6965249 Classification of Periodontal Diseases 3rd Year

5/20/2018 6965249 Classification of Periodontal Diseases 3rd Year

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Classification of

Periodontal Diseases

Hayder Alwaeli: BDS, M.Sc. & J. Board


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Gingiva

-Fibrous mucosa surrounding the teeth & covering the coronal of the

alveolar process Consists of 3 parts

1. Free Gingiva

2. Attached Gingiva

3. Interdental Gingiva


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Clinical Features of Normal (Healthy) Gingiva


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New Classification System

1999 International Workshop for the

Classification of Periodontal Diseases


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Classification ofPeriodontal Diseases

American Academy of

Periodontology (AAP)

The International

Workshop 1999


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Character is t ics common to al l gingival diseases

1. Signs & symptoms are confined to gingiva

2. The presence of dental plaqueto initiate & / or exacerbte the severity

of the lesion3. Clinically signs of inflammation:

Enlarged gingival contour : edematous or fibrotic

Red in color &/ or bluish red Bleeding upon stimulating

gingival exudates

Pathological in sulcular depth

No radiographic evidence

4. Reversibility of the disease by removing the etiology (ies)

5. Possible role as a precursor to attachment lossaround tooth


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Per iodont i t is

-An inflammatory disease of the supporting tissue of the teeth caused by specific

microorganisms or specific group, resulting in progressive destruction of

periodontal ligament & alveolar bone with pocket formation, recession, or both

-The primary clinical features of periodontitis

a. Clinical attachm ent los s

b. alveolar bone loss

c. periodon tal po cket ing

d. gingival inf lamm ation( enlargement or recession )

e. increased mobi l i ty , dr i f t ing & / tooth exfol iat ion may occu r

h. progress con t inuous ly as chron ic inf lamm ation or by burs t of act iv i ty

-Several bacterial species associated with periodontitis. P. ging ivalis . T. den tic ola

. Act inob c i l lus act inom ycetum cmitans . E. corrodens

. P. interm edia . E. nodatum

. C. rectu s

. B . fo rs thus


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Addition of a Section on Gingival

DiseasesI. Gingivitis associated with

dental plaque only

A. Without localcontributing factors

B. With localcontributing factors


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II. Gingival diseases modifiedby systemic factors

A. Endocrine system1. Puberty-associated

2. Menstrual cycle-associated

3. Pregnancy associated

a. Gingivitisb. Pyogenic

granuloma

4. Diabetes mellitus-associated

B. Blood dyscrasias

1. Leukemia-associatedgingivitis

2. Other


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A. Endocrine system

1. Puberty-associated



a- Gingivitis

b. Pyogenicgranuloma


B. Blood dyscrasias


2. Other


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a- Gingivitisb. Pyogenic

granuloma


B. Blood dyscrasias


2. Other


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granuloma


B. Blood dyscrasias


2. Other


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granuloma


B. Blood dyscrasias


2. Other


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a- Gingivitisb. Pyogenicgranuloma


B. Blood dyscrasias


2. Other


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granuloma


B. Blood dyscrasias


2. Other


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Ill. Gingival diseases modified bymedications

1. Drug-influenced gingival

enlargements

a. AnticonvulsantPhenytoin

b. Immunosupressent

Cyclosporin A

c. Calcium ChannelBlockers Nifedipine,Verapamil, Diltiazem, &Sodium Valporate

2- Drug-influenced gingivitis

a. Oral contraceptive-associatedgingivitis

b. Other


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Ill. Gingival diseases modified bymedications

1. Drug-influenced gingival

enlargements

a. AnticonvulsantPhenytoin

b. Immunosupressent

Cyclosporin A

c. Calcium ChannelBlockers Nifedipine,Verapamil, Diltiazem, &Sodium Valporate

2- Drug-influenced gingivitis

a. Oral contraceptive-associatedgingivitis

b. Other


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IV. Gingival diseases modified by malnutrition

