CLASSIFICATION OF

PERIODONTAL DISEASE
CONTENTS

 INTRODUCTION
 NEED FOR CLASSIFICATION
 VARIOUS CLASSIFICATION SYSTEMS
 SUMMARY
 CONCLUSION
 REFERENCES
INTRODUCTION

 Systematic arrangement into classes or groups based on perceived

common characteristics
 A means of giving order to a group of disconnected facts.
NEED FOR CLASSIFICATION

 Provides a framework for scientifically studying

Etiology Pathogenesis Diagnosis Treatment

 To assess the prognosis, outcome and determine the treatment plan.

 For logical and systemic organisation of knowledge about disease.
 Helps to communicate among clinicians, researchers, students, epidemiologist, public
health workers.
HISTORY OF CLASSIFICATION

Gottelib 1920 –
Paradental
John Riggs 1885 Pyorrhea
– Rigg’s Disease

Fauchard 1723 –
Scurvy of Gums

Giralamo
Cardano – 1st
to differentiate
Periodontal
disease
DOMINANT PARADIGMS

INFECTIOUS
1970 – ETIOLOGY/HOST
1870-1920
CLINICAL FEATURES 1920-1970
CLASSICAL PATHOLOGY
PRESENT RESPONSE
 1
DAVIS CLASSIFICATION (1879)

GINGIVAL PERIODONTAL
RIGG’S DISEASE
RECESSION DESRUCTION
• Minimal or no • With limited deposits • Necrosed alveolus
inflammation • Lack of nutrition • Death of periodontal
membrane
G.V.BLACK CLASSIFICATION (1886)

Constitutional
Painful gingivitis Simple gingivitis
gingivitis

Calcic
inflammation of Phagedenic
peridental pericementitis
membrane
LIMITATIONS

 No scientific evidence
 No accepted terminology or classification system
 2
MCCAL & BOX (1925)

 Introduced the term

PERIODONTITIS

 He classified it as SIMPLE Periodontitis

COMPLEX Periodontitis
GOTTEILEB AND ORBAN (1942)

• GINGIVITIS – local, systemic

INFLAMMATORY • PERIODONTITIS – simple, complex

NON INFLAMMATORY / • Periodontosis – systemic, Hereditary, Idiopathic

DEGENERATIVE

HYPERTROPHY

ATROPHY

TRAUMATISM
WHO CLASSIFICATION (1961)

Gingivitis Periodontitis

ACUTE CHRONIC ACUTE CHRONIC

Acute Chronic Periodontal Periodontitis
ulcerative gingivitis abscess simplex
gingivitis Chronic Ulcerative Periodontitis
Acute non- Hypertrophic periodontitis complex
specific gingivitis
gingivitis
Demerits

 Degenerative and neoplastic are not included

 Systemic disease were not included
 Periodontal traumatism not considered
 Considered only the inflammatory disease of periodontium,
 3
PAGE AND SHROEDER (1982)

• Chronic marginal gingivitis

GINGIVITIS • Acute necrotising gingivitis

• Juvenile Periodontitis
PERIODONTITS • Rapidly Progressive Periodontitis
• Adult type Periodontitis
AAP (1986)

PRE PUBERTAL

JUVENILE
LOCALISED JUVENILE
PERIODONTITIS

ADULT GENERALISED
PERIODONTITIS JUVENILE
PERIODONTITIS
NECROTIZING
ULCERATIVE
PERIODONTITIS

REFRACTORY
PERIODONTITIS
WORLD WORKSHOP CLASSIFICATION OF
CLINICAL PERIODONTITIS AAP (1989)

PERIODONTITIS

PERIODONTITIS
NECROTISING
ADULT EARLY ONSET ASS WITH REFRACTORY
ULCERATIVE
PERIODONTITIS PERIODONTITIS SYSTEMIC PERIODONTITIS
PERIODONTITIS
DISEASE

RAPIDLY
PREPUBERTAL JUVENILE
PROGRESSIVE
PERIODONTITITS PERIODONTITIS
PERIODONTITIS
 DEMERIT
MERITS
S

Gingival condition
s
not included

Inclusion of Rapidlly
refractory progressive and
EOP

Inclusion of
systemic disease Only age and onse
t
EUROPEAN WORKSHOP ON
PERIODONTICS 1993

ADULT EARLY ONSET NECROTISING

PERIODONTITIS PERIODONTITIS PERIODONTITIS
1999 CLASSIFICATION

 In 1996 – World Workshop in Periodontics – The need for revised classification sstem for
periodontal disease was emphasized.
 In 1997 – American Academy of Periodontics – Organised a committee and held an
International workshop for the revision of the classification
 October 30 – November 2, 1999 – The International Workshop for Classification of
Periodontal disease and Condition was held and new system was proposed.
1989  1999

