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Classification of periodontal diseases
Periodontium
The periodontium consist of the investing & supporting tissues of the teeth which include gingiva .
periodontal ligament ,cementum & alveolar bone.

DISEASE

A pathological condition of a part, organ, or system of an organism resulting from various causes, such
as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs
or symptoms

CLASSIFICATION

Systematic collection of data or knowledge & its arrangement in sequential manner in order to facilitate
its understanding or knowledge

USES 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 OUTCOMES

HISTORICAL DEVLOPMENT OF CLASSIFICATION SYSTEM

        CLINICAL CHARACTERISTIC PARADIGM

        CLASSICAL PATHOLOGY PARADIGM

        INFECTION / HOST RESPONSE PARADIGM

CLINICAL CHARACTERISTIC PARADIGM

        Very little to know about the etiology & pathogenesis of periodontal disease

C. 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
G. V. BLACK CLASSIFICATION (1886)

       CONSTITUTIONAL GINGIVITIS

       PAINFULL FORM OF GINGIVITIS

       SIMPLE GINGIVITIS

       INFLAMMATION OF THE PERIODONTAL MEMBRANE

       PHAGEDENIC PERIODONTITIS

LITTLE OR NO EVIDENCE WAS USED TO SUPPORT THE OPINION OF CLINICIAN OF THE TIME



CLASSICAL 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                 METABOLIC

ORBAN CLASSIFICATION (1942)

   1. INFLAMMATORY

   2. DYSTROPHIC

   3. NEOPLASTIC

   4. PATHOLOGIC REACTION PRODUCED BY OCCLUSAL TRAUMA
W.HO. EXPERT COMMITEE ON DENTAL HEALTH IN 1961 SUGGESTED

      ETIOLOGY PLAYS SECONDARY & IMPORTANT PART IN CLASSIFICATION

      CLINICAL ASSESMENT LACK SUFFICIENT PRECISION TO SERVE AS

INFECTION / HOST RESPONSE PARADIGM

      ROBERT KOCH IN 1876 – GERM THEORY OF DISEASE

      W. D. MILLER SUGGESTED THAT 3 FACTOR’S ARE CONSIDERRED FOR PYRRHOEA

PRITCHARD CLASSIFICATION {1972}

      INFLAMMATION WITH SURFACE DESTRUCTION

      DISEASE AFFECTING SURFACE OR GINGIVA

      DISEASE AFFECTING DEEPAR STRUCTURE

RAMFORD & ASH CLASSIFICATION (1979)

   1. GINGIVITIS

   2. GINGIVAL ATROPHY OR RECESSION

   3. TRAUMA FROM OCCLUSION

   4. PERIODONTITIS

GRANT , 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
FUNTIONALLY INDUCED DISEASES
                                           TRAUMATIC OCCLUSION
                                           DISEASE ATROPHY
                          TRAUMA
                                   ACCIDENTAL
                                   HABITS

Page & Schroeder classification (1982)
1) Prepubertal periodontitis
                          Generalized
                          Localized
2) Juvenile periodontitis
3) Rapidly progressing periodontitis
4) Adult type periodontitis

Topic’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
type A
                       type B
       Prepubertal
       Juvenile
       Post juvenile
       Symptomatic


Suzuki classification (1988)
       Adult periodontitis
       Early onset periodontitis
       Juvenile periodontitis
       Post juvenile periodontitis
       Prepubertal periodontitis

Genco classification (1990)
       Periodontitis in adult
       Periodontitis in juvenile
              localized
              generalized
       Periodontitis with systemic involvement
       Primary neutrophil disorders
       Secondary neutrophil impairment
       Misellaneous condition

Weatherford classification (1987)
       Disease affecting surface of gingiva
       Disease affecting deeper structure
       Periodontal traumaties
       Periodontal abscess

CLASSIFICATION OF THE WORLD WORKSHOP, 1989
     PERIODONTITIS
              a. Adult periodontitis.
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 periodontitis


EUROPEAN 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
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
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. 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) 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
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. Generalized
III. Aggressive Periodontitis
         A. Localized
         B. Generalized
IV. 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
8. Infantile genetic agranulocytosis
                       9. Cohen syndrome
                       10. Ehlers-Danlos syndrome (Types IV and VIII)
                       11. Hypophosphatasia
V. 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 abscess
VII. Periodontitis Associated With Endodontic Lesions
               A. Combined periodontic-endodontic lesions
VIII. 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
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



