2. INTRODUCTION
NEED FOR A CLASSIFICATION SYSTEM
1. TO PROVIDE A SCIENTIFIC FRAMEWORK
2. A FRAMEWORK TO STUDY ETIOLOGY, PATHOGENESIS &
TREATMENT IN A ORDERLY FASHION
3. PROVIDE CLINICIANS A WAY TO ORGANIZE HEALTH CARE
NEEDS
CRITERIAS FOR DIFFERENT CLASSIFICATION SYSTEM
1. CLINICAL FEATURES
2. NATURE OF THE PATHOLOGICAL CHANGES
3. ETIOLOGY
3. HISTORICAL BACKGROUND
• GINGIVAL & PD : – AS OLD AS HUMAN HISTORY
• REPORTED AS EARLY AS 3000 BC
• ORAL DISEASE CLASSIFIED : – 2500BC IN CHINESE LITERATURE
FONG YA : -- INFLAMMATORY CONDITIONS
YA KON : -- DISEASES OF THE SOFT INVESTING TISSUE OF
THE TEETH
CHONG YA :-- DENTAL CARIES
• 1823, ALPHONSE TOIRAC : FIRST USED THE TERM PYORRHEA ALVEOLARIS
• JOHN W RIGGS (1811-1885) 1st SPECIALIST :-- RIGGS DISEASE
• BERNHARD GOTTLIEB :-- 1885-1950
• BALINT J. ORBAN :-- 1899-1960
• OTHERS
4. • THE TERM PERIODONTAL DISEASE REFERS TO ALL DISEASE
PROCESSES TO WHICH THE PERIODONTIUM IS SUBJECTED
• IN AN EFFORT TO PROVIDE A USEFUL GUIDE FOR THE CLINICAL
MANAGEMENT OF PERIODONTAL PROBLEMS VARIOUS
CLASSIFICATIONS HAVE BEEN DEVELOPED
• SOME CLASSIFICATION INCLUDE GINGIVAL DISEASE, WHEREAS
OTHER DO NOT
8. AAP, SEP’ 1953
PERIODONTAL DISEASE (PERIODONTOPATHIES)
INFLAMMATION DYSTROPHY (RETROGRESSION)
GINGIVITIS MARGINAL
PERIODONTITIS
PERIODONTAL
TRAUMATISM
GINGIVOSIS PERIODONTOSIS
ACUTE/CHRONIC
1. ABRASION
2. LOCAL ETIOLOGICAL
FACTORS
a. MATERIA ALBA
b. CALCULUS
c. IRRITATING
RESTORATIONS
d. FOOD IMPACTION
e. INFECTIONS
f. OTHER CAUSES
3. DRUG ACTION-
ALLERGY
4. HORMONAL
5. SYSTEMIC
6. IDIOPATHIC
1. 2ndARY TO
LONG-STANDING
GINGIVITIS
2. INITIAL LESION
DISUSE
1. MALFUNCTIONAL OCCLUSION
a. MALOCCLUSION
b. LOSS OF TEETH, DRIFTING, & ELONGATION
c. PREMATURE CONTACTS
d. FAULTY CENTRIC RELATIONSHIP
2. FAULTY RESTORATIONS
a. INCORRECT ANATOMY OF OCCLUSAL
RECONSTRUCTION
b. FAULTY BRIDGES
c. FAULTY CLASP etc.
