1. Classification of periodontal diseases
Periodontium
The periodontium consist of the investing & supporting tissues of the teeth which include gingiva .
periodontal ligament ,cementum & alveolar bone.
DISEASE
A pathological condition of a part, organ, or system of an organism resulting from various causes, such
as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs
or symptoms
CLASSIFICATION
Systematic collection of data or knowledge & its arrangement in sequential manner in order to facilitate
its understanding or knowledge
USES OF CLASSIFICATION
IDENTIFICATION OF THE ETIOLOGY & UNDERSTANDING OF THE PATHOLOGY
FOR DIAGNOSIS PROGNOSIS & TREATMENT PLANING
FACILITATES COMMUNICATION AMONG THE CLINICIAN , RESEARCHER’S EDUCATORS ,
STUDENT, EPIDIMIOLOGIST & PUBLIC HEALTH WORKER’S
PREDICTING TREATMENT OUTCOMES
HISTORICAL DEVLOPMENT OF CLASSIFICATION SYSTEM
CLINICAL CHARACTERISTIC PARADIGM
CLASSICAL PATHOLOGY PARADIGM
INFECTION / HOST RESPONSE PARADIGM
CLINICAL CHARACTERISTIC PARADIGM
Very little to know about the etiology & pathogenesis of periodontal disease
C. G. DAVIS CLASSIFICATION(1879)
Gingival recession with minimum or no inflammation
Periodontal destruction secondary to time deposits
“ RIGG’S DISEASE” the hallmark of which was loss of alveolus without loss of gums
2. G. V. BLACK CLASSIFICATION (1886)
CONSTITUTIONAL GINGIVITIS
PAINFULL FORM OF GINGIVITIS
SIMPLE GINGIVITIS
INFLAMMATION OF THE PERIODONTAL MEMBRANE
PHAGEDENIC PERIODONTITIS
LITTLE OR NO EVIDENCE WAS USED TO SUPPORT THE OPINION OF CLINICIAN OF THE TIME
CLASSICAL PATHOLOGY PARADIGM
TWO FORMS OF DESTRUCTIVE PERIODONTAL DISEASES
1. INFLAMMATORY
2. NON INFLAMMATORY
GOTTLIB CLASSIFICATION {1928}
1. INFLAMMATORY – SCHMUTZ PYORRHOEA [POOR ORAL HYGINE ]
2. DEGENRATIVE OR ATROPHIC-
DIFFUSE ALVEOLAR ATROPHY
SYSTEMATIC METABOLIC
ORBAN CLASSIFICATION (1942)
1. INFLAMMATORY
2. DYSTROPHIC
3. NEOPLASTIC
4. PATHOLOGIC REACTION PRODUCED BY OCCLUSAL TRAUMA
3. W.HO. EXPERT COMMITEE ON DENTAL HEALTH IN 1961 SUGGESTED
ETIOLOGY PLAYS SECONDARY & IMPORTANT PART IN CLASSIFICATION
CLINICAL ASSESMENT LACK SUFFICIENT PRECISION TO SERVE AS
INFECTION / HOST RESPONSE PARADIGM
ROBERT KOCH IN 1876 – GERM THEORY OF DISEASE
W. D. MILLER SUGGESTED THAT 3 FACTOR’S ARE CONSIDERRED FOR PYRRHOEA
PRITCHARD CLASSIFICATION {1972}
INFLAMMATION WITH SURFACE DESTRUCTION
DISEASE AFFECTING SURFACE OR GINGIVA
DISEASE AFFECTING DEEPAR STRUCTURE
RAMFORD & ASH CLASSIFICATION (1979)
1. GINGIVITIS
2. GINGIVAL ATROPHY OR RECESSION
3. TRAUMA FROM OCCLUSION
4. PERIODONTITIS
GRANT , STERN & LISTGARTEN CLASSIFICATION {1988}
BACTERIAL INDUCED DISEASES
GINGIVITIS
PERIODONTITIS
ADULT TYPE
POST JUVENILE
EARLY ONSET
JUVENILE
LOCALIZED
GENERALIZED
ACUTE NECROTIZING ULCERATIVE GINGVITIS
ACUTE ABSCESS
PERICORONITIS
5. type A
type B
Prepubertal
Juvenile
Post juvenile
Symptomatic
Suzuki classification (1988)
Adult periodontitis
Early onset periodontitis
Juvenile periodontitis
Post juvenile periodontitis
Prepubertal periodontitis
Genco classification (1990)
Periodontitis in adult
Periodontitis in juvenile
localized
generalized
Periodontitis with systemic involvement
Primary neutrophil disorders
Secondary neutrophil impairment
Misellaneous condition
Weatherford classification (1987)
Disease affecting surface of gingiva
Disease affecting deeper structure
Periodontal traumaties
Periodontal abscess
CLASSIFICATION OF THE WORLD WORKSHOP, 1989
PERIODONTITIS
a. Adult periodontitis.
6. b. Early-onset periodontitis:
i. Prepubertal periodontitis:
1.1. Localized
2.2. Generalized
ii. Juvenile periodontitis
1.1. Localized
2.2. Generalized
c. Periodontitis associated with systemic diseases
d. Necrotising ulcerative periodontitis
e. Refractory periodontitis
EUROPEAN WORKSHOP, CLASSIFICATION 1993
A. PRIMARY DESCRIPTORS
a. Adult periodontitis
b. Early-onset periodontitis
c. Necrotising ulcerative periodontitis
B. SECONDARY DESCRIPTORS
a. Tooth distribution.
b. Rate of progression.
c. Treatment response.
d. Associated with systemic diseases.
e. Microbiological characteristics.
f. Ethnicity.
g. Other factors.