 CONCLUSION
The 1999 classification system has been approved by the AAP, is now official terminology for that
organization, 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 future
publications 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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Classification of periodontal diseases

  • 1. Classification of periodontal diseases Periodontium The periodontium consist of the investing & supporting tissues of the teeth which include gingiva . periodontal ligament ,cementum & alveolar bone. DISEASE A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms CLASSIFICATION Systematic collection of data or knowledge & its arrangement in sequential manner in order to facilitate its understanding or knowledge USES 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 OUTCOMES HISTORICAL DEVLOPMENT OF CLASSIFICATION SYSTEM CLINICAL CHARACTERISTIC PARADIGM CLASSICAL PATHOLOGY PARADIGM INFECTION / HOST RESPONSE PARADIGM CLINICAL CHARACTERISTIC PARADIGM Very little to know about the etiology & pathogenesis of periodontal disease C. 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. G. V. BLACK CLASSIFICATION (1886) CONSTITUTIONAL GINGIVITIS PAINFULL FORM OF GINGIVITIS SIMPLE GINGIVITIS INFLAMMATION OF THE PERIODONTAL MEMBRANE PHAGEDENIC PERIODONTITIS LITTLE OR NO EVIDENCE WAS USED TO SUPPORT THE OPINION OF CLINICIAN OF THE TIME CLASSICAL 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 METABOLIC ORBAN CLASSIFICATION (1942) 1. INFLAMMATORY 2. DYSTROPHIC 3. NEOPLASTIC 4. PATHOLOGIC REACTION PRODUCED BY OCCLUSAL TRAUMA
  • 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 AS INFECTION / HOST RESPONSE PARADIGM ROBERT KOCH IN 1876 – GERM THEORY OF DISEASE W. D. MILLER SUGGESTED THAT 3 FACTOR’S ARE CONSIDERRED FOR PYRRHOEA PRITCHARD CLASSIFICATION {1972} INFLAMMATION WITH SURFACE DESTRUCTION DISEASE AFFECTING SURFACE OR GINGIVA DISEASE AFFECTING DEEPAR STRUCTURE RAMFORD & ASH CLASSIFICATION (1979) 1. GINGIVITIS 2. GINGIVAL ATROPHY OR RECESSION 3. TRAUMA FROM OCCLUSION 4. PERIODONTITIS GRANT , 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. FUNTIONALLY INDUCED DISEASES TRAUMATIC OCCLUSION DISEASE ATROPHY TRAUMA ACCIDENTAL HABITS Page & Schroeder classification (1982) 1) Prepubertal periodontitis Generalized Localized 2) Juvenile periodontitis 3) Rapidly progressing periodontitis 4) Adult type periodontitis Topic’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. type A type B Prepubertal Juvenile Post juvenile Symptomatic Suzuki classification (1988) Adult periodontitis Early onset periodontitis Juvenile periodontitis Post juvenile periodontitis Prepubertal periodontitis Genco classification (1990) Periodontitis in adult Periodontitis in juvenile localized generalized Periodontitis with systemic involvement Primary neutrophil disorders Secondary neutrophil impairment Misellaneous condition Weatherford classification (1987) Disease affecting surface of gingiva Disease affecting deeper structure Periodontal traumaties Periodontal abscess CLASSIFICATION OF THE WORLD WORKSHOP, 1989 PERIODONTITIS a. Adult periodontitis.
  • 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 periodontitis EUROPEAN 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. 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. 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. 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) 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. 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. Generalized III. Aggressive Periodontitis A. Localized B. Generalized IV. 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. 8. Infantile genetic agranulocytosis 9. Cohen syndrome 10. Ehlers-Danlos syndrome (Types IV and VIII) 11. Hypophosphatasia V. 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 abscess VII. Periodontitis Associated With Endodontic Lesions A. Combined periodontic-endodontic lesions VIII. 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. 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 CONCLUSION The 1999 classification system has been approved by the AAP, is now official terminology for that organization, 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 future publications 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