Classification System Of Periodontal Disease Question And Answers

Classification System Of Periodontal Diseases

Write short note on recent classification of periodontal disease and condition.
Or
Write short note on classification of periodontal disease and conditions.
Answer. The classification by American Academy of Periodontology (AAP) 1999 (International Workshop for Classification of Periodontal Disease) is as follows:

Gingival Disease

• Dental plaque-induced gingival diseases: These disease may occur on periodontium with no attachment loss or someone with attachment loss that is stable and not progressing.
  • Gingivitis associated with dental plaque only:
    • Without local contributing factors.
    • With local contributing factors.
  • Gingival diseases modified by systemic factors:
    • Associated with endocrine system:
      • Puberty-associated gingivitis.
      • Menstrual cycle-associated gingivitis.
      • Pregnancy-associated.
        • Gingivitis
        • Pyogenic granuloma.
      • Diabetes mellitus associated gingivitis.
    • Associated with blood dyscrasias:
      • Leukemia-associated gingivitis.
      • Others.

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• • Gingival diseases modified by medications:
    • Drug-influenced gingival diseases:
      • Drug-influenced gingival enlargements.
      • Drug-influenced gingivitis.
        • Oral contraceptive-associated gingivitis
        • Others.
  • Gingival diseases modified by malnutrition:
    • Ascorbic acid deficiency gingivitis.
    • Others.
• Non-plaque-induced gingival lesions:
  • Gingival diseases of specific bacterial origin:
    • Neisseria gonorrhoeae.
    • Treponema palladium.
    • Streptococcal species.
    • Others.
  • Gingival diseases of viral origin:
    • Herpes virus infections.
      • Primary herpetic gingivostomatitis
      • Recurrent oral herpes
      • Varicella-zoster.
    • Others.
  • Gingival diseases of fungal origin:
    • Candida species infections: generalized gingival candidiasis.
    • Linear gingival erythema.
    • Histoplasmosis.
    • Others.
  • Gingival lesions of genetic origin:
    • Hereditary gingival fibromatosis.
    • Others.
  • Gingival manifestations of systemic conditions:
    • Mucocutaneous lesions:
      • Lichen planus.
      • Pemphigoid.
      • Pemphigus vulgaris.
      • Erythema multiforme.
      • Lupus erythematosus.
      • Drug induced.
      • Others.
    • Allergic reactions:
      • Dental restorative materials:
        • Mercury
        • Nickel
        • Acrylic
        • Others.
      • Reactions attributable to:
        • Toothpastes or dentifrices
        • Mouth rinses or mouthwashes
        • Chewing gum additives
        • Foods and additives.
      • Others.
  • Traumatic lesions (factitious, iatrogenic, or accidental):
    • Chemical injury.
    • Physical injury.
    • Thermal injury.
  • Foreign body reactions.
  • Not otherwise specified (NOS).

Chronic Periodontitis

• Localized: Less than 30% of sites involved.
• Generalized: More than 30% of sites involved.
• Slight: 1–2 mm clinical attachment loss.
• Moderate: 3–4 mm clinical attachment loss.
• Severe: More than 5 mm clinical attachment loss.

Aggressive Periodontitis

• Localized: Slight, moderate or severe.
• Generalized.

Periodontitis as a Manifestation of Systemic Diseases

• Associated with hematological disorders:
  • Acquired neutropenia.
  • Leukemias.
  • Others.
• Associated with genetic disorders:
  • Familial and cyclic neutropenia.
  • Down syndrome.
  • Leukocyte adhesion defiiency syndrome.
  • Papillon-Lefévre syndrome.
  • Chèdiak-Higashi syndrome.
  • Histiocytosis syndrome.
  • Glycogen storage disease.
  • Infantile genetic agranulocytosis.
  • Cohen syndrome.
  • Ehlers-Danlos syndrome (Types 4 and 8).
  • Hypophosphatasia.
  • Others.

Necrotizing Periodontal Diseases

• Necrotizing ulcerative gingivitis.
• Necrotizing ulcerative periodontitis.

Abscesses of the Periodontium

• Gingival abscess.
• Periodontal abscess.
• Pericoronal abscess.

Periodontitis Associated with Endodontic Lesions

Combined periodontic-endodontic lesions.

Developmental or Acquired

Deformities and Conditions:

• Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis:
  • Tooth anatomic factors.
  • Dental restorations/appliances.
  • Root fractures.
  • Cervical root resorption and cemental tear.
• Mucogingival deformities and conditions around teeth:
  • Gingival/soft tissue recession, facial or lingual surfaces, interproximal (papillary).
  • Lack of keratinized gingiva.
  • Decreased vestibular depth.
  • Aberrant frenum/muscle position.
  • Gingival excess:
    • Pseudopocket
    • Inconsistent gingival margin
    • Excessive gingival display
    • Gingival enlargement.
  • Abnormal color.
• Mucogingival deformities and conditions on edentulous ridges:
  • Vertical and/or horizontal ridge deficiency.
  • Lack of gingival/keratinized tissue.
  • Gingival/soft tissue enlargement.
  • Aberrant frenum/muscle position.
  • Decreased vestibular depth.
  • Abnormal color.
• Occlusal trauma:
  • Primary occlusal trauma.
  • Secondary occlusal trauma.

Following are the changes which are made in the Classification Proposed by International Workshop (1999)

• Separate section on gingival disease is added.
• Adult periodontitis’ is replaced by ‘chronic periodontitis’ and ‘early onset periodontitis’ by ‘aggressive periodontitis’.
• Separate entity for refractory periodontitis is not given.
• Separate classification is given for ‘periodontitis as a manifestation of systemic diseases’.
• ‘Necrotizing ulcerative periodontitis’ is replaced with the ‘Necrotizing periodontal diseases’.
• Additional categories such as, ‘periodontal abscess, periodontal endodontic lesions’ and developmental or acquired deformities and conditions are added.