3. 2ndARY TO MARGINAL PERIODONTITIS
4. SECONDARY TO PERIODONTOSIS
NEOPLASIA
ANOMALIES
9. GLICKMAN, 1958
GINGIVAL DISEASE
CH DESTRUCTIVE PD
GINGIVITIS
GINGIVAL ENLARGEMENT
RECESSION (ATROPHY
ACUTE
CHRONIC
SPECIFIC
NONSPECIFIC
SPECIFIC
NONSPECIFIC
ANG
AHG
THRUS
ALLERGIC
ACUTE NONSPECIFIC GINGIVITIS
TB,SYPHILIS
DERMATOSES
CH THRUSH
OTHER MYCOTIC INFECTION
CH DES GING
CH MENOPAUSAL GINGIVOSTOMATITIS
OR SENILE ATROPHIC GINGIVITIS
CH MARGINAL GINGIVITIS
INFLAMATORY
NONINFLAMATORY
COMBINED
CONDITIONED
NEOPLASTIC
INFLAMMATORY
TRAUMATIC
DEGENERATIVE & CATABOLIC
COMBINED
13. TYPE HISTOPATH ETIOLOGY
PERIODONTITIS SIMPLE CH INFLAMATION OF GINGIVA, PERODONTAL POCKET,
BONE RESORPTION,DESTRUCTION OF Pdl,
LOCAL IRRITANTS
COMPOUND CH INFLA, RESORPTION OF Alv BONE & CEMENTUM,
DESTRUCTION OF Pdl, INCIDENCE OF INFRABONY
POCKET, ANGULAR BONE DESTRUCTION
LI & OCCLUSAL
DISHARMONY
PERIODONTOSIS EARLY NONINFLAMMATORY DEGENERATION OF Pdl,
OSTEOLYSIS(?), DIMINISHED FORMATION OF
CEMENTUM(?)
SYSTEMIC
ADVANCED NONINFLAMMATORY DEGENERATION OF THE
SUPPORTING PERIODONTAL TISSUE, COMPLICATED
BY INFLAMMATION &/0R TFO
SYSTEMIC, LI &/OR
OCCLUSAL DISHARMONY
TFO DEGENERATIVE & NECROTIC CHANGES IN THE
SUPPORTING PERIODONTAL TISSUE WITH TENDENCY
TOWARD WIDENING OF THE Pdl & ANGULAR BONE
LOSS
OCCLUSAL DISHARMONY
PERIODONTAL
ATROPHY
PRESENILE REDUCTION IN HEIGHT OF THE PERIODONTIUM UNKNOWN
DISUSE THINNING OF Pdl, THINNING & REDUCTION IN THE
NUMBER OF PERIODONTAL FIBERS, DISRUPTION OF
FIBER BUNDLE ARRANGEMENT, THCKENED
CEMENTUM, REDUCTION IN HEIGHT OF ALV BONE
DIMINUTION OR ABSENCE
OF OCCLUSAL FORCES
20. WORLD WORKSHOP IN CLINICAL PERIODONTICS, 1989
ADULT PERIODONTITIS
EOP
RAPIDLY PROGRESSING PERIODONTITIS
ASSOCIATED WITH SYSTEMIC
DISEASE
DOWN SYNDROME
PREPUBERTAL
JUVENILE
GENERALIZED LOCALIZED
DIABETES TYPE I
PAPILLON-LEFEVRE
NUP
REFRACTORY PERIODONTITIS
AIDS
OTHER DISEASES
27. PERIODONTAL DISEASE AND CONDITIONS
A. PERIODONTITIS IN ADULTS
1. AAP CLASIFICATION I, II, III, IV
2. EPIDEMIOLOGICAL
1. MODERATELY PROGRESSING PERIODONTITIS
2. RAPIDLY PROGRESSING PERIODONTITIS
3. CLINICAL BASED ON TREATMENT
1. REFRECTORY
2. RECURRENT
4. CLINICAL BASED ON HISTORY
1. RECURRENT ACUTE NECROTIZING ULCERATIVE PERIODONTITIS
2. POSTLOCALIZED JUVENILE PERIODONTITIS
28. B. PERIODONTITIS IN JUVENILES
