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Periodontal disease classification

Periodontal disease classification- The 1989 World Workshop in Clinical Periodontics recommended the following categories of periodontitis. This system is the one most familiar to a majority of clinicians.

I. Adult periodontitis

Early-onset periodontitis

A. Prepubertal periodontitis

1. Generalized

2. Localized

B. Juvenile periodontitis

1. Generalized

2. Localized

C. Rapidly progressive periodontitis

Ill. Periodontitis associated with systemic disease

IV. Necrotizing ulcerative periodontitis

V. Refractory periodontitis

One of the generally accepted periodontal disease classification for gingivitis was:

I. Plaque-associated gingivitis

II. Acute necrotizing ulcerative gingivitis (ANUG)

Ill. Hormonal gingivitis

IV. Drug-induced gingival overgrowth

V. Desquamative gingivitis (associated with vesiculobullous diseases)

During the ensuing decade, it was determined that this disease classification system excluded many of the diseases and conditions of the periodontium that clinicians and researchers confront on a daily basis. Further work was necessary to develop a new, mere inclusive system.

Periodontal disease classification
Periodontal disease classification

What is the 1999 periodontal disease classification?

The American Academy of Periodontology convened the 1999 International Workshop for a periodontal disease classification and Conditions to reassess the disease classification system that was developed by the 1989 World Workshop in Clinical Periodontics.

Based on current knowledge and philosophies, a more comprehensive periodontal disease classification and conditions that affect the periodontiurn aas proposed. Major changes include the addition of a section on gingival diseases, changing the names of adult perodantitis to chronic periodontitis, early onset periodontitis to aggressive periodontitis, and the elimination of refractory periodontitis as a periodontal disease classification.

Periodontitis as a manifestation of systemic disease has been further clarified in periodontal disease classification, new categories added on periodontal abscesses, perio-endodontic lesions, and the developmental or acquired deformities and conditions, and the replacement of necrotizing ulcerative periodontitis with necrotizing periodontal diseases.

1. Gingival Diseases

A. Dental Plaque-Induced Girtgival Diseases

1. Gingivitis associated with dental plaque only

a. Without 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 –

  • Gingivitis
  • 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

– Oral contraceptive-associated gingivitis

– Other

4. Gingival diseases modified by malnutrition

a. Ascorbic acid-deficiency gingivitis

b. Other

B. Nonplaque- 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

c. Histoplasmosis

d. Other

4. Gingival lesions of genetic origins (periodontal disease classification)

a. Hereditary gingival fibromatosis

b. Other

5. Gingival manifestations of systemic conditions

a. Mucocutaneous disorders

b. Other

3. Gingival diseases of fungal origin

a. Candida-species infections

– Generalized gingival candidiasis

b. Linear gingival erythema

2. Gingival disease of viral origin

a. Herpesvirus infections

1. Primary herpetic gingivostomatitis

2. Recurrent oral herpes

3. Pemphigus vulgaris

4. Erythema multiforme

5. Lupus erythematosus

6. Drug induced

7. Other

b. Allergic reactions

1. Dental restorative materials

– Mercury

– Nickel

– Acrylic

– Other

2- Reactions attributable to periodontal disease classification

– Toothpastes/dentifrices

– Mouthrinses/mouthwashes

– Chewing gum additives

– Foods and additives

3. Other

6. Traumatic lesions (factitious, iatrogenic, accidental)

– Chemical injury

– Physical injury

– Thermal injury

7. Foreign body reaction

8. Not otherwise specified (NOS)

II. Chronic periodontal disease classification

A. Localized

B. Generalized

B. Generalized

1. Acquired neutropenias

2. Leukemias

3. Other

B. Associated With Genetic Disorders

1. Familial and cyclic neutropenia

2. Down syndrome

3. Leukocyte adhesion deficiency syndromes

4. Papillon-Lefevre syndrome

5. Chediak-Higashi syndrome

5. histiocytosis syndromes

7. Glycogen storage disease

8. Infantile genetic agranulocytosis

9. Cohen syndrome

10. Ehlers-Danlos syndrome (Types IV and VIII)

11. Hypophosphatasia

12. Other

V. Necrotizing Periodontal Diseases

A. Necrotizing Ulcerative Gingivitis (NUG)

III. Aggressive periodontal disease classification

A. Localized

B. Generalized

IV. Periodontitis as a Manifestation of Systemic Diseases

A. Associated With Hematologic Disorders

1. Acquired neutropenias

2. Leukemias

3. Other

B. Periodontal disease classification Associated With Genetic Disorders

1. Familial and cyclic neutropenia

2. Down syndrome

3. Leukocyte adhesion deficiency syndromes

4. Papillon-Lefevre syndrome

5. Chediak-Higashi syndrome

5. histiocytosis syndromes

7. Glycogen storage disease

8. Infantile genetic agranulocytosis

9. Cohen syndrome

10. Ehlers-Danlos syndrome (Types IV and VIII)

11. Hypophosphatasia

12. Other

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

VII. Periodontal disease classification 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

1. Tooth anatomic factors

2. Dental restorations/appliances

3. Root fractures

4. Cervical root resorption and cemental tears

B. Mucogingival Deformities and periodontal disease classification 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

6. Abnormal color

C. Mucogingival Deformities and Conditions on Edentulous Ridges

1. Vertical and/or horizontal ridge deficiency

2. Lack of gingival/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

*Periodontal disease classification Cases of chronic and aggressive periodontitis may be generally described by the extent and severity of the disease. Localized disease would be  30% of sites involved and generalized disease as >30% of sites involved. Slight disease would have 1-2 mm of clinical attachment loss (CAL), moderate disease 3-4 mm CAL, and severe disease >5 mm CAL.

About Dr. Muna

Dr. Muna Taqi is a Dental surgeon from India who has more than 10 years of experience in the field of Oral & Maxillofacial surgery, Endodontics, & Pedodontics. She has worked in multinational medical corporates in Middle East and is also a consultant dental surgeon for many. She has authored many articles for medical journals & websites and is a consultant dental expert for Healthdrip.

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