Vol. 23, No.

8 August 2001
Classification of periodontal diseases and conditions
Lieutenant Commander Kenn K. Kaneshiro, DC, USN and Catain !ar" #. $ere%, DC, USN
Purpose
A ne& eriodontal 'lassi(i'ation s)stem has *een u*lished
in the Annals o( $eriodontolog) +Volume ,, Num*er 1,
De'em*er 1---.+1.. Classi(i'ation s)stems ro/ide a
(rame&or" to s'ienti(i'all) stud) the etiolog),
athogenesis, and treatment o( diseases in a s)stemati'
aroa'h. Ne& 'lassi(i'ations or modi(i'ations o(
'lassi(i'ation s)stems should most 'ertainl) *e e0e'ted as
our "no&ledge o( eriodontal disease gro&s. 1hese
s)stems allo& the 'lini'ians to organi%e the eriodontal
needs and 'on'erns o( their atients +2.. 1he urose o(
this Clinical Update is to des'ri*e the ne& 'lassi(i'ation o(
eriodontal diseases and 'onditions and 'omare it to the
re/iousl) used 'lassi(i'ation o( eriodontitis.
Background
1he re/iousl) utili%ed 'lassi(i'ation s)stem 'ame (rom a
'onsensus rea'hed at the 1-8- 2orld 2or"sho in Clini'al
$eriodonti's +3.. 1his s)stem had man) short'omings
in'luding 'onsidera*le o/erla in disease 'ategories,
asso'iating atient age &ith onset o( disease and rates o(
rogression, and inade3uate 'lassi(i'ation 'riteria +2.. 4n
1--3, #anne) roosed a 'lassi(i'ation o( eriodontal
diseases that (urther de(ined or added ne& 'ategories +,..
Sin'e the 1--5 2orld 2or"sho in $eriodonti's re'ogni%ed
the need (or a ne& 'lassi(i'ation s)stem (or eriodontal
diseases, the 1--- 4nternational 2or"sho (or the
Classi(i'ation o( $eriodontal Diseases and Conditions set
out to re/ise this 'lassi(i'ation s)stem to hel &ith
diagnosis and treatment.
Changes in the Classification System for Periodontal
Diseases
1here is a detailed 'lassi(i'ation o( gingi/al diseases and
lesions that are either dental la3ue6indu'ed or not
rimaril) asso'iated &ith dental la3ue. 1he dental
la3ue6indu'ed gingi/al diseases 'an *e modi(ied &ith
s)stemi' (a'tors, medi'ations, and malnutrition +7.. Non6
la3ue indu'ed gingi/al lesions 'an *e (rom a se'i(i'
*a'teria, /irus, (ungus, geneti' origin, s)stemi' 'ondition,
traumati' lesion, or (oreign *od) rea'tion +5..
8Adult $eriodontitis9 is no& termed 8Chroni'
$eriodontitis.9 1his ta"es a&a) the age6deendent +37
)ears old. nature o( the adult eriodontitis diagnosis. 1he
term 8Chroni' $eriodontitis9 does not iml) that the disease is
nonresonsi/e to treatment +2.. 8Chroni' $eriodontitis9 'an
*e su*di/ided as lo'ali%ed +30: o( the sites are a((e'ted. and
generali%ed +; 30: o( the sites are a((e'ted.. Disease se/erit)
is di/ided into three 'ategories *ased on the amount o( 'lini'al
atta'hment loss +CAL.< Slight = 1 to 2 mm CAL, Moderate
= 3 to , mm CAL, and Severe = 7 mm CAL +>..
8?arl)6@nset $eriodontitis9 +?@$. is no& termed 8Aggressi/e
$eriodontitis.9 ?@$ in'luded raidl) rogressi/e, Au/enile,
and reu*ertal eriodontitis. 4t &as assumed that these
diseases a((e'ted )ounger eole and there &as un'ertaint)
&ith the uer age limit (or this 'ategor). 1here(ore the age6
deendent nature o( +?@$. &as remo/ed +2.. $atients &ho
met the 'lini'al 'riteria (or lo'ali%ed Au/enile eriodontitis
+LB$. or generali%ed Au/enile eriodontitis +CB$. are no& said
to ha/e Lo'ali%ed Aggressi/e $eriodontitis +8lo'ali%ed (irst
molarDin'isor resentation &ith interro0imal atta'hment loss
on at least t&o ermanent teeth, one o( &hi'h is a (irst molar,
and in/ol/ing no more than t&o teeth other than (irst molars
and in'isors9. +8. or Cenerali%ed Aggressi/e $eriodontitis
+8generali%ed interro0imal atta'hment loss a((e'ting at least
three ermanent teeth other than (irst molars and in'isors9.
