Anda di halaman 1dari 11

ABSES GUSI

Dimana gusi mengalami pembengkakan, sakit dan kadang mengeluarkan nanah. Penyebabnya : Infeksi pada akar gigi atau
sekitar gigi, infeksi pada gusi dan dapat menyebabkan bengkak pada wajah. Pencegahannya : * Sikat gigi dengan cara yang
benar dan gunakan pasta gigi yang nyaman untuk kesehatan gigi dan gusi anda. * Periksakan gigi anda rutin tiap 6 bulan
sekali ke dokter gigi. * Kurangi makanan yang manis dan yang kering. Produk yang dapat digunakan untuk membuat
masalah tersebut adalah : * Rooibos SOD Tea pengganti air minum, mencegah sariawan dan mengurangi peradangan gusi,
menjaga kesehatan mulut. * Pasta Gigi MuMin (Siwak) atau Pasta Gigi ALL WHITE Penggunaannya bertujuan untuk
melindungi gigi dari infeksi dan kerusakan email. * UIE K-Liquid Chlorophyll 2 x sehari. Untuk mengurangi peradangan
yang terjadi di mulut, mengurangi pendarahan di gusi dan abses gigi. * Propolis Platinum Dosis : 2 x 3-5 tetes sehari.
Sebagai antibakteri yang mencegah terjadinya infeksi. Mengurangi pembengkakan yang terjadi di gusi dan di mulut. Dan
mematikan kuman yang menyebabkan sariawan atau bengkak pada gusi.
AnnPeriodontol

Classificationsystemsarenecessaryinordertoprovideaframe
workinwhichtoscientificallystudytheetiology,pathogenesis,
andtreatmentofdiseasesinanorderlyfashion.Inaddition,such
systemsgivecliniciansawaytoorganizethehealthcareneeds
oftheirpatients.Thelasttimescientistsandcliniciansinthe
fieldofperiodontologyandrelatedareasagreeduponaclassi
ficationsystemforperiodontaldiseaseswasin1989attheWorld
WorkshopinClinicalPeriodontics.1Subsequently,asimplerclas
sificationwasagreeduponatthe1stEuropeanWorkshopinPeri
odontology.2Theseclassificationsystemshavebeenwidelyused
bycliniciansandresearchscientiststhroughouttheworld.Unfor
tunately,the1989classificationhadmanyshortcomingsinclud
ing:1)considerableoverlapindiseasecategories,2)absence
ofagingivaldiseasecomponent,3)inappropriateemphasison
ageofonsetofdiseaseandratesofprogression,and4)inade
quateorunclearclassificationcriteria.The1993Europeanclas
sificationlackedthedetailnecessaryforadequatecharacteriza
tionofthebroadspectrumofperiodontaldiseasesencountered
inclinicalpractice.Theneedforarevisedclassificationsystem
forperiodontaldiseaseswasemphasizedduringthe1996World
WorkshopinPeriodontics.3In1997theAmericanAcademyof
Periodontologyrespondedtothisneedandformedacommit
teetoplanandorganizeaninternationalworkshoptorevisethe
classificationsystemforperiodontaldiseases.Theproceedings
inthisvolumearetheresultofthisreclassificationeffort.The
processinvolveddevelopmentbytheOrganizingCommitteeof
anoutlineforanewclassificationandidentificationofindivid
ualstowritestateofthesciencereviewsforeachoftheitems
ontheoutline.Thereviewerswereencouragedtodepartfrom
thepreliminaryoutlineifthereweredatatosupportanymod
ifications.OnOctober30November2,1999,theInternational
WorkshopforaClassificationofPeriodontalDiseasesandCon
ditionswasheldandanewclassificationwasagreedupon(Fig.
1).Thispapersummarizeshowthenewclassificationforperi
odontaldiseasesandconditionspresentedinthisvolumediffers
fromtheclassificationsystemdevelopedatthe1989World
WorkshopinClinicalPeriodontics.1Inaddition,ananalysisof
therationaleisprovidedforeachofthemodificationsand
changes.AnnPeriodontol1999;4:16.
KEYWORDS
Periodontaldiseases/classification;gingivaldiseases/
classification.

DevelopmentofaClassificationSystem

forPeriodontalDiseasesandConditions
GaryC.Armitage*

*UniversityofCalifornia,SanFrancisco,California.

CHANGESINTHE
CLASSIFICATIONSYSTEMFOR
PERIODONTALDISEASES
AdditionofaSectiononGingival
Diseases
Asmentionedabove,the1989classifi
cationdidnotincludeasectionongin
givaldiseases.Thishasbeenremedied
bythedevelopmentofadetailedclas
sificationofgingivaldiseasesandlesions
thatareeitherdentalplaqueinduced
(pages1819)ornotprimarilyassoci
atedwithdentalplaque(pages3031).
Animportantfeatureofthesectionon
dentalplaqueinduceddiseasesis
acknowledgmentthattheclinicalexpres
sionofgingivitiscanbesubstantially
modifiedby:1)systemicfactorssuch
asperturbationsintheendocrinesys
tem,2)medications,and3)malnutri
tion.Thesectiononnonplaqueinduced
gingivallesionsincludesawiderange
ofdisordersthataffectthegingiva.Many
ofthesedisordersarefrequentlyencoun
teredinclinicalpractice.
ReplacementofAdultPeriodontitis
WithChronicPeriodontitis
Fromtheoutset,thetermAdultPeri
odontitiscreatedadiagnosticdilemma
forclinicians.Epidemiologicdataand
clinicalexperiencesuggestthattheform
ofperiodontitiscommonlyfoundin
adultscanalsobeseeninadolescents.4
Ifthisistrue,howcannonadults(e.g.,
adolescents)withthistypeofperiodon
titisbesaidtohaveadultperiodontitis?
Clearly,theagedependentnatureofthe
adultperiodontitisdesignationcreated
problems.Therefore,workshoppartici
pantsconcludedthatitwouldbemore

Page 2
DevelopmentofaClassificationSystemforPeriodontalDiseasesandConditions
Volume4Number1December1999

2
I.GingivalDiseases
A.Dentalplaqueinducedgingivaldiseases*
1.Gingivitisassociatedwithdentalplaqueonly
a.withoutotherlocalcontributingfactors
b.withlocalcontributingfactors(SeeVIIIA)
2.Gingivaldiseasesmodifiedbysystemicfactors
a.associatedwiththeendocrinesystem
1)pubertyassociatedgingivitis
2)menstrualcycleassociatedgingivitis
3)pregnancyassociated

a)gingivitis
b)pyogenicgranuloma
4)diabetesmellitusassociatedgingivitis
b.associatedwithblooddyscrasias
1)leukemiaassociatedgingivitis
2)other
3.Gingivaldiseasesmodifiedbymedications
a.druginfluencedgingivaldiseases
1)druginfluencedgingivalenlargements
2)druginfluencedgingivitis
a)oralcontraceptiveassociatedgingivitis
b)other
4.Gingivaldiseasesmodifiedbymalnutrition
a.ascorbicaciddeficiencygingivitis
b.other
B.Nonplaqueinducedgingivallesions
1.Gingivaldiseasesofspecificbacterialorigin
a.Neisseriagonorrheaassociatedlesions
b.Treponemapallidumassociatedlesions
c.streptococcalspeciesassociatedlesions
d.other
2.Gingivaldiseasesofviralorigin
a.herpesvirusinfections
1)primaryherpeticgingivostomatitis
2)recurrentoralherpes
3)varicellazosterinfections
b.other
3.Gