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CLASSIFICATION OF DISEASES AFFECTING THE PERIODONTIUM

Gingivitis

Refers to the inflammation of the soft tissues that surround the teeth

Compounding Facto s !o Gingivitis


Lack of proper hygiene Periods of susceptibility (puberty, pregnancy (progesterone level), menopause) Smoking Diet (poor nutrition)

Medications Diabetes mellitus Metal poisoning rauma!mastication in"ury ooth cro#ding!overlap Mouth breathing

Cont ast "#t$##n H#a%t&' ( Dis#as#d Gingiva


$ealthy %oral pink Stippled &nife'edge margin Diseased Light red ) red to magenta Loss of stippling S#elling!edema!fibrosis Margin rolled, blunted, receded or hyperplastic (leeding!e)udate Malodor

%L*SS+,+%* +-. -, P/R+-D-. *L D+S/*S/S *.D %-.D+ +-.S (0111 2-RLD 2-R&S$-P %L*SS+,+%* +-. (3 **P) 4+.4+5*L D+S/*S/S
Pla6ue induced gingival diseases .on'pla6ue induced gingival diseases

%$R-.+% P/R+-D-. + +S
Locali7ed 4enerali7ed

*44R/SS+5/ P/R+-D-. + +S
Locali7ed 4enerali7ed

P/R+-D-. + +S *S * M*.+,/S * +-. -, S3S /M+% D+S/*S/S ./%R- +8+.4 P/R+-D-. *L D+S/*S/S .ecroti7ing ulcerative gingivitis (.94) .ecroti7ing ulcerative periodontitis (.9P) *(S%/SS/S -, $/ P/R+-D-. +9M 4ingival abscess Periodontal abscess

P/R+-D-. + +S *SS-%+* /D 2+ $ /.D-D-. +% L/S+-.S /ndo perio lesion Perio endo lesion %ombined lesion

D/5/L-PM/. *L -R *%:9+R/D D/,-RM+ +/S *.D %-.D+ +-.S Locali7ed tooth related factors predisposing to pla6ue induced gingival disease or periodontitis Mucogingival deformities and conditions around the teeth Mucogingival deformities and conditions on edentulous ridge -cclusal trauma

4+.4+5*L D+S/*S/S
D/. *L PL*:9/'+.D9%/D 4+.4+5*L D+S/*S/S Disease may occur on a periodontium #ith no attachment loss or #ith attachment loss that is stable and not progressing; +; 4+.4+5+ +S *SS-%+* /D 2+ $ D/. *L PL*:9/ -.L3 *; #ithout local factors (; #ith local contributing factors

++; 4+.4+5*L D+S/*S/S M-D+,+/D (3 S3S /M+% ,*% -RS *; *ssociated #ith the endocrine system 0; Puberty associated gingivitis <; Menstrual cycle associated gingivitis =; Pregnancy associated a; 4ingivitis b; Pyogenic granuloma >; Diabetes mellitus associated gingivitis (; *ssociated #ith blood dyscrasias 0; Leukemia associated gingivitis <; -thers

+++; 4+.4+5*L D+S/*S/ M-D+,+/D (3 M/D+%* +-.S *; Drug influenced gingival disease 0; Drug induced gingival enlargement <; Drug induced gingivitis a; oral contraceptive associated b; others +5; 4+.4+5*L D+S/*S/S M-D+,+/D (3 M*L.9 R+ +-. *; *scorbic acid deficiency gingivitis (; -thers

.-.'PL*:9/ +.D9%/D 4+.4+5*L L/S+-.S +; 4ingival disease of specific bacterial origin a; .eisseria gonorrhea b; reponema pallidum c; Streptococcal sp d; -thers ++; 4ingival disease of viral origin a; $erpes virus infections 0; primary herpetic gingivostomatitis <; recurrent oral herpes =; varicella 7oster

+++ 4+.4+5*L D+S/*S/ -, ,9.4*L -R+4+. *; %andida sp infection ? gingival candidosis (; Linear gingival erythema %; $istoplasmosis D; -thers +5; 4+.4+5*L L/S+-.S -, 4/./ +% -R+4+. *; $ereditary gingival fibromatosis (; -thers