• LOCALIZED
• GENERALIZED
C. PERIODONTITIS WITH SYSTEMIC INVOLVEMENT
1. PERIODONTITIS IN PRIMARY NEUTROPHIL DISORDERS
a. AGRANULOCYTOSIS
b. CYCLIC NEUTROPENIA
c. CHÉDIAK-HIGASHI SYNDROME
d. NUTROPHIL ADHERENCE ABNORMALITIES
e. JOB’S SYNDROME
f. LAZY LEUKOCYTE SYNDROME
g. NEUTROPHIL FUNCTIONAL ABNORMALITIS
29. 2. PERIODONTITIS IN SYSTEMIC DISEASE WITH SECONDARY
OR ASSOCIATED NEUTROPHIL IMPAIRMENT
a. DIABETES MELLITUS TYPE I
b. DIABETES MELLITUS TYPE II
c. PAPILLON-LeFèvre SYNDROME
d. DOWN’S SYNDROME
e. INFLAMMATORY BOWL DISEASE :CROHN’S DISEASE
f. PRELEUKEMIC SYNDROME
g. ADDISON’S DISEASE
h. AIDS
30. 3. OTHER SYSTEMIC DISEASES ASSICUATED WITH CHANGES
IN THE STERUCTURE OF PERIODONTAL ATTACHMENT
APPARATUS
a. EHLERS-DANLOS SYNDROME (VIII)
b. HISTOCYTOSIS (EOSINOPHILIC GRANLOMA)
c. SARCOIDOSIS
d. SCLERODERMA
e. HYPOPHOSPHATASIA
f. HYPOADRENOCORTICISM
g. HYPERTHYROIDISM
31. D. MISCELLANEOUS CONDITIONS AFFCTING THE PERIODONTIUM
1. PERIODONTAL ABSCESSES
2. PERIODONTAL CYSTS
3. ANKYLOSIS
4. ROOT RESORPTION
5. PERIODONTAL-PULPAL COMMUNICATING LESIONS
6. PERICORONAL ABSCESSES
7. DENTAL HYPERSENSITIVITY
8. RETAINED ROOTS
9. BONY SEQUESTRATION
10. INFECTIONS ASSOCIATED WITH FRACTURED ROOTS OR ANATOMIC DEFECTS
11. NEOPLASMSOF THE ATTACHMENT APPARATUS
32. RANNEY, 1993
• GINGIVITIS
– GINGIVITIS, PLAQUE BACTERIAL
• NONAGGRAVATED
• SYSTEMICALY AGGRAVATED BY SEX HORMONES, DRUGS,
SYSTEMIC DISEASES
– NUG
• SYSTEMIC DETERMINANTS UNKNOWN
• RELATED TO HIV
– GINGIVITIS , NONPLAQUE
• ASSOCIATED WITH SKIN DISEASES; ALLERGIC; INFECTIOUS
33. • PERIODONTITIS
– ADULT PERIODONTITIS
• NONAGGRAVATED
• SYSTEMICALY AGGRAVATED (NEUTROPENIAS, LEUKEMIAS, LAZY LEUKOCYTE SYNDROME,
AIDS, DIABETES MELLITUS, CROHN’S DISEASE, ADDISON,S DISEASE)
– EARLY ONSET PERIODONTITIS
• LOCALIZED EOP
– NEUTROPHIL ABNORMALITIS
• GENERALIZED EOP
– IMMUNODEFICIENCY, NEUTROPHIL ABNORMALITIS
• EOP RELATED TO SYSTEMIC DISEASE
– LEUKOCYTE ADHESION DEFICIENCY,HYPOPHOSPHATASIA, PAPILLON-LeFèvre SYNDROME,
NEUTROPENIAS, LEUKEMIAS, CHÉDIAK-HIGASHI SYNDROME, AIDS, DIABETES MELLITUS TYPE I,
TRISOMY 21,HISTOCYTOSIS X, EHLERS-DANLOS SYNDROME (TYPE VIII)
• EOP, SYSTEMIC DETERMINANTS UNKNOWN
– NUP
• SYSTEMIC DETERMINANTS UNKNOWN
• RELATED TO HIV
• RELATED TO NUTRITION
– PERIODONTAL ABSCESS
