CLASSIFICATION OF

PERIODONTAL DISEASES
Dr. Julia Al- Hadidi
 ?WHY CLASSIFY

Disease classification, including

periodontal diseases, ideally provides a
short, but comprehensive review of all
known disease processes affecting a
It helps to systematically tissue or organ.
reach a differential diagnosis,
prognosis and develop a treatment
.plan
 Former classification of the
World Workshop
in Clinical Periodontics ( 1989)
Adult periodontitis

Early onset periodontitis Prepubertal

(localized or generalized) Juvenile
(localized or generalized) Rapidly
.progressive periodontitis

Periodontitis associated with systemic

diseases
Downs syndrome
Diabetes type I
Papillon-Lefvre syndrome. AIDS
Other diseases

Necrotising ulcerative periodontitis

Refractory periodontitis
 Current Classification
Latest classification was
by thedeveloped
American Academy of
.Periodontology (AAP) in 1999
New Classification
Gingival Diseases

Periodontal Diseases
 Notes
Gingivitis on a
periodontium with
attachment loss
that is stable &
not progressing

Periodontitis is
further classified
on the basis of
extent & severity
 Plaque induced gingivitis
Inflammation of marginal gingiva
Swelling and easy bleeding

Usually asymptomatic

Occurs quickly after interruption of oral hygiene

practices

Untreated, may progress to

periodontitis in
susceptible individuals
Associated WithGingivitis
Dental Plaque
Papillary Gingivits
Marginal gingivits
Diffuse Gingivitis
 Herpetic Gingivostomatitis

Contiguous vesicles & ulcers

Diffuse vesicular eruptions on gingiva and intra-oral
mucosa
Herpes simplex 1 & 2
,Primary form may have lymphadenopathy
fever,malaise
Secondary form will usually just manifest as pain &
vesicles (Herpes labialis)
Necrotizing Ulcerative Gingivitis

or Previously known as Vincents Infection

Trench Mouth
:Signs and symptoms include
Acute pain

Foul breath

Interproximal gingival necrosis (punched out papillae)

Necrotizing Ulcerative Gingivitis

:Usually associated with

Poor oral hygiene
Situational STRESS
Smoking

NUG is now considered as an oral hallmark of

immunosuppression
HIV/AIDS
Diabetes
Malnutrition
NUG
Gingivitis Associated With Local
Factors: Calculus
Pregnancy
Vitamin C Deficiency
Drug induced gingival hyperplasia

:Usually associated with

Immunosuppressive
drugs
Hypotensive agents
Anti-convulsion drugs
Phenytoin Enlargement
Cyclosporine Enlargement
Candidosis
Hereditary Gingival Fibromatosis
Desquamative Gingivits
Allergic Gingivitis
Chemical Injury
Physical Injury
 Periodontitis
:Group of Diseases manifested as
Progressive destruction of PDL
&
alveolar bone with
Pocket formation .1
Gingival Recession .2
Or both .3
 Chronic periodontitis
Prevalent in adults but can occur in
children
Amount of destruction consistent with
local factors
Associated with a variable microbial
pattern
Subgingival calculus frequently found
 Chronic periodontitis
Slow to moderate rate of progression
with
possible periods of rapid progression
:Possibly modified or associated with
Systemic diseases such as D.M &HIV
Local factors predisposing to periodontitis
Environmental factors such as
cigarette smoking & emotional stress
 Chronic Periodontitis
Localized Slight
mm CAL 1-2
of sites involved 30%> )average(

Generalized Moderate
mm CAL 3-4
of sites involved 30%<
Severe
mm CAL 5<
Chronic Periodontitis

Mild Moderate Severe

 Aggressive Periodontitis
Localised
incisor disease1st molar OR
i.e: localised proximal attachment loss on at
least 2 permanent teeth, one of which is a 1st
molar

Generalised
Proximal attachment loss affecting at least 3
teeth other than 1st molars and incisors
 Primary features
People are in most cases otherwise
healthy

Familial aggregation : runs in

families

Rapid rate of disease progression

 Secondary Features
Amount of plaque may be inconsistent
with amount of destruction
Elevated proportions of
A.a(Aggregatibacter
actinomycetemcomitans) ,& P.gingivalis
Phagocyte abnormalities
Hyper-responsive macrophage
phenotype
Progression of attachment & bone loss
may be self-arresting
Localized Aggressive Periodontitis
LAP
Localized first molar/ incisor presentation with
interproximal attachment loss on at least 2
permenant teeth, one of which is a 1st molar

be involved ( other teeth mayNo more than 2

than 6s & incisors)
Age of onset around puberty
Lack of apparent inflammation in some cases
Robust serum antibody response to infecting
agents
LAP
LAP
Rapid rate of progression
 Generalized Aggressive
Perodontitis
Patient usually under 30
Otherwise healthy
Generalized interproximal attachment
loss affecting at least 3 teeth other than
1st molars & incisors
Periods of destruction & quiescence
Poor serum antibody response to
infecting
.agents
Generalised Aggressive
Periodontitis
Periodontitis as a
Manifestation of
Systemic
Diseases
LEUKEMIA
 Acute Periodontal Abscess
Associated with Pre-
existing periodontal
disease
Periodontal pocket
becomes
occluded
Usually the result of a
foreign object
Shiny, red, raised and
rounded masses on
gingiva
Can drain through the
tissues or the pocket
 ?What Has Been Changed
Inclusion of a section on gingival diseases .1

Replacement of Adult Periodontitis with .2

Chronic Periodontitis

Replacement of Early-Onset .3
Periodontitis
with Aggressive Periodontitis

No Refractory Periodontitis .4
More details on Periodontitis as a .5
manifestation of systemic diseases
Replacement of Necrotising Ulcerative .6
Periodontitis with Necrotising Periodontal
Diseases

New categories: periodontal abscess, .7

periodontic-endodontic lesions,
developmental or acquired deformities and
. conditions
THANK YOU