Classification Of Periodontal Diseases 1st Lectur

Classification of Periodontal Diseases Hayder Alwaeli: BDS, M.Sc. & J. Board

New Classification System • 1999 International Workshop for the Classification of Periodontal Diseases

Classification of Periodontal Diseases

• American Academy of Periodontology (AAP) • The International Workshop 1999

Clinical Features of Normal (Healthy) Gingiva

 Characteristics common to all gingival diseases  Signs & symptoms are confined to gingiva  The presence of dental plaque to initiate & / or exacerbte the severity of the lesion  Clinically signs of inflammation: •

Enlarged gingival contour : edematous or fibrotic

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Red in color &/ or bluish red

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Bleeding upon stimulating

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↑ gingival exudates

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Pathological ↑ in sulcular depth

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No radiographic evidence

4. Reversibility of the disease by removing the etiology (ies) 5. Possible role as a precursor to attachment loss around tooth

-Diagnosis need a full description Localized Chronic Marginal Gingivitis

Generalized Chronic Marginal Gingivitis

Localized Chronic Papillary Gingivitis

Localized Chronic Diffuse Gingivitis

Generalized Chronic Diffuse Gingivitis

Periodontitis The Old Classifications

Periodontitis • Chronic • Aggressive • Periodontitis as a manifestations of systemic diseases

Chronic periodontitis • • • • • •

The most prevalent form in adults Amount of destruction consistent with local factors Associated with a variable microbial pattern Subgingival calculus frequently found Slow to moderate rate of progression Possibly modified by or associated with the

following:

Systemic diseases Local factors predisposing factors Environmental factors

Chronic periodontitis Localized form: <30% of sites involved Generalized form: >30% of sites involved Slight: 1-2 mm of clinical attachment loss Moderate: 3-4 mm of clinical attachment loss Severe: ≥5 mm of clinical attachment loss

Generalized Severe Chronic Periodontitis

Generalized Severe Chronic Periodontitis

Generalized Severe Chronic Periodontitis

Generalized Severe Chronic Periodontitis

Aggressive Periodontitis Primary Features • Except for the presence of periodontitis, patients are otherwise clinically healthy • Rapid attachment loss and bone destruction • Familial aggregation

Aggressive Periodontitis Secondary Features • Amounts of microbial deposits are inconsistent with the severity of periodontal tissue destruction • Elevated proportions of Aa and, in some populations, P. gingivalis may be elevated • Phagocyte abnormalities • Hyper-responsive macrophage phenotype, including elevated levels of PGE2 and IL-1β • Progression of attachment loss and bone loss may be self-arresting

Localized Aggressive Periodontitis • Circumpubertal onset of disease • Localized presentation with

interproximal attachment loss on at least two permanent teeth, one of which is a first molar, and involving no more than two teeth other than first molars and incisors

• Robust serum antibody response to infecting agents

Localized Aggressive Periodontitis

Generalized Aggressive Periodontitis • Usually affects persons under 30 years of age • Generalized proximal attachment loss affecting at least three teeth other than first molars and incisors • Pronounced episodic nature of periodontal destruction • Poor serum antibody response to infecting agents

Generalized Aggressive Periodontitis

FINALLY ,, Please read; • Chapter 4 pages; 64 – 72 Classification of Diseases and Condition Affecting the Periodontium