34. JAN LINDHE, 1993
DIAGNOSIS OF THE PERIODONTAL LESION
GINGIVITIS
PERIODONTITIS LEVIS
PERIODONTITIS GRAVIS
..et COMPLICATA
35. DIAGNOSIS CRITERIA MISCELLANEOUS
GINGIVITIS NO LOSS OF SUPPORTING
TISSUES (PSEUDOPOCKETS)
BLEEDING ON PROBING
PERIODONTITIS
LEVIS
HORIZONTAL LOSS OF
SUPPORTING TISSUES <1/3 OF
THE ROOT LENGTH
BLEEDING ON PROBING
PERIODONTITIS
GRAVIS
HORIZONTAL LOSS OF
SUPPORTING TISSUES >1/3 OF
THE ROOT LENGTH
BLEEDING ON PROBING
..et COMPLICATA ANGULAR BONY DEFECTS:
INTERDENTAL CRATERS
INFRABONY POCKETS
FURCATION INVOLVEMENT 2, 3
LINDHE, 1993 P.319
EACH TOOTH IN THE DENTITION AN INDIVIDUAL DIAGNOSIS
39. INTERNATIONAL WORKSHOP FOR CLASSIFICATION
OF PERIODONTAL DISEASE & CONDITIONS, 1999
SALIENT FEATURS
1. ADDITION OF A SECTION ON GINGIVAL DISEASES
2. REPLACEMENT OF ADULT PERIODONTITIS WITH CHRONIC PERIODONTITIS
3. REPLACEMENT OF EOP WITH AGGRESSIVE PERIODONTITIS
4. ELIMINATION OF A SEPARATE DISEASE CATEGORY FOR REFRACTORY
PERIODONTITIS
5. REPLACEMENT OF NUP WITH NECROTIZING PERIODONTAL DISEASES
6. ADDITION OF A CATEGORY ON PERIODONTAL ABSCESS
7. ADDITION OF A CATEGORY ON PERIODONTIC-ENDODONTIC
LESIONSRETANTION OF THE DISEASE CATEGORY “PERIODONTITIS AS
MANIFESTATION OF SYSTEMIC DISEASES
40. PERIODONTAL DISEASES & CONDITIONS
GINGIVAL DISEASES
CHRONIC PERIODONTITIS
AGGRESSIVE PERIODONTITIS
PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES
NECROTIZING PERIODONTAL DISEASES
PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS
DEVELOPMENTAL OR ACQUIRED DEFORMITIS & CONDITIONS
41. 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 ENDOCRINE SYSTEM
i. PUBERTY ASSOCIATED
ii. MENSTRUAL CYCLE ASSOCIATED
iii. PREGNENCY ASSOCIATED
GINGIVITIS
PYOGENIC GRANULOMA
iv. DIABETES MELLITUS ASSOCIATED
b. ASSOCIATED WITH BLOOD DYSCRASIAS
i. LEUKEMIA-ASSOCIATED GINGIVITIS
ii. OTHERS
42. 3. GINGIVAL DISEASES MODIFIED BY MEDICATIONS
a. DRUG-INFLUENCED GINGIVAL DISEASE
i. DRUG-INFLUENCED GINGIVAL ENLARGEMENTS
ii. DRUG-INFLUENCED GINGIVITIS
# ORAL CONTRACEPTIVE ASSOCIATED
# OTHER
4. GINGIVAL DISEASE MODIFIED BY MALNUTRITION
a. ASCORBIC ACID DEFICIENCY GINGIVITIS
b. OTHER
43. B. NON-PLAQUE INDUCED GINGIVAL LESIONS
1. GINGIVAL DISEASE OF SPECIFIC BACTERIAL ORIGIN
a. NEISSERIA GONORRHEA –ASSOCIATED LESION
b. TREPONEMA PALIDUM –ASSOCIATED LESION