5; 4+.4+5*L M*.+,/S * +-. -, S3S /M+% %-.D+ +-.S *; Mucocutaneous lesions 0; Lichen planus <; Pemphigoid =; pemphigus vulgaris >; /rythema multiforme @; Lupus erythematosis A; Drug induced B; -thers (; *llergic reactions 0; Dental restorative materials ( mercury, acrylic) <; Reactions to toothpaste, mouth rinse, che#ing gum additives food and additives =; -thers

5+; R*9M* +% L/S+-.S ( +* R-4/.+% -R *%%+D/. *L) *; %hemical in"ury (; Physical %; hermal 5++; ,-R/+4. (-D3 R/*% +-.S 5+++; .- - $/R2+S/ SP/%+,+/D

P# iodontitis
Defined as an inflammation of the gingiva #ith some loss of both attachment of the periodontal ligament and bony support Probably related to the specific flora present in dental pla6ue and the ability of the host to counteract the affects of the organisms present

%L*SS+,+%* +-. -, 5*R+-9S ,-RMS -, P/R+-D-. + +S **P 2-RLD 2-R&S$-P 01C1 *dult Periodontitis ? *ge of onset D =@ years Slo# rate of disease progression .o defect in host defense /arly onset periodontitis ' *ge of onset E =@ years (Prepubertal, Fuvenile or Rapidly progressive) Rapid rate of disease progression Defect in host defense *ssociated #ith specific microflora

Periodontitis associated to #ith systemic disease infection,

'

Systemic disease that predispose rapid rate of periodontitis Diabetes, do#n syndrome, $+5 Papillon Lefevre syndrome

.ecroti7ing ulcerative clinical periodontitis

' Similar to *.94 but #ith associated attachment loss

Refractory Periodontitis ' Recurrent periodontitis that does not respond to treatment

EUROPEAN *OR+SHOP ON PERIODONTOLOG, -../


*dult periodontitis' *ge of onset fourth decade of life Slo# rate of disease progression .o defect in host response /arly onset ' *ge of onset prior to Periodontitis fourth decade of life Rapid rate of disease progression defect in the host defense .ecroti7ing ' issue necrosis #ith attachment and periodontitis bone loss

AAP *OR+SHOP FOR CLASSIFICATION OF PERIODONTAL DISEASE -...

%hronic periodontitis *ggressive periodontitis Periodontitis as a manifestation of systemic diseases

CHRONIC PERIODONTITIS

Prevalent in adults Destruction consistent #ith local factors 5ariable microbial pattern Subgingival calculus present Slo# to moderate rate of progression Modified by systemic diseases like Diabetes, $+5 Local factors predisposing to periodontitis Smoking and stress

C& onic p# iodontitis


%lassified into Locali7ed form E =GH of sites involved 4enerali7ed form D =GH of sites involved Slight I 0'<mm of %*L Moderate I ='>mm of %*L Severe I @mm of %*L

AGGRESSI0E PERIODONTITIS

clinically healthy pt Rapid attachment and bone loss Microbial deposits inconsistent #ith disease severity ,amilial aggregation Diseased site infected #ith *a *bnormal phagocyte function $yperresponsive macrophage +ncreased P4/< and +L'0J Self arresting disease progression

AGGRESSI0E PERIODONTITIS
%lassified into Locali7ed form circumpubertal onset first molar or incisor disease #ith attachment loss on t#o permanent teeth #ith one first molar Robust serum antibody response 4enerali7ed form under =G years of age generali7ed attachment loss other than 0st molars and incisors episodic nature of periodontal destruction poor serum antibody response

PERIODONTITIS AS A MANIFESTATION OF S,STEMIC DISEASE


0;$ematological disorders a; *c6uired neutropenia b; Leukemia c; -thers <; 4enetic disorders a; %yclic neutropenia b; Do#n Syndrome c; Papillon Lefevere d; %hediak $igashi syndrome e; Leukocyte adhesion deficiency f; $ypophosphatasia =; .ot other#ise specified