CLASSIFICATION OF   PERIODONTAL       DISEASES       INDIAN DENTAL ACADEMY        Leader in Continuing Dental Education  w...
INDEX INTRODUCTION NEED FOR CLASSIFICATION DEVELOPMENT & EVOLUTION OF  CLASSIFICATION SYSTEMS CONCLUSION        www.in...
INTRODUCTIONCLSSIFYING PERIODONTAL DISEASES – A LONG STANDING DILEMMA       www.indiandentalacadem
 There has been a debate on the diagnosis  and classification of periodontal diseases. Diagnosis is defined as the act o...
 Any attempt to group the entire  constellation of periodontal diseases into  an early and widely accepted classification...
NEED FOR CLASSIFICATION For the purpose of diagnosis,prognosis and  treatment planning. To understand the etiology,patho...
 Facts can be filed for future references. Helps       to     communicate       among  clinicians,researchers,educators,...
The development and evolution   of classification systems Influenced by paradigms that reflect the  understanding the nat...
 The dominant paradigms in the historical  development of classification system  primarily based on I.Clinical features ...
 Classification systems in the modern era  represent a blend of all three paradigms. The ideas which are believed to be ...
 The classification systems should be  viewed as dynamic works-in-progress that  need to be periodically modified based o...
 The ancient medical works refer to the  various diseases of teeth & periodontium  but without using any particular  term...
I.CLINICAL  CHARACTERISTICSPARADIGM(1870-1920) In the late 1800&early 1900s clinicians  used case descriptions and their ...
 In 1811-1875 John M Riggs lectured on  the treatment of periodontal disease.After  that periodontitis was called “Rigg’s...
 In 1879 C.G Davis published a paper ,he  believed that there were three distinct  forms of destructive periodontal disea...
 3.Rigg’s disease : loss of alveolus without  loss of gum.the perceived problem was a  necrosed alveolus or death of the ...
 In 1886 G.V.Black published on  classification based on their clinical  characteristics and his understanding of  their ...
 5.Phagedinic periodontitis:the pattern of  alveolar bone destruction is irregular.it  may occur rapidly or slowly. In a...
In the later part of the 19th century periodontitis went under numerous names: Pyorrhea alveolaris Riggs disease Calcic...
II.CLASSICAL PATHOLOGY    PARADIGM(1920-1970) The concept emerged from the debate on  periodontal diseases by the clinica...
 Gottileb is generally considered to be the  first author who clearly distinguished  various forms of periodontal disease...
 2.Alveolar atrophy or diffuse atrophy:     Non inflammatory disease exhibiting  loosening of teeth,elongation of and  wa...
 3.Paradental-pyorrhoe:     Irregularly distributed pockets varying  from shallow to extremely deep.this may  be started ...
 Mc Call & Box in 1925 introduced a term  ‘periodontitis’    to     denote       those  inflammatory diseases in which th...
 Becks (1931) made a distinction between  PARADENTITIS,a         disease      ‘which  originates from the gum tissue in t...
 Orban & Weinmann (1942) used the term  periodontosis to designate this ‘non  inflammatory disease’. Periodontosis was c...
 Orban classified periodontal diseases  according to the “pathologic” categories of  Inflammation  Degeneration  Atrophy ...
*InflammationI.gingivitis(little or no pocket formation)  A.local-    calculus,foodimpaction,irritating restorations,drug ...
*DegenerationI.Periodontosis)A.Systemic disturbances  1.Diabetes  2.Endocrine dysfunctions  3.Bood dyscrasias  4.Nutrition...
*Atrophy I.Peridontal atrophy(recession,no   inflammation,no pockets)    A.Local trauma(eg;from tooth brush)    B.Presenil...
*Hypertrophy I.gingival hypertrophy   A.Chronic irritation   B.Drug action   C.Idiopathic*Traumatism I.Periodontal traumat...
 During 1950 & 1960s the importance of  dental plaque as the major etiologic factor  for periodontal diseases became more...
In 1966 the workshop in periodontics  concluded the report: ‘Evidence to support the conventional concept of  periodontos...
 Soon after the workshop a study was  published by Butler(1969) introducing the  JUVENILE PERIODONTITIS instead of  perio...
III.Infection/Host response      Paradigm(1970-present) In1876 Robert Koch published the  experimental proof of the germ ...
