perio disease classifications_1

8/13/2019 Perio Disease Classifications_1

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Preyesh Patel and Alaa Guni, BDS 4 students

Classification of periodontal diseases-the eternal quest

Classifying and grouping entities is integral to human nature. It enforces a sense of belonging so much so, that the entire human species is subdivided into various races, religions andcastes. It would be interesting to see if this phenomenon is reciprocated amongst animals.

When it came to tackling the age old concern of classifying periodontal disease, various factors were considered when formulating the classification that is now accepted worldwide:World Worskshop in Periodontology, 1999. These factors included: Aetiology, clinical presentation as well as prognosis/outcome.

As a dental student appreciation of these finely tuned (so far) classifications can be difficult. However, after sifting thro ugh many resources, we have formulated a table of our own. A

summary of the classifications of the periodontal diseases coupled with its appropriate management. This will serve as a quick and simple tool when revising for exams or even as a referencewhen in practice.


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Diagnosis Features Treatment

Gingivitis Non-plaque induced Fungal origin-Candidosis

Featurespseudomembranous candido-sis may present as white lesions,

chronic erythematous candidosis pre-sents as redness along the gingival mar-

gins.

Antifungal

OH reinforcement

review

Mucocutaneous disordersOral Lichen

Planus, Benign mucous membranepemphigoid, pemphigus vulgaris, ery-

thema multiforme

Featuresdesquamative lesions, gingi-val ulcerations

Topical ointments, steroids

OH reinforcement

Review

Traumatraumatic brushing technique

Featuresfrictional keratosis

Instruction on atraumatic brushing tech-

nique

Periodontitis Incidental attachment loss Loss of attachment doesnt fit into criteriaof aggressive or chronic periodontitis

Isolated areas of attachment loss in an other-

wise healthy dentition associated with

trauma, malpositioned tooth, impacted third

molars, subginigival caries and endo infec-

tions May predispose to periodontitis

Treat local defect

OH reinforcement

Review

Incipient chronic periodontitis Age of onset can be in adolescence (1314

years) Interproximal clinical attachment loss of1

2 mm (commonly seen on maxillary first

molars, mandibular incisors), associated

withpresence of plaque, subgingival calcu-lus

Pockets of 45 mm. Bone loss no more than 0.5 mm over an 18-

month period (bite-wing radiographs usually

show horizontal bone loss).

OH reinforcement

Non-surgical rsd Review


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Periodontitis Chronic PeriodontitisMild1-2mm cal, 50% bone lossLocalised30% sites affected

Common, most prevalent in adults Amount of destruction consistent with presence of local factors Subgingival calculus frequent finding Slow to moderate rate of progression but have periods of rapid progres-

sion Apical migration of epithelial attachment

Loss of alveolar bone and connective tissue

Severity modified by smoking, diabetes, stress and HIV May present with moderately severe gingival inflammation

OH reinforcement Non-surgical rsd Review If treatment fails reassess and consider local antimicro-

bial adjunct.

Aggressive periodontitis-Localised: Circumpubertal onset

restricted to interproximal areas (IP

CAL is >3mm) of first molar and

incisors. (arc shaped) involving no more than two teeth

other than first molar or incisorGeneralised- Generalised Interproximal attach-

ment loss affecting at least 3 teeth

other than first molars and incisors(


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Periodontitis Abscesses (periodontal) Forms close to the gingival margin Tender to lateral percussion

Pulp vital for true perio lesions

Drainage (to relieve patient!) RSD if allowed

Course of antimicrobials:Metronidazole (preffered aseffective against anaerobic bacteria)or a mix of met-ronidazole and amoxicillin if cellulitis present

Review

Perio-endo lesion -Primarily endodontic History of trauma or pulpitis Heavily restored

Fracture of tooth? Localised pockets and relatively healthy periodontium generally

Non-vital TTP

Extractionor extirpate the pulp and monitor

If improvement shown (reduction in symptoms and re-

duced lesion on LCPA) RCT followed by RSD

Perio-endo lesion -Primarily periodontic History of periodontitis Vital/non-vital pulp upon testing Lack of restoration/fracture or history of trauma No history of pulpitis TTP

Extractionor extirpate the pulp and monitor

If improvement shown (reduction in symptoms and re-

duced lesion on LCPA) RCT followed by RSD

perio disease classifications_1

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