A. Ascorbic acid deficiency gingivitis

B. Other


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Non -Plaque-Induced Gingival Lesions

I- Gingival diseases of specificbacterialorigin

A. Neisseria gono rrhea

B. Treponema pall idum

C.Streptococcal sp ecies

D. Other

II. Gingival diseases of viralorigin

A. Herpesvirus infections

1. Primary herpeticgingivostomatitis

2. Recurrent oral herpes

3. Varicella zoster

B. Other

III. Gingival diseases of

fungaloriginA. Candida-species

infections: Generalizedgingival candidosis

B. Linear gingival erythema

C. Histoplasmosis

D. Other


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IV- Gingival lesions of genetic

originA. Hereditary gingival fibromatosis

B. Other

V. Gingival manifestations ofsystemicconditions

A. Mucocutaneous lesions

1. Lichen planus

2. Pemphigoid

3. Pemphigus vulgaris

4. Erythema multiforme

5. Lupus erythematosus6- Drug induced

7. Other

B. Allergic reactions

1. Dental restorative materials(mercury, acrylic, nickel)

2. Reactions attributable to

a- tooth pastes

b- mouth washes

c- chewing gum

d- foods and additives

VI: traumaticlesions:

Factitious, Iatrogenic, & Accidental

A- chemical injury

B- physical injury

C- thermal injury

VII: Foreignbodyreactions

VIII: not otherwise specified


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Hereditary Gingival Fibromatosis

Clinical Features:

no sex predilection apparent when the teeth are erupting,usually enlargement begins in puberty

gingival overgrowth, gingiva may coverthe teeth possibly completely

more common in posterior mandibularareas

pink, firm, smooth and uniform

asymptomatic, nonhemorrhagic,

nonexudative possible apparent delay in dental

eruption

malpositioning of teeth, retention ofdeciduous teeth, esthetic and functionalproblems


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Classification ofPeriodontal Diseases

American Academy of

Periodontology (AAP)

The International

Workshop 1999


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PeriodontitisThe Old Classifications


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World Wo rkshop in Cl in ical Per iodon t ics (1989)

Form of Priodontitis Basic Characteristics

Adult Periodontitis >35 years

Slow rate of progression

No defects in host defenses

Early onset Periodontitis- Prepubertal

- Juvenile

- Rapidly progressive

< 35 yearsRapid rate of progression

Defects in host defenses

Associated with specific microflora

Periodontitis associated with

systemic diseases

Systemic diseases that predispose to

rapid rates of destruction (e.g.

Diabetes)

Necrotizing Ulcerative

Periodontitis

Similar to NUG but with clinical

attachment loss


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European Class if ication (1993)


Adult Periodontitis 4th decade




- Juvenile


Prior to 4

th

decadeRapid rate of progression


Periodontitis associated withsystemic diseases

Systemic diseases that predispose torapid rates of destruction (e.g.

Diabetes)


Periodontitis

Tissue necrosis with clinical

attachment loss & bone loss


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Drawbacks of the old class i f ications






- Juvenile


Prior to 4

th

decadeRapid rate of progression




Diabetes)


Periodontitis

Tissue necrosis with attachment

clinical attachment & bone loss

Considerable overlap in disease categories


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Drawbacks of the old c lass i f ications





Early onset Periodontitis

- Prepubertal

- Juvenile


Prior to 4thdecade

Rapid rate of progression




Diabetes)


Periodontitis



Absence of a gingival disease component


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- Prepubertal

- Juvenile


Prior to 4thdecade





Diabetes)


Periodontitis



Inappropriate emphasis on age of

onset of disease and rates of progression


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- Prepubertal

- Juvenile


Prior to 4thdecade





Diabetes)


Periodontitis



Inadequate or inappropriate classification criteria


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Periodontitis

Chronic

Aggressive

Periodontitis as a manifestations ofsystemic diseases

C


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The most prevalent form in adults

Amount of destruction consistent with local factors Associated with a variable microbial pattern