CURRENT CLASSIFICATION
INTERNATIONAL WORKSHOP FOR A CLASSIFICATION OF PERIODONTAL DISEASES & CONDITION
–(1999)
GOAL – “COURSE CORRECTION” OR “FINE TUNING” OF 1989 CLASSIFICATION
7. I. Gingival Diseases
A. Dental plaque-induced gingival diseases*
1. Gingivitis associated with dental plaque only
a. without other local contributing factors
b. with local contributing factors
2. 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) other
3. Gingival diseases modified by medications
a. drug-influenced gingival diseases
1) drug-influenced gingival enlargements
2) drug-influenced gingivitis
a) oral contraceptive-associated gingivitis
4. Gingival diseases modified by malnutrition
a. ascorbic acid-deficiency gingivitis
b. other
B. Non-plaque-induced gingival lesions
1. Gingival diseases of specific bacterial origin
a. Neisseria gonorrhea-associated lesions
b. Treponema pallidum-associated lesions
c. streptococcal species-associated lesions
d. other
8. 2. Gingival diseases of viral origin
a. herpesvirus infections
1) primary herpetic gingivostomatitis
2) recurrent oral herpes
3) varicella-zoster infections
b. other
3. Gingival diseases of fungal origin
a. Candida-species infections
1) generalized gingival candidosis
b. linear gingival erythema
c. histoplasmosis
d. other
4. Gingival lesions of genetic origin
a. hereditary gingival fibromatosis
b. other
5. Gingival manifestations of systemic conditions
a. mucocutaneous disorders
1) Lichen planus
2) pemphigoid
3) pemphigus vulgaris
4) erythema multiforme
5) Lupus erythematosus
6) drug-induced
b. allergic reactions
1) dental restorative materials
a) mercury
b) nickel
c) acrylic
d) other
9. 2) Reaction attributable to
a)toothpastes/dentifrices
b)Mouthrinses / mouthwashes
c)Chewing bum additives
6. Traumatic lesions (factitious, iatrogenic,
accidental)
a. chemical injury
b. physical injury
c. thermal injury
7. Foreign body reaction
8. Not otherwise specified (NOS)
II. Chronic Periodontitis
A. Localized
B. Generalized
III. Aggressive Periodontitis
A. Localized
B. Generalized
IV. Periodontitis as a Manifestation of Systemic Diseases
A. Associated with hematological disorders
1. Acquired neutropenia
2. Leukemias
3. Other
B. Associated with genetic disorders
1.Familial and cyclic neutropenia
2 Down syndrome
3. Leukocyte adhesion deficiency syndromes
4. Papillon-Lefèvre syndrome
5. Chediak-Higashi syndrome
6. Histiocytosis syndromes
7. Glycogen storage disease
10. 8. Infantile genetic agranulocytosis
9. Cohen syndrome
10. Ehlers-Danlos syndrome (Types IV and VIII)
11. Hypophosphatasia
V. Necrotizing Periodontal Diseases
A. Necrotizing ulcerative gingivitis (NUG)
B. Necrotizing ulcerative periodontitis (NUP)
VI. Abscesses of the Periodontium
A. Gingival abscess
B. Periodontal abscess
C. Pericoronal abscess
VII. Periodontitis Associated With Endodontic Lesions
A. Combined periodontic-endodontic lesions
VIII. Developmental or Acquired Deformities and Conditions
A. Localized tooth-related factors that modify or predispose to plaque-induced gingival
diseases/periodontitis
1. Tooth anatomic factors
2. Dental restorations/appliances
3. Root fractures and cemental tears
B. Mucogingival deformities and conditions around teeth
1. Gingival/soft tissue recession
a. facial or lingual surfaces
b. interproximal (papillary)
2. Lack of keratinized gingiva
3. Decreased vestibular depth
4. Aberrant frenum/muscle position
5. Gingival excess
a. pseudopocket
b. inconsistent gingival margin
c. excessive gingival display
11. d. gingival enlargement
C. Mucogingival deformities and conditions on edentulous ridges
1. 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
CONCLUSION
The 1999 classification system has been approved by the AAP, is now official terminology for that
organization, and will be used in accredited graduate periodontal programs and board examinations.
The Parameters of Care4 approved by the AAP have adopted the new classification and future
publications will use it as their standard.
REFERANCES
Clinical periodontology Carranza, Newman
8th edition & 9th edition
Periodontal therapy Nabers & Stalker
Foundation of periodontic for dental hygienist Jill’s Nield – gehrig, Donald E.william
![G. V. BLACK CLASSIFICATION (1886)
CONSTITUTIONAL GINGIVITIS
PAINFULL FORM OF GINGIVITIS
SIMPLE GINGIVITIS
INFLAMMATION OF THE PERIODONTAL MEMBRANE
PHAGEDENIC PERIODONTITIS
LITTLE OR NO EVIDENCE WAS USED TO SUPPORT THE OPINION OF CLINICIAN OF THE TIME
CLASSICAL PATHOLOGY PARADIGM
TWO FORMS OF DESTRUCTIVE PERIODONTAL DISEASES
1. INFLAMMATORY
2. NON INFLAMMATORY
GOTTLIB CLASSIFICATION {1928}
1. INFLAMMATORY – SCHMUTZ PYORRHOEA [POOR ORAL HYGINE ]
2. DEGENRATIVE OR ATROPHIC-
DIFFUSE ALVEOLAR ATROPHY
SYSTEMATIC METABOLIC
ORBAN CLASSIFICATION (1942)
1. INFLAMMATORY
2. DYSTROPHIC
3. NEOPLASTIC
4. PATHOLOGIC REACTION PRODUCED BY OCCLUSAL TRAUMA](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)