 Harald & loe in 1965-1968 studied on  experimental gingivitis and concluded  there is a significant relationship between...
 This finding is coupled with demonstration  in 1977-1979 that neutrophils from  patients with juvenile periodontitis had...
 In 1982 Page & Schroder defined  periodontitis as an inflammatory disease of  the periodontium characterised by the  pre...
 In 1986 the AAP adopted the following   classificationI.Juvenile periodontitis A.prepubertal periodontitis B.localized...
 In 1988 Jhonson et al presented a more extensive   classification to detect the groups and individuals   at high risk fo...
VI.Traumatic periodontitis      eg:gingival recession and loss of attachment as a result of abrasion during oral         h...
 The next major landmark in classification  emerged from the 1989 World Work Shop  in clinical periodontics follows as:I....
III. Periodontitis associated with systemic   diseasesIV.Necrotizing ulcerative PeriodontitisV.Refractory Periodontitis   ...
 The short comings of 1989 classification:1.considerable      overlap     in     clinical  characteristics of the differe...
 In 1993 Ranney et al recommended the  elimination of refractory periodontitis and  periodontitis associated with systemi...
 In 1993 first European Work Shop on  periodontology given a statement on the  basis of the reports produced by  papapano...
 1993 classification   I.Adult periodontitis  II.Early onset periodontitis  III.Necrotizing periodontitis            www....
 The need for a revised classification  system for periodontal diseases was  emphasized during the 1996 World Work  Shop ...
 On October 30 – November 2nd 1999, the  International    Work      Shop    for   a  classification of periodontal diseas...
Classification of periodontal diseases &conditions         www.indiandentalacadem
Gingival diseaseswww.indiandentalacadem
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www.indiandentalacadem
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www.indiandentalacadem
Conclusion The classified system proposed by ‘1999  international work shop for a classification  of periodontal diseases...
 Since it is probable that essentially all  dentists & periodontists in the world are  convinced that most periodontal di...
References1.Clinical     periodontology-Carranza    9th  edition.2.Critical issues in periodontal diagnosis-  Periodontolo...
Thank youwww.indiandentalacadem
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Classification of periodontal diseases 1 /certified fixed orthodontic courses by Indian dental academy

  1. 1. CLASSIFICATION OF PERIODONTAL DISEASES INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
  2. 2. INDEX INTRODUCTION NEED FOR CLASSIFICATION DEVELOPMENT & EVOLUTION OF CLASSIFICATION SYSTEMS CONCLUSION www.indiandentalacadem
  3. 3. INTRODUCTIONCLSSIFYING PERIODONTAL DISEASES – A LONG STANDING DILEMMA www.indiandentalacadem
  4. 4.  There has been a debate on the diagnosis and classification of periodontal diseases. Diagnosis is defined as the act of identifying a disease from its signs and symptoms. Classification is defined as the act or method of distribution into groups. www.indiandentalacadem
  5. 5.  Any attempt to group the entire constellation of periodontal diseases into an early and widely accepted classification system is fraught with difficulty,and inevitably considerable controversy. Despite the dilemma,in the past hundred years,experts have periodically assembled to develop a new classification system for periodontal diseases. www.indiandentalacadem
  6. 6. NEED FOR CLASSIFICATION For the purpose of diagnosis,prognosis and treatment planning. To understand the etiology,pathology of the diseases of the periodontium. For logical,systemic separation and organization of knowledge about disease. www.indiandentalacadem
  7. 7.  Facts can be filed for future references. Helps to communicate among clinicians,researchers,educators,students, epidemiologists and public health workers. www.indiandentalacadem
  8. 8. The development and evolution of classification systems Influenced by paradigms that reflect the understanding the nature of periodontal diseases during a given historical period. Over time,thoughts that guided the classification of periodontal diseases can be placed into three dominant paradigms. www.indiandentalacadem
  9. 9.  The dominant paradigms in the historical development of classification system primarily based on I.Clinical features of the diseases (1870-1920) II.The concepts of classical pathology (1920-1970) III.The infectious etiology of the diseases (1970-present) www.indiandentalacadem
