The new periodontitis classification is more descriptive and not temporal as was the previous system. The terms adult, juvenile, early onset, and prepubertal have been replaced with various forms of chronic and aggressive disease.
In addition, many periodontal conditions that were not addressed in any previous periodontitis classification system have been described. The term refractory periodontitis has been removed as a distinct disease entity, as the current thinking is that any type of periodontitis may be refractory.
Chronic periodontitis. As the name implies, in periodontitis classification this type of periodontitis has a relatively long-standing history in a patient. This disease is characterized by relatively slow progress, loss of attachment and underlying bone with increased pocket depth.
It may have periods of rapid attachment loss followed by prolonged periods of inactivity. It is related to the presence of plaque and calculus, with a variety of associated bacteria involved. There may be modifying local factors used in periodontitis classification, such as restorative overhangs, food impaction, or open contacts, and systemic factors, such as uncontrolled diabetes mellitus or cigarette smoking.
Most often, chronic periodontitis is responsive to mechanical therapy. It is no longer referred to as adult periodontitis as this disease may, albeit rarely, be seen in children.
Aggressive periodontitis. This Category replaces what used to be known as the early-onset periodontal diseases. Localized aggressive periodontitis replaces the older term, juvenile periodontitis, that is manifest by rapid and severe attachment loss in the incisor and permanent first molar regions.
Actinobacillus actinomycetemcomitans is associated with a majority of cases in periodontitis classification. These patients have shown abnormalities in neutrophil function that may be related to a hyperimmune effect of their macrophages. This type of aggressive periodontitis has a fairly clear inheritance pattern.
The localized pattern affects 14 or fewer teeth, mostly confined to the incisors and first molars. The generalized form of aggressive periodontitis, formerly known as rapidly progressive periodontitis, affects 15 or more teeth with possible immunologic changes as well. In periodontitis classification it is characterized by episodic, rapid, and severe attachment loss. At times, this disease may be difficult to control.
Periodontitis as a manifestation of systemic diseases. With the exception of Down syndrome, most of the listed genetic disorders are relatively rare. The Down syndrome patient is a challenge because of the difficulty in maintaining good oral hygiene.
The prevalence and severity of periodontitis is high compared to unaffected siblings, and attachment loss may appear in the deciduous dentition. As the roots of teeth are often short, these patients may lose teeth earlier due to the early onset of disease and the root anatomy. These are some of the periodontitis classification.