1) Addition of gingival diseases

2) Adult periodontitis  chronic periodontitis
3) Early onset periodontitis  Aggressive periodontitis
4) Elimination of Refractory periodontitis
5) Periodontitis as a manifestation of systemic disease but diabetes was not include
6) NUP  NUD
7) Addition of Periodontal abscess
8) Addition of Endo-Perio lesions
9) Addition of Developmental and Mucogingival deformity
CLASSIFICATION
Gingival disease
Chronic periodontitis
Aggressive periodontitis
Periodontitis as a manifestation of systemic disease
Necrotizing periodontal disease
Abscess of periodontium
Endo – Perio lesion
Developmental or acquired conditions
 Gingival disease

Non-plaque
Plaque induced
induced
 Dental plaque
only
Endocrine
Modified by
systemic factors
Plaque induced Blood dyscriasis
Medication

Malnutrition
 DENTAL PLAQUE ONLY
 MODIFIED BY SYSTEMIC FACTORS - ENDOCRINE
 MODIFIED BY SYSTEMIC FACTORS – BLOOD DYSCRIASIS
 MEDICATION
 MALNUTRITION
 Bacterial origin

Viral origin

Fungal origin

Genetic origin
Mucocutaneous
Non plaque induced
lesion
Manifestation of
systemic conditions
Allergic reactions
Traumatic lesions

Foreign body
reaction

NOS
BACTERIAL VIRAL

FUNGAL GENETIC
TRAUMATIC LESION

SYSTEMIC CONDITIONS
FOREIGN BODY REACTION
CHRONIC PERIODONTITIS

 LOCALIZED: upto 30% sites

 GENERALIZED: more than 30%sites
 SEVERITY:
 Slight: CAL 1-2mm
 Moderate: CAL 3-4mm
 Severe: CAL 5mm or more
 AGGRESSIVE PERIODONTITIS

AGGRESSIVE
PERIODONTITIS

LOCALIZED GENERALISED
AGGRESSIVE AGGRESSIVE
PERIODONTITIS PERIODONTITIS
Localised aggressive periodontitis Generalised Aggressive periodontitis
 Circumpubertal onset  Generalised Interproximal attachment loss
affecting atleast three permanent teeth other
 Robust Serum Antibody response to infecting
than first molar and incisors.
agents
 Affects person <30yrs of age
 Clinical features:
 Minimal plaque accumulation
 Episodic nature of destruction of attachment
and alveolar bone
 Lack of clinical inflammation
 Poor serum antibody response to infecting
 Deep periodontal pockets
agent.
 Advanced bone loss
MANIFESTATION OF SYSTEMIC DISEASE

A. Associated with hematological disorders B. Associated with genetic disorders

• 1. Acquired neutropenia • 1. Familial and cyclic neutropenia
• 2. Leukemias • 2 Down syndrome
• 3. Other • 3. Leukocyte adhesion deficiency syndromes
• 4. Papillon-Lefèvre syndrome
• 5. Chediak-Higashi syndrome
• 6. Histiocytosis syndromes
• 7. Glycogen storage disease
• 8. Infantile genetic agranulocytosis
• 9. Cohen syndrome
• 10. Ehlers-Danlos syndrome (Types IV and VIII)
• 11. Hypophosphatasia
• 12. Other
PAPILLON LEFEVRE SYNDROME CHEDIAK HIGASHI SYNDROME
NECROTIZING PERIODONTAL DISEASE
ABSCESS OF PERIONDONTIUM

GINGIVAL ABSCESS PERIODONTAL ABSCESS PERICORONAL ABSCESS

PERIODONTITIS WITH ENDODONTIC LESION
DEVELOPMENTAL OR ACQUIRED DEFORMITIES
AND CONDITIONS

DEVELOPMENTAL

Mucogingival Mucogingival
Localised tooth
deformities around deformities on Occlusal trauma
related factors
tooth edentulous ridges
 Localised tooth related factors

Mucogingival deformities on edentulous ridges Mucogingival deformities around tooth

 Occlusal trauma
MERITS

 Addition of gingival disease

 Heterogenous category like RP, EOP eliminated
 Criteria based on age and rate of progression eliminated
 These changes were brought about not arbitrarily but based on understanding of the nature
of periodontal disease
DEMERITS

 Overlapping of criteria for disease

 Risk factors such as smoking, diabetes not elaborated.
CONCLUSION

 Classification system for periodontal disease has evolved based on the understanding of
the nature of the disease.
 Although classification system for periodontal disease currently in use are based on
infection/host paradigm, some features of the old paradigm are still retained.
 This system is also needed to be modified based on the future research.
THANK YOU