  10. 10.  Classification systems in the modern era represent a blend of all three paradigms. The ideas which are believed to be clearly outmoded or incorrect have been discarded. The new paradigm rests on a foundation of the still valid components of the older or previous paradigms. www.indiandentalacadem
  11. 11.  The classification systems should be viewed as dynamic works-in-progress that need to be periodically modified based on current thinking and new knowledge. www.indiandentalacadem
  12. 12.  The ancient medical works refer to the various diseases of teeth & periodontium but without using any particular terminology. The first specific name for periodontal disease was introduced by Fauchard in 1723 using the term ‘SCURVY OF THE GUMS’. www.indiandentalacadem
  13. 13. I.CLINICAL CHARACTERISTICSPARADIGM(1870-1920) In the late 1800&early 1900s clinicians used case descriptions and their personal interpretation of what they saw clinically as the primary basis for classifying periodontal diseases. www.indiandentalacadem
  14. 14.  In 1811-1875 John M Riggs lectured on the treatment of periodontal disease.After that periodontitis was called “Rigg’s disease”. www.indiandentalacadem
  15. 15.  In 1879 C.G Davis published a paper ,he believed that there were three distinct forms of destructive periodontal disease: 1.Gingival recession with minimal or no inflammation due to trauma from tooth brushing or decreased vascular action. 2.Periodontal destruction secondary to ‘lime deposits’-the gum retires slowly and the alveolar border deprived of nutrition,at the point of pressure is consentaneously absorbed. www.indiandentalacadem
  16. 16.  3.Rigg’s disease : loss of alveolus without loss of gum.the perceived problem was a necrosed alveolus or death of the periodontal membrane. www.indiandentalacadem
  17. 17.  In 1886 G.V.Black published on classification based on their clinical characteristics and his understanding of their cause into five groups 1.constitutional gingivitis 2.painful form of gingivitis(NUG) 3.simple gingivitis 4.the destruction of alveolar bone slowly in even or generalized pattern.(chronic periodontitis) www.indiandentalacadem
  18. 18.  5.Phagedinic periodontitis:the pattern of alveolar bone destruction is irregular.it may occur rapidly or slowly. In a later publication Black replaced the term ‘phagedinic periodontitis’ with ‘chronic suppurative pericementitis’. www.indiandentalacadem
  19. 19. In the later part of the 19th century periodontitis went under numerous names: Pyorrhea alveolaris Riggs disease Calcic inflammation of the periodontal membrane Phagedinic pericementitis The dominant term used for periodontal disease was pyorrhea alveolaris. www.indiandentalacadem
  20. 20. II.CLASSICAL PATHOLOGY PARADIGM(1920-1970) The concept emerged from the debate on periodontal diseases by the clinical scholars in Europe and North America concluded - There were two forms of periodontal disease 1.Inflammatory (degenerative) 2.Noninflammatory(dystrophic) www.indiandentalacadem
  21. 21.  Gottileb is generally considered to be the first author who clearly distinguished various forms of periodontal disease. In 1920s he classified periodontal disease into four groups. 1.Schmutz pyorrhea: due to accumulation of deposits on the teeth and was characterised by inflammation,shallow pockets, and resorption of alveolar crest. www.indiandentalacadem
  22. 22.  2.Alveolar atrophy or diffuse atrophy: Non inflammatory disease exhibiting loosening of teeth,elongation of and wandering of teeth in individuals who were free of caries & dental deposits,pockets are formed in later stages www.indiandentalacadem
  23. 23.  3.Paradental-pyorrhoe: Irregularly distributed pockets varying from shallow to extremely deep.this may be started as Schmutz-pyorrhoe or diffuse atrophy. 4.Occlusal trauma: A form of physical overload was believed to result in resorption of the alveolar bone and loosening of teeth. www.indiandentalacadem
  24. 24.  Mc Call & Box in 1925 introduced a term ‘periodontitis’ to denote those inflammatory diseases in which the gingiva,bone & periodontal ligament are involved. Periodontitis was sub classified on the basis of presumed etiologic factors into 1.simplex periodontitis:due to local bacterial factors 2.complex periodontitis:due to systemic etiologic factors. www.indiandentalacadem
