure Periodontal traumaties Periodontal abscessCLASSIFICATION OF THE WORLD WORKSHOP, 1989 PERIODONTITIS a. Adult periodontitis.
  6. 6. 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 periodontitisEUROPEAN 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.CURRENT CLASSIFICATION INTERNATIONAL WORKSHOP FOR A CLASSIFICATION OF PERIODONTAL DISEASES & CONDITION –(1999) GOAL – “COURSE CORRECTION” OR “FINE TUNING” OF 1989 CLASSIFICATION
  7. 7. 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 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 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
  8. 8. 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. Candida-species infections 1) generalized gingival candidosis b. linear gingival erythema c. histoplasmosis d. other4. Gingival lesions of genetic origin a. hereditary gingival fibromatosis b. other5. 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 b. allergic reactions 1) dental restorative materials a) mercury b) nickel c) acrylic d) other
  9. 9. 2) Reaction attributable to a)toothpastes/dentifrices b)Mouthrinses / mouthwashes c)Chewing bum additives 6. Traumatic lesions (factitious, iatrogenic, accidental) a. chemical injury b. physical injury c. thermal injury 7. Foreign body reaction 8. Not otherwise specified (NOS)II. Chronic Periodontitis A. Localized B. GeneralizedIII. Aggressive Periodontitis A. Localized B. GeneralizedIV. Periodontitis as a Manifestation of Systemic Diseases A. Associated with hematological disorders 1. Acquired neutropenia 2. Leukemias 3. Other 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
  10. 10. 8. Infantile genetic agranulocytosis 9. Cohen syndrome 10. Ehlers-Danlos syndrome (Types IV and VIII) 11. HypophosphatasiaV. 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 abscessVII. Periodontitis Associated With Endodontic Lesions A. Combined periodontic-endodontic lesionsVIII. 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 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
  11. 11. d. gingival enlargement 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 CONCLUSIONThe 1999 classification system has been approved by the AAP, is now official terminology for thatorganization, 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 futurepublications will use it as their standard.REFERANCES Clinical periodontology Carranza, Newman 8th edition & 9th edition Periodontal therapy Nabers & Stalker Foundation of periodontic for dental hygienist Jill’s Nield – gehrig, Donald E.william

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