تصنيف الأمراض حول السنية Classification of periodontal diseases

WHY CLASSIFY?
Disease classification, ideally provides a short, but comprehensive review of all known disease processes affecting a tissue or organ
It helps to systematically reach a differential diagnosis, prognosis and develop a treatment plan

Numerous classifications (previously)
Reasons for controversy:
-Incomplete understanding of aetiology

-Complexity of the disease process

-Incomplete understanding of interactions between various aetiological factors

-Using different criteria by different investigators

1-Disease associated with gingiva ‘gingivitis’
2-Diseases associated with other tooth supporting structures ‘perioodontitis’

Former classification of the World Workshop in Clinical Periodontics (1989):
-Adult periodontitis

-Early onset periodontitis
Prepubertal (localized or generalized)
Juvenile (localized or generalized)
Rapidly progressive periodontitis.

-Periodontitis associated with systemic diseases
Down syndrome
Diabetes type I
Papillon-Lefèvre syndrome.
AIDS
Other diseases

-Necrotizing ulcerative periodontitis


-Refractory periodontitis



Current Classification
Latest classification was developed by the
American Academy of Periodontology (AAP) in 1999

CHANGES IN THE CLASSIFICATION SYSTEM FOR PERIODONTAL DISEASES
Addition of a Section on “Gingival Diseases”
Replacement of “Adult Periodontitis” With “Chronic Periodontitis”
Replacement of “Early-Onset Periodontitis” With “Aggressive Periodontitis”

Before arriving at a periodontal diagnosis, the clinician must answer three basic questions:
1-What periodontal disease does the patient have?
2-How sever is the problem?
3-Is the disease localized or generalized?

GINGIVAL DISEASES
Plaque-Induced Gingival Diseases
Most common form of gingival disease
Plaque is primary etiological factor
Clinical signs of inflammation that are confined to the gingiva
No attachment loss

Non plaque induced Gingival diseases
COURSE AND DURATION
Acute gingivitis is of sudden onset & short duration & can be painful
Chronic gingivitis is slow in onset & of long duration, and is painless, unless complicated by acute or subacute exacerbations
Most common type (99%)
Recurrent gingivitis reappears after having been eliminated by treatment or disappearing spontaneously

DESCRIPTION
Localized gingivitis is confined to the gingiva of a single tooth or group of teeth (<30% of surfaces)
Generalized gingivitis involves the entire mouth

The distribution of gingival disease in individual cases is described by combining the preceding terms as follows:

Generalized chronic marginal gingivitis
associated with maxillary left central incisor

Localized chronic diffuse gingivitis

Generalized chronic papillary gingivitis

localized chronic diffuse gingivitis in the area of upper left maxillary teeth

Clinical features of gingivitis
Gingival Bleeding on Probing
The two earliest symptoms of gingival inflammation preceding established gingivitis, are:
1-Increased gingival crevicular fluid production rate
2-Bleeding from the gingival sulcus on gentle probing
BOP is of value for the early diagnosis and prevention of more advanced gingivitis
1-Easily detectable clinically
2-BOP appears earlier than a change in color or other visual signs of inflammation
3-More objective sign that requires less subjective estimation by the examiner
Most common cause of BOP is chronic inflammation
Bleeding is provoked by mechanical trauma
Sites with BOP have a greater area of inflammation than sites that do not bleed
The severity of the bleeding and the ease with which it is provoked depend on the intensity of the inflammation
Should be checked 30 to 60 seconds after probing

-Changes in the Surface Texture of the Gingiva
-Changes in the Consistency of the Gingiva

-Changes in Position of the Gingiva
-Positions of the Gingiva & gingival recession
-Recession is exposure of the root surface by an apical shift in the position of the gingiva

Histologically
Junctional epi is usually present at CEJ or coronal to it

Apical migration of junctional epithelium

Presence of gingival inflammation without loss of attachment CAUSES Gingivitis
Presence of gingival inflammation with loss of attachment CAUSES Periodontitis

Actual and apparent positions of the gingiva
-The actual position is the level of the coronal end of the epithelial attachment on the tooth
-Apparent position is the level of the crest of the gingival margin

The severity of recession is determined by the actual position of the gingiva, not its apparent position

1-Gingivitis Associated with Dental Plaque Only
2-Gingival Diseases Modified by Systemic Factors;
Endocrine changes
Blood dyscrasias
3-Gingival diseases modified by medications
Phenytoin
Cyclosporine
Calcium channel blockers
4-Gingival Diseases Modified by Malnutrition
Severe ascorbic acid (vitamin C) deficiency or scurvy


Non-Plaque-Induced Gingival Lesions
-Rare
-They are observed in lower socioeconomic groups, developing countries, and immunocompromised individuals
-Gingival Diseases of Specific Bacterial Origin
-Gingival Diseases of Viral Origin
-Gingival Diseases of Fungal Origin
-Gingival Diseases of Genetic Origin
-Foreign Body Reaction