Classification of periodontal diseases

The term periodontal diseases is USUALLY used to describe a range of

inflammatory conditions which affect the tooth supporting tissues,
induced by the accumulation of plaque.
Strictly speaking though the term describes any condition affecting the
periodontal tissues, including those that are not initiated by plaque.
A classification system provides a structure to study the aetiology,
pathological processes and treatment of a disease. It should also be
flexible enough to allow the introduction of new diagnoses when needed.
The classification of periodontal diseases has developed as understanding
about the aetiology of periodontal diseases has increased in the past 20
years.
So when we look at diagnosis, it tells us that we can understand the
disease based on its key features and this information will therefore
inform us of our treatment approach. However, reaching a diagnosis can
sometimes be an inexact science because even when using a
classification system there is considerable overlap between the
categories. This means that often we come up with a best fit diagnosis,
obviously taking into consideration aetiological factors, medical history,
dental history, social history and clinical findings. Obviously reaching a
working diagnosis is crucial because that will then determine the
treatment sequence.
A classification system may be based on clinical features, or on the
aetiological factors. It can be argued that a classification system based on
aetiology may be more useful in terms of treatment. However, periodontal
diseases have complex aetiology in which local and systemic factors
combine to contribute to the disease. This is especially true in
periodontits, so it is difficult to use a classification system based just on
aetiology. To make matters more complex, the same aetiological factors
may combine in different patients to cause clinically different diseases (eg
aggressive vs chronic or localised vs generalised).

Current possible diagnoses:

Plaque related periodontal diseases are by far the most common of all
conditions affecting the periodontal tissues. Studies have shown that the
prevalence of moderate to severe periodontitis in the world is 15-20%.
The current classification is shown and is based on a consensus reached in
the World Workshop in Periodontitis in 1999. It divides the conditions
into:

Gingival diseases- confined to the gingival tissues

Periodontal diseases- inflammatory conditions that involve the

deeper supporting tissues which result in loss of apical bone,
periodontal ligament and migration of the junctional epithelium.
Developmental or acquired defects- gingival recession and other
mucogingival problems

How do I reach a periodontal diagnosis (checklist):

Is it a plaque related periodontal disease or not?

What is the severity of the problem? Is it limited to the gingival
tissues or is there associated attachment loss?
Is it localised to a few teeth or is it generalised?
Are there significant risk factors and systemic factors that might
have impacted on the progression of the periodontal problems?
Any additional conditions also present?