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Academy Report: Diagnosis of Periodontal Diseases
Academy Report: Diagnosis of Periodontal Diseases
Position Paper
Diagnosis of Periodontal Diseases*
This position paper on the diagnosis of periodontal diseases was prepared by the Research, Science and Ther-
apy Committee of the American Academy of Periodontology. It is intended for the information of the dental
profession and other interested parties. The purpose of the paper is to provide the reader with a general
overview of the important issues related to the diagnosis of periodontal diseases. It is not intended as a com-
prehensive review of the subject. J Periodontol 2003;74:1237-1247.
P
laque-induced periodontal diseases are mixed associated with connective tissue attachment loss also
infections associated with relatively specific lead to the resorption of coronal portions of tooth-
groups of indigenous oral bacteria.1-6 Suscepti- supporting alveolar bone.16
bility to these diseases is highly variable and depends This simple separation of plaque-induced peri-
on host responses to periodontal pathogens.7-11 odontal diseases into two categories is not as clear-
Although bacteria cause plaque-induced inflammatory cut as it first appears. For example, if sites that have
periodontal diseases, progression and clinical char- been successfully treated for periodontitis develop
acteristics of these diseases are influenced by both some gingival inflammation at a later date, do those
acquired and genetic factors that can modify sus- sites have recurrent periodontitis or gingivitis super-
ceptibility to infection.12-15 imposed on a reduced but stable periodontium?
There are currently no data to definitively answer
TRADITIONAL APPROACH TO DIAGNOSIS this question. However, since not all sites with gin-
Despite our increased understanding of the etiology givitis necessarily develop loss of attachment and
and pathogenesis of periodontal infections, the diag- bone,17 it is reasonable to assume that gingivitis can
nosis and classification of these diseases is still based occur on a reduced periodontium in which ongoing
almost entirely on traditional clinical assessments.16,17 attachment loss is not occurring. A similar problem
To arrive at a periodontal diagnosis, the dentist must exists when the term “periodontitis” is assigned to
rely upon such factors as: 1) presence or absence of sites with attachment loss and periodontal pockets
clinical signs of inflammation (e.g., bleeding upon in which ongoing periodontal destruction is not
probing); 2) probing depths; 3) extent and pattern of occurring.
loss of clinical attachment and bone; 4) patient’s Demonstration of the progression of periodontitis
medical and dental histories; and 5) presence or requires documentation of additional attachment loss
absence of miscellaneous signs and symptoms, occurring between at least two time points. Since this
including pain, ulceration, and amount of observable is not always possible, especially when a patient is
plaque and calculus.18-20 examined for the first time, most clinicians assign the
Plaque-induced periodontal diseases have tradi- diagnosis of “periodontitis” to inflamed sites that also
tionally been divided into two general categories based have loss of attachment and bone. This is a prudent
on whether attachment loss has occurred: gingivitis practice since such sites may be either currently
and periodontitis. Gingivitis is the presence of gingi- progressing or are at an increased risk for further
val inflammation without loss of connective tissue periodontal destruction. Therefore, demonstration of
attachment.16 Periodontitis can be defined as the pres- progressive attachment loss is not generally consid-
ence of gingival inflammation at sites where there ered to be a requirement for using “periodontitis” as
has been a pathological detachment of collagen fibers a diagnostic label.
from cementum and the junctional epithelium has At the 1999 International Workshop for Classification
migrated apically. In addition, inflammatory events of Periodontal Diseases and Conditions, a reclas-
sification of the different forms of plaque-induced
periodontal diseases was developed.21 This revised
* This paper was developed under the direction of the Research, Science
and Therapy Committee and approved by the Board of Trustees of the
classification includes seven general types of plaque-
American Academy of Periodontology in May 2003. induced periodontal diseases: 1) gingivitis, 2) chronic