rese'ti/el) +8.. 1he #aidl) $rogressi/e $eriodontitis +#$$.
designation has *een eliminated &ith these atients no& under
the 8Cenerali%ed Aggressi/e $eriodontitis9 or 8Chroni'
$eriodontitis9 'ategories. 1he 8$reu*ertal $eriodontitis9
'ategor) is no& in'luded in 8$eriodontitis as a !ani(estation
o( S)stemi' Diseases9+2..

#e(ra'tor) eriodontitis re(ers to disease in multile sites in
atients &hi'h 'ontinue to demonstrate atta'hment loss a(ter
aarentl) aroriate thera). Ee'ause eriodontal thera)
sometimes (ails to arrest the rogression o( the di((erent
'ategories o( eriodontitis, re(ra'tor) eriodontitis is not a
single disease entit). 1he re(ra'tor) designation 'an *e used
as an adAe'ti/e in the ne& 'lassi(i'ation, +e.g., re(ra'tor)
'hroni' eriodontitis. and has there(ore *een remo/ed as a
searate disease 'ategor) +2..
8$eriodontitis as a !ani(estation o( S)stemi' Disease9 has
*een retained in the ne& 'lassi(i'ation, &hi'h in'ludes those
asso'iated &ith hematologi'al as &ell as geneti' disorders.
Dia*etes mellitus, osteoorosis and estrogen de(i'ien') are not
in'luded on the list o( s)stemi' diseases. All three 'an *e
signi(i'ant modi(iers o( eriodontitis *ut there is insu((i'ient
data to 'on'lude that there is a se'i(i' dia*etes mellitus,
Clinical Update
Naval Postgraduate Dental School
National Naval Dental Center
Bethesda, Maryland
13
osteoorosis, or estrogen asso'iated (orm o( eriodontitis
+2,-..
8Ne'roti%ing Ul'erati/e $eriodontitis9 +NU$. has *een
rela'ed &ith 8Ne'roti%ing $eriodontal Diseases.9 1here
is still de*ate o/er 8Ne'roti%ing Ul'erati/e Cingi/itis9
+NUC.DNU$ and these 'an *e the result o( s)stemi' disease
*ut until (urther resear'h 'lari(ies these 3uestions
Ne'roti%ing $eriodontal Diseases has *een in'luded +2,10..
1he 8A*s'esses o( the $eriodontium9 'ategor) has *een
added sin'e it does resent se'ial diagnosti' and treatment
'hallenges. 1his 'ategor) is *ased on lo'ation +i.e.,
gingi/al, eriodontal, eri'oronal.. Clini'al (eatures 'an
in'lude< ain, s&elling, 'olor 'hange, tooth mo*ilit),
e0trusion o( teeth, urulen'e, sinus tra't (ormation, (e/er,
l)mhadenoath), radiolu'en') o( the e((e'ted al/eolar
*one, and /aria*le duration +2,11..
F$eriodontitis Asso'iated 2ith ?ndondonti' Lesions9
'ategor) has *een added. Ee'ause 'om*ined eriodontal
and endodonti' lesions ma) de/elo indeendentl) or as a
se'ondar) lesion, this 'lassi(i'ation does not di((erentiate as
to the initial etiolog) o( the lesion +12..
8De/elomental or A'3uired De(ormities and Conditions9
'ategor) has *een added. 1his is rimaril) *ased on
'lini'al and morhologi'al 'riteria and the se/erit) and
etiologi' 'hara'teristi's 'ould *e used as se'ondar)
des'ritors o( the lesions. Also 'onsidered &ere lo'ali%ed
tooth6related (a'tors that modi() or redisose to la3ue6
indu'ed gingi/al diseasesDeriodontitis su'h as la3ue
retenti/e restorationsDalian'es and tooth anatomi'
(a'tors. !u'ogingi/al de(ormities and 'onditions 'an
o''ur around teeth as &ell as on edentulous ridges. 1his
'ategor) also in'ludes *oth rimar) and se'ondar) o''lusal
trauma +2..
