CLASSIFICATION OF PERIODONTAL DISEASES

Dr. J. Crawford

Wednesday October 28, 1998

BEHAVIORAL OBJECTIVES OF THE LECTURE:

You should be able to classify Periodontitis using the 1989 World Workshop in Periodontics classification.

You should be able to classify Periodontal diseases using the ADA/AAP Case type system and describe the clinical features of each case type.

 

CLASSIFICATION OF PERIODONTAL DISEASES

"Periodontal disease" is used as a generic term to describe all diseases of the periodontium as "heart disease" or "lung disease" are generic terms. There are many specific periodontal diseases and many classifications have been developed (see page 60 in Carranza and Newman).

It is most important that you understand the difference between gingivitis and periodontitis:

GINGIVITIS: no attachment loss and no bone loss has occurred

PERIODONTITIS: both attachment loss and bone loss have occurred.

Gingivitis is almost always a reversible condition, i.e. it can be treated and no loss of periodontal tissue results. In contrast, the periodontal tissues lost in periodontitis are restored only in a limited number of situations by special surgical techniques.

GINGIVITIS

A. MARGINAL

B. ERUPTIVE

                    C.  PREGNANCY

D. PUBERTAL

E. NECROTIZING ULCERATIVE

                    F. HYPERPLASTIC

                    G. LEUKEMIC

                    H. DESQUAMATIVE

I. TRAUMATIC

J. GINGIVAL BANDING

The classification of Gingivitis has been covered in Preventive Dentistry Peri 311 and will not be further discussed here.

PERIODONTITIS

1. ADULT PERIODONTITIS

2. PREPUBERTAL PERIODONTITIS*

        Generalized or Localized

3. JUVENILE PERIODONTITIS*              *Early Onset Periodontitis

        Generalized or Localized

4. RAPIDLY PROGRESSIVE PERIODONTITIS*

5. PERIODONTITIS ASSOCIATED WITH SYSTEMIC DISEASES

6. NECROTIZING ULCERATIVE PERIODONTITIS

7. REFRACTORY PERIODONTITIS

This classification is based on the 1989 World Workshop in Clinical Periodontics.

(See Table 4-2 in Carranza and Newman).

The following descriptions are from the American Academy of Periodontology Glossary of Periodontal Terms (1992).

 

ADULT PERIODONTITIS

A form of periodontitis that usually has an onset beyond age 35. Bone resorption usually progresses slowly and predominantly in the horizontal direction. Well-known local environmental factors are prominent and abnormalities in host defense have not been found.

EARLY ONSET PERIODONTITIS

Age of onset is usually prior to 35 years; rapid rate of progression of tissue destruction;manifestation of defects in host defense and composition of the associated flora different from that of adult periodontitis.

PREPUBERTAL PERIODONTITIS

May be generalized or localized; onset between eruption of the primary dentition and puberty; may affect the primary and the mixed dentition; characterized by severe gingival inflammation, rapid bone loss, tooth mobility, and tooth loss.

JUVENILE PERIODONTITIS

May be generalized or localized; onset during the circumpubertal period; familial distribution; relative paucity of microbial plaque. Less acute signs of inflammation than would be expected based upon the severity of destruction; may be associated with abnormalities in leukocyte chemotaxis and bacteriocidal activity.

Comment: There is evidence that some patients with juvenile periodontitis exhibited bone loss in the deciduous dentition and so the onset was earlier than the circumpubertal period.

RAPIDLY PROGRESSIVE PERIODONTITIS

Most of the teeth are affected; the extent of clinical signs of inflammation may be less than expected; the age of onset is usually in the early 20's through the mid 30's.

 

NECROTIZING ULCERATIVE PERIODONTITIS

Severe and rapidly progressive disease that has a distinctive erythema of the free gingiva, attached gingiva and alveolar mucosa; extensive soft tissue necrosis. Severe loss of periodontal attachment; deep pocket formation is not evident.

Comment: Necrotizing Ulcerative Periodontitis may follow Necrotizing Ulcerative Gingivitis if the latter is not effectively treated. Necrotizing Ulcerative Periodontitis may be associated with HIV infection.

PERIODONTITIS ASSOCIATED WITH SYSTEMIC DISEASE

Several systemic diseases appear to predispose the affected individuals to periodontitis, which may be of the early onset type, but which may differ considerably from the early onset form described above.

Comment: A predisposition to Periodontitis is associated with systemic diseases which are characterized by defects in host response, particularly defects in neutrophil numbers or functions.

REFRACTORY PERIODONTITIS

Includes patients who are unresponsive to any treatment provided - whatever the thoroughness or frequency - as well as patients with recurrent diseases at single or multiple sites.

Comment: A high percentage of patients with Refractory Periodontitis smoke cigarettes

The ADA/AAP Case Types

I Gingivitis

II Early Periodontitis

Progression of gingival inflammation into the marginal bone, resulting in mild bone loss and mild-to moderate pocket formation; usually no increased tooth mobility.

III Moderate Periodontitis

A more advanced state of the above condition; the increased destruction of the periodontal attachment apparatus is manifest by moderate to deep pockets, moderate to severe bone loss and tooth mobility.

IV Advanced Periodontitis

Further progression of periodontitis with generalized deep pockets and/or frank loss of gingival tissue, severe bone loss and marked tooth mobility patterns.

V Refractory Periodontitis

Periodontitis which does not respond to conventional therapy or which recurs soon after treatment. Many cases appear to be associated with smoking

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