c. STRPTOCOCCAL SPEIES –ASSOCIATED LESION
d. OTHER
2. GINGIVAL DISEASE OF VIRAL ORIGIN
a. HERPES VIRUS INFECTIONS
i. PRIMARY HERPETICGINGIVOSTOMATITIS
ii. RECCURENT
iii. VERICELLA-ZOSTER INFECTIONS
b. OTHER
44. 3. GINGIVAL DISEASE OF FUNGAL ORIGIN
a. CANDIDA SPECIES INFECTIONS
i. GENERALIZED GINGIVAL CANDIDOSIS
b. LINER GINGIVAL ERYTHEMA
c. HISTOPLASMOSIS
d. OTHER
4. GINGIVAL LESIONS OF GENETIC ORIGIN
a. HEREDITARY GINGIVAL FIBROMATOSIS
b. OTHER
5. GINGIVAL MANIFESTATIONS OF SYSTEMIC CONDITIONS &
MUCOCUTENEOUS DISORDERS
a. MUCOCUTENEOUS DISORDERS
i. LICHEN PLANUS
ii. PEMPHIGOID
iii. PEMPHIGUS VULGARIS
iv. ERYTHEMA MULTIFORME
V. LUPUS ERYTHEMATOSUS
Vi DRUG-INDUCED
vii. OTHER
45. b. ALLERGIC REACTIONS
i. DENTAL RESTORATIVE MATERIALS
MURCURY
NICKEL
ACRYLIC
OTHER
ii. REACTIONS ATTRIBUTED TO
TOOTHPASTES
MOUTHWASHES
CHEWING GUM ADDITIVES
FOODS & ADDITIVES
iii. OTHERS
6. TRAUMATIC LESIONS/FACTITOUS/IATROGENIC/ACCEDENTAL
a. CHEMICAL
b. PHYSICAL
c. THERMAL
7. FOREIGN BODY
8. NOT OTHERWISE SPECIFIED
49. • PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS
a. COMBINED PERIODONTIC-ENDODONTIC LESIONS
• DEVELOPMENTAL OR AQUIRED DEFORMITIES & CONDITIONS
a. LOCALIZED TOOTH-RELATED FACTORS THAT MODIFY OR PREDISPOSE
TO PLAQUE-INDUCED GINGIVAL DISEASE/PERIODONTITIS
i. TOOTH ANATOMIC FACTOR
ii. DENTAL RESTORATIONS
iii. ROOT FRACTURES
iv. CERVICAL ROOT RESORPTION AND CEMENTAL TEARS
50. b. MUCOGINGIVAL DEFORMITIES & CONDITIONS AROUND TEETH
i. GINGIVAL/SOFT TISSUE RECESSION
FACIAL OR LONGUAL SURFACES
INTERPROXIMAL (PAPILLARY)’
ii. LACK OF KERATINIZED GINGIVA
iii. DECREASED VESTIBULAR DEPTH
iv. ABBERENT FRENUM / MUSCLE POSITION
v. GINGIVAL EXCESS
PSEUDOPOCKETS
INCONSISTENT GINGIVAL MARGIN
EXCESSIVE GINGIVAL DISPLAY
GINGIVAL ENLARGEMENT
vi. ABNORMAL COLOR
51. C. MUCOGINGIVAL DEFORMITIES & CONDITIONS ON EDENTULOUS RIDGES
i. VERTICAL & /0R HORIZONTAL RIDGE DEFICIENCY
ii. LACK OF GINGIVA/KERATINIZED TISSUE
iii. GINGIVAL/SOFT TISSUE ENLARGEMENT
iv. ABERRANT FRENUM/MUSCLE POSITION
v. DECREASED VESTIBULAR DEPTH
vi. ABNORMAL COLOR
D. OCCLUSAL TRAUMA
i. PRIMARY OCCLUSAL TRAUMA
ii. SECONDARY OCCLUSAL TRAUMA
52.
53. TO STUDY A DISEASE
• IT IS ESSENTIAL TO STANDARIZE TERMINOLOGY
• A RECOGNIZED CLASSIFICATION SYSTEM
• EASE OF COMMUNICATION
