CLASSIFICATION OF DISEASES AFFECTING THE PERIODONTIUM

Gingivitis

Refers to the inflammation of the soft tissues that surround the teeth

Compounding Factors for Gingivitis

Lack of proper hygiene Periods of susceptibility (puberty, pregnancy (progesterone level), menopause) Smoking Diet (poor nutrition)

Medications Diabetes mellitus Metal poisoning Trauma/mastication injury Tooth crowding/overlap Mouth breathing

Contrast Between Healthy & Diseased Gingiva

Healthy Coral pink Stippled Knife-edge margin Diseased Light red red to magenta Loss of stippling Swelling/edema/fibrosis Margin rolled, blunted, receded or hyperplastic Bleeding/exudate Malodor

CLASSIFICATION OF PERIODONTAL DISEASES AND CONDITIONS (1999 WORLD WORKSHOP CLASSIFICATION BY AAP) GINGIVAL DISEASES
Plaque induced gingival diseases Non-plaque induced gingival diseases

CHRONIC PERIODONTITIS
Localized Generalized

AGGRESSIVE PERIODONTITIS
Localized Generalized

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES NECROTIZING PERIODONTAL DISEASES Necrotizing ulcerative gingivitis (NUG) Necrotizing ulcerative periodontitis (NUP) ABSCESSES OF THE PERIODONTIUM Gingival abscess Periodontal abscess

PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS Endo perio lesion Perio endo lesion Combined lesion

DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND CONDITIONS Localized tooth related factors predisposing to plaque induced gingival disease or periodontitis Mucogingival deformities and conditions around the teeth Mucogingival deformities and conditions on edentulous ridge Occlusal trauma

GINGIVAL DISEASES
DENTAL PLAQUE-INDUCED GINGIVAL DISEASES Disease may occur on a periodontium with no attachment loss or with attachment loss that is stable and not progressing. I. GINGIVITIS ASSOCIATED WITH DENTAL PLAQUE ONLY A. without local factors B. with local contributing factors

II. GINGIVAL DISEASES MODIFIED BY SYSTEMIC FACTORS A. Associated with the endocrine system 1. Puberty associated gingivitis 2. Menstrual cycle associated gingivitis 3. Pregnancy associated a. Gingivitis b. Pyogenic granuloma 4. Diabetes mellitus associated gingivitis B. Associated with blood dyscrasias 1. Leukemia associated gingivitis 2. Others

III. GINGIVAL DISEASE MODIFIED BY MEDICATIONS A. Drug influenced gingival disease 1. Drug induced gingival enlargement 2. Drug induced gingivitis a. oral contraceptive associated b. others IV. GINGIVAL DISEASES MODIFIED BY MALNUTRITION A. Ascorbic acid deficiency gingivitis B. Others

NON-PLAQUE INDUCED GINGIVAL LESIONS I. Gingival disease of specific bacterial origin a. Neisseria gonorrhea b. Treponema pallidum c. Streptococcal sp d. Others II. Gingival disease of viral origin a. Herpes virus infections 1. primary herpetic gingivostomatitis 2. recurrent oral herpes 3. varicella zoster

III GINGIVAL DISEASE OF FUNGAL ORIGIN A. Candida sp infection gingival candidosis B. Linear gingival erythema C. Histoplasmosis D. Others IV. GINGIVAL LESIONS OF GENETIC ORIGIN A. Hereditary gingival fibromatosis B. Others

V. GINGIVAL MANIFESTATION OF SYSTEMIC CONDITIONS A. Mucocutaneous lesions 1. Lichen planus 2. Pemphigoid 3. pemphigus vulgaris 4. Erythema multiforme 5. Lupus erythematosis 6. Drug induced 7. Others B. Allergic reactions 1. Dental restorative materials ( mercury, acrylic) 2. Reactions to toothpaste, mouth rinse, chewing gum additives food and additives 3. Others

VI. TRAUMATIC LESIONS ( IATROGENIC OR ACCIDENTAL) A. Chemical injury B. Physical C. Thermal VII. FOREIGN BODY REACTIONS VIII. NOT OTHERWISE SPECIFIED

Periodontitis
Defined as an inflammation of the gingiva with some loss of both attachment of the periodontal ligament and bony support Probably related to the specific flora present in dental plaque and the ability of the host to counteract the affects of the organisms present

CLASSIFICATION OF VARIOUS FORMS OF PERIODONTITIS AAP WORLD WORKSHOP 1989 Adult Periodontitis Age of onset > 35 years Slow rate of disease progression No defect in host defense Early onset periodontitis - Age of onset < 35 years (Prepubertal, Juvenile or Rapidly progressive) Rapid rate of disease progression Defect in host defense Associated with specific microflora

Periodontitis associated to with systemic disease infection,

Systemic disease that predispose rapid rate of periodontitis Diabetes, down syndrome, HIV Papillon Lefevre syndrome

Necrotizing ulcerative clinical periodontitis

- Similar to ANUG but with associated attachment loss

Refractory Periodontitis - Recurrent periodontitis that does not respond to treatment

EUROPEAN WORKSHOP ON PERIODONTOLOGY 1993

Adult periodontitis- Age of onset fourth decade of life Slow rate of disease progression No defect in host response Early onset - Age of onset prior to Periodontitis fourth decade of life Rapid rate of disease progression defect in the host defense Necrotizing - Tissue necrosis with attachment and periodontitis bone loss

AAP WORKSHOP FOR CLASSIFICATION OF PERIODONTAL DISEASE 1999

Chronic periodontitis Aggressive periodontitis Periodontitis as a manifestation of systemic diseases

CHRONIC PERIODONTITIS

Prevalent in adults Destruction consistent with local factors Variable microbial pattern Subgingival calculus present Slow to moderate rate of progression Modified by systemic diseases like Diabetes, HIV Local factors predisposing to periodontitis Smoking and stress

Chronic periodontitis
Classified into Localized form < 30% of sites involved Generalized form > 30% of sites involved Slight : 1-2mm of CAL Moderate : 3-4mm of CAL Severe : 5mm of CAL

AGGRESSIVE PERIODONTITIS

clinically healthy pt Rapid attachment and bone loss Microbial deposits inconsistent with disease severity Familial aggregation Diseased site infected with Aa Abnormal phagocyte function Hyperresponsive macrophage Increased PGE2 and IL-1 Self arresting disease progression

AGGRESSIVE PERIODONTITIS
Classified into Localized form circumpubertal onset first molar or incisor disease with attachment loss on two permanent teeth with one first molar Robust serum antibody response Generalized form under 30 years of age generalized attachment loss other than 1st molars and incisors episodic nature of periodontal destruction poor serum antibody response

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE

1.Hematological disorders a. Acquired neutropenia b. Leukemia c. Others 2. Genetic disorders a. Cyclic neutropenia b. Down Syndrome c. Papillon Lefevere d. Chediak Higashi syndrome e. Leukocyte adhesion deficiency f. Hypophosphatasia 3. Not otherwise specified