Conclusions
4t is generall) a''eted that eriodontal disease is
&idesread in the oulation. !arshall6Da) +13. (ound
that >1: o( the oulation has 'hroni' destru'ti/e
eriodontal disease at an) gi/en time, and a stud) at a
militar) dental 'lini' *) Gorning +1,. sho&ed that 3>: o(
the su*Ae'ts had gingi/itis onl), 33: had earl)
eriodontitis, 1,: had moderate eriodontitis, 17: had
ad/an'ed eriodontitis, 0.7: had Au/enile eriodontitis and
0.7 : had ne'roti%ing gingi/itis. 4n addition, Eial and
!ellonig +17. (ound a re/alen'e o( 0.35: Bu/enile
$eriodontitis &hile !el/in, Sandi(er, and Cra) +15. (ound
a re/alen'e o( 0.>5: Bu/enile $eriodontitis &ith *oth
studies on na/al re'ruit oulations. 1hese studies reresent a
'onsidera*le amount o( eriodontal atients in our Na/)
oulation. 4n addition, eriodontal 'onditions asso'iated &ith
re'ession de(e'ts should not *e o/erloo"ed. $eriodontal
disease is &ell do'umented in our Na/) oulation, and it is
imortant (or all dentists to e0amine and do'ument the
eriodontal status o( ea'h atient. 1he ne& 'lassi(i'ation
s)stem hels identi() these eriodontal diseases and 'onditions
so atients 'an re'ei/e roer re(erral and treatment.
References
1. Annals o( $eriodontolog), Volume ,, Num*er 1, De'em*er
1---.
2. Armitage C. De/eloment o( a 'lassi(i'ation s)stem (or
eriodontal diseases and 'onditions. Annals o( $eriodontolog)
1--- De'H ,+1.<167.
3. Cen'o #, editor6in6'hie(. 1--5 2orld 2or"sho in $eriodonti's,
Annals o( $eriodontolog) 1--5 BulH 1361>H Lansdo&ne, Virginia.
,. #anne) ##. Classi(i'ation o( eriodontal diseases. $eriodontol
2000. 1--3 BunH2<13627.
7. Consensus #eort< Dental la3ue6indu'ed gingi/al diseases.
Annals o( $eriodontolog) 1--- De'H ,+1.<1861-.
5. Consensus #eort< Non6la3ue6indu'ed gingi/al lesions.
Annals o( $eriodontolog) 1--- De'H ,+1.<30631.
>. Consensus #eort< Chroni' eriodontitis. Annals o(
$eriodontolog) 1--- De'H ,+1.<38.
8. Consensus #eort< Aggressi/e eriodontitis. Annals o(
$eriodontolog) 1--- De'H ,+1.<73.
-. Consensus #eort< $eriodontitis as a mani(estation o( s)stemi'
Diseases. Annals o( $eriodontolog) 1--- De'H ,+1.<5,.
10. Consensus #eort< Ne'roti%ing eriodontal diseases. Annals
o( $eriodontolog) 1--- De'H ,+1.<>8.
11. Consensus #eort< A*s'esses o( the eriodontium. . Annals o(
$eriodontolog) 1--- De'H ,+1.<83.
12. Consensus #eort< $eriodonti'6endodonti' lesions. . Annals o(
$eriodontolog) 1--- De'H ,+1.<-0.
13. !arshall6Da) CD. $eriodontal disease< re/alen'e and
in'iden'e. B $eriodontol 1-77H25<1876203.
1,. Gorning C!, Gat'h CL, Luts"us B< 1he re/alen'e o(
eriodonti's in a militar) oulation. B Am Dent Asso'. 1--0
No/H121 +7.<515622.
17. Eial BB and !ellonig B1< #adiograhi' e/aluation o( Au/enile
eriodontitis +eriodontosis.. B $eriodontol. 1-8> !a)H78+7.<32165.
15. !el/in 2L, Sandi(er BE, Cra) BL< 1he re/alen'e and se0
ratio o( Au/enile eriodontitis in a )oung ra'iall) mi0ed oulation.
B $eriodontol. 1--1 !a)H52+7.<3306,
Dr. Kaneshiro is a resident in the $eriodonti's Deartment. Dr.
$ere% is Chairman o( the $eriodonti's Deartment and the Na/)
Se'ialt) Leader (or $eriodonti's.
1he oinions and assertions 'ontained in this arti'le are the ri/ate
ones o( the authors and are not to *e 'onstrued as o((i'ial or re(le't6
ing the /ie&s o( the Deartment o( the Na/)
1,