  25. 25.  Becks (1931) made a distinction between PARADENTITIS,a disease ‘which originates from the gum tissue in the form of gingivitis’ and GENUINE PARADENTOSIS ‘which originates in the bony alveolus,perhaps in the form of an osteopathy’. www.indiandentalacadem
  26. 26.  Orban & Weinmann (1942) used the term periodontosis to designate this ‘non inflammatory disease’. Periodontosis was considered a separate disease entity,distinctly different from periodontitis,which was considered as the sequel of gingivitis of deeper periodontal structures and therefore of a inflammatory origin. It is not mentioned specifically that it was a disease entity particular to young patients. www.indiandentalacadem
  27. 27.  Orban classified periodontal diseases according to the “pathologic” categories of Inflammation Degeneration Atrophy Hypertrophy Traumatism. www.indiandentalacadem
  28. 28. *InflammationI.gingivitis(little or no pocket formation) A.local- calculus,foodimpaction,irritating restorations,drug action etc. B.systemic- pregnancy,diabetes,tuberculosis,syphilis,nutritional disorders,drug action,allergy,hereditary,idiopathic etc.II.periodontitis A.simplex(secondary to gingivitis)-bone loss,pockets,abscess can form:cases have calculus. B.complex(secondary to periodontosis)-etiologic factors similar to periodontitis:cases have little,if any calculus. www.indiandentalacadem
  29. 29. *DegenerationI.Periodontosis)A.Systemic disturbances 1.Diabetes 2.Endocrine dysfunctions 3.Bood dyscrasias 4.Nutritional disturbances 5.Nervous disorders 6.Infectious diseases(acute &chronic)B.HereditaryC.Idiopathic www.indiandentalacadem
  30. 30. *Atrophy I.Peridontal atrophy(recession,no inflammation,no pockets) A.Local trauma(eg;from tooth brush) B.Presenile C.Senile D.Disuse E.Following inflammation F.Idiopathic www.indiandentalacadem
  31. 31. *Hypertrophy I.gingival hypertrophy A.Chronic irritation B.Drug action C.Idiopathic*Traumatism I.Periodontal traumatism A.Occlusal trauma www.indiandentalacadem
  32. 32.  During 1950 & 1960s the importance of dental plaque as the major etiologic factor for periodontal diseases became more and more evident. The ultimate proof of association between plaque and gingival inflammation was shown by Loe and coworkers in their experimental gingivitis studies(1965,1966). www.indiandentalacadem
  33. 33. In 1966 the workshop in periodontics concluded the report: ‘Evidence to support the conventional concept of periodontosis is unsubstantiated.It was the consensus of the section that the term periodontosis is ambiguous and it should be eliminated from nomenclature.Nevertheless,the committee is aware that some evidence exists to indicate that a clinical entity different from adult periodontitis may occur in adolescents and young adults’. www.indiandentalacadem
  34. 34.  Soon after the workshop a study was published by Butler(1969) introducing the JUVENILE PERIODONTITIS instead of periodontosis. www.indiandentalacadem
  35. 35. III.Infection/Host response Paradigm(1970-present) In1876 Robert Koch published the experimental proof of the germ theory of disease and established the koch’s postulates. Miller (1890) was an early advocate of this paradigm that would come to dominate the field nearly a hundred years later. www.indiandentalacadem
  36. 36.  Harald & loe in 1965-1968 studied on experimental gingivitis and concluded there is a significant relationship between plaque flora and development of gingivitis. The next major discovery in periodontal microbiology was the preliminary demonstration in 1976-1977 of microbial specificity at sites with periodontosis. www.indiandentalacadem
  37. 37.  This finding is coupled with demonstration in 1977-1979 that neutrophils from patients with juvenile periodontitis had defective chemotactic and phagocytic activities,marked the beginning of the dominance of infection/host response paradigm. www.indiandentalacadem
  38. 38.  In 1982 Page & Schroder defined periodontitis as an inflammatory disease of the periodontium characterised by the presence of periodontal pockets and active bone resorption with acute inflammation. They suggested four different forms of periodontitis. 1.prepubertal periodontitis 2.juvenile periodontitis 3.rapidly progressive periodontitis 4.adult periodontitis 5.ANUG/P www.indiandentalacadem
  39. 39.  In 1986 the AAP adopted the following classificationI.Juvenile periodontitis A.prepubertal periodontitis B.localized juvenile periodontitis C.generalized juvenile periodontitisII.Adult periodontitisIII.NUG/P Necrotizing ulcerative gingivo periodontitis.IV.Refractory periodontitis www.indiandentalacadem