Subgingival calculus frequently found

Slow to moderate rate of progression

Possibly modified by or associated with thefollowing:

Systemic diseases

Local factorspredisposing factorsEnvironmental factors

Chronic periodontitis

Ch i i d titi


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Chronic periodontitis

Localized form: 30% of sites involved

Slight: 1-2 mm of clinical attachment loss

Moderate: 3-4 mm of clinical attachment lossSevere: 5 mm of clinical attachment loss


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Generalized Severe Chronic Periodontitis


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Aggressive Periodontitis


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Primary Features

Except for the presence of periodontitis,patients are otherwise clinically healthy

Rapid attachment loss and bone destruction

Familial aggregation



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Secondary Features

Amounts of microbial deposits are inconsistent with

the severity of periodontal tissue destruction

Elevated proportions ofAa and, in some populations,P. gingivalis may be elevated

Phagocyte abnormalities

Hyper-responsive macrophage phenotype, including

elevated levels of PGE2 and IL-1

Progression of attachment loss and bone loss maybe self-arresting

Localized A i P i d titi


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LocalizedAggressive Periodontitis

Circumpubertal onset of

disease

Localized presentation withinterproximal attachmentloss on at least two

permanent teeth, one ofwhich is a first molar, andinvolving no more thantwo teeth other than firstmolars and incisors

Robust serum antibodyresponse to infecting agents


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Localized Aggressive Periodontitis

Generalized Aggressive Periodontitis


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GeneralizedAggressive Periodontitis

Usually affects persons under

30 years of age

Generalized proximal attachmentloss affecting at least threeteeth other than first molars and

incisors

Pronounced episodic nature ofperiodontal destruction

Poor serum antibody response toinfecting agents


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Generalized Aggressive Periodontitis


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Periodontitis as a Manifestation of Systemic Diseases

1. Hematologic disorders

a. Acquired neutropenia

b. Leukemias

c. Other

2. Genetic disorders

a. Familial and cyclic neutropenia

b. Down syndrome

c. Leukocyte adhesion deficiencysyndromes

d. Papillon-Lefevre syndrome

e. Chediak-Higashi syndrome

f. Histiocytosis syndromes

g- Glycogen storage disease

h. Infantile genetic agranulocytosis

i. Cohen syndrome

j. Ehlers-Danlos syndromek. Hypophosphatasia

l. Other

3. Not otherwise specified

Hematologic disorders


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Hematologic disorders

Agranulocytosis

Neutropenia


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Genetic disorders


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Necrotizing Periodontal Diseases

Necrotizing ulcerative gingivitis

Necrotizing ulcerative periodontitis


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Abscesses of the periodontium

Gingival

Periodontal

Pericoronal



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endodontic lesions

Combined perio-endo lesions

Developmental or acquired


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deformities and conditions

A. Localized tooth-related factors that modify or predispose

to plaque-induced gingival diseases/periodontitis

1. Tooth anatomic factors

a. Enamel Pearls; Associated with attachment

loss specially in furcation areas

b. Cervical Enamel Projections;

found 15 % to 24 % of mandibular molars

found 9 % to 25 % of maxillary molars

2. Dental restorations/appliances3. Root fractures

4. Cervical root resorption and cemental tears



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B. Mucogingival deformities and conditions around teeth

1. Gingival/soft tissue recessionA. facial or lingual surfaces

B. interproximal (papillary)

2. Lack of keratinized gingiva

3. Decreased vestibular depth4. Aberrant frenum/muscle position

5. Gingival excess

A. pseudopocket

B. inconsistent gingival marginC. excessive gingival display

D. gingival enlargement

E. Abnormal color



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C. Mucogingival deformities and conditions on

edentulous ridges1. 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

FINALLY


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Please read;

Chapter 4pages; 64 72

Classification of Diseasesand Condition Affectingthe Periodontium

FINALLY ,,

6965249 Classification of Periodontal Diseases 3rd Year

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