  40. 40.  In 1988 Jhonson et al presented a more extensive classification to detect the groups and individuals at high risk for periodontal disease.I.Childhood periodontitisII.Juvenile periodontitis -localized,generalizedIII.Post juvenile periodontitisIV.Adult onset periodontitis -slowly progressive -rapidly progressiveV.periodontitis associated with systemic diseases(diabetes,scurvy,immunodeficiencies, immunosupressive states,blood dyscrasias) www.indiandentalacadem
  41. 41. VI.Traumatic periodontitis eg:gingival recession and loss of attachment as a result of abrasion during oral hygiene practice(tooth brushing,woodsticks,charcoal,brick dust)VII.Iatrogenic periodontitis due to inappropriate restorations or inappropriate instrumentation of the gingival crevice. www.indiandentalacadem
  42. 42.  The next major landmark in classification emerged from the 1989 World Work Shop in clinical periodontics follows as:I. Adult periodontitisII.Early onset periodontitis A.Prepubertal periodontitis -localized,generalized B. Juvenile periodontitis -localized,generalized C. Rapidly progressive periodontitis www.indiandentalacadem
  43. 43. III. Periodontitis associated with systemic diseasesIV.Necrotizing ulcerative PeriodontitisV.Refractory Periodontitis www.indiandentalacadem
  44. 44.  The short comings of 1989 classification:1.considerable overlap in clinical characteristics of the different disease categories2.Absence of gingival diseases3.Inappropriate emphasis on age of onset of disease and rates of progression4.Inadequate or unclear classification criteria5.Rapidly progressive & prepubertal perodontitis and refractory periodontitis were heterogenous category6.The periodontitis categories had non validated age dependent criteria www.indiandentalacadem
  45. 45.  In 1993 Ranney et al recommended the elimination of refractory periodontitis and periodontitis associated with systemic diseases.he suggested to consider these in specific context rather than treating them as a unique category. Ranney proposed four major categories I. Adult periodontitis II. Early onset periodontitis III. Necrotizing ulcerative Periodontitis IV.periodontal abcess www.indiandentalacadem
  46. 46.  In 1993 first European Work Shop on periodontology given a statement on the basis of the reports produced by papapanou. ‘There is a insufficient knowledge to separate truly different diseases (disease heterogenicity)from differences in the presentation/severity of the same disease(phenotypic variation). www.indiandentalacadem
  47. 47.  1993 classification I.Adult periodontitis II.Early onset periodontitis III.Necrotizing periodontitis www.indiandentalacadem
  48. 48.  The need for a revised classification system for periodontal diseases was emphasized during the 1996 World Work Shop in periodontics. www.indiandentalacadem
  49. 49.  On October 30 – November 2nd 1999, the International Work Shop for a classification of periodontal diseases and conditions was held and a new classification was agreed upon. www.indiandentalacadem
  50. 50. Classification of periodontal diseases &conditions www.indiandentalacadem
  51. 51. Gingival diseaseswww.indiandentalacadem
  52. 52. www.indiandentalacadem
  53. 53. www.indiandentalacadem
  54. 54. www.indiandentalacadem
  55. 55. www.indiandentalacadem
  56. 56. www.indiandentalacadem
  57. 57. Conclusion The classified system proposed by ‘1999 international work shop for a classification of periodontal diseases and conditions’ has corrected some of the problems associated with the previous system that had been in use since 1989. Nevertheless the new system is far from perfect and will need to be modified once there are sufficient new data to justify revisions. www.indiandentalacadem
  58. 58.  Since it is probable that essentially all dentists & periodontists in the world are convinced that most periodontal diseases are infections,it is unlikely that the Infection/Host response paradigm will be replaced in the near future. www.indiandentalacadem
  59. 59. References1.Clinical periodontology-Carranza 9th edition.2.Critical issues in periodontal diagnosis- Periodontology 2000;vol 39:2005.3.Controversies in periodontology- Periodontology 2000;vol30:2002.4.Classification & Epidemiology of periodontal diseases-Periodontology 2000;vol2:1993.5.Annals of periodontology 1999. www.indiandentalacadem
  60. 60. Thank youwww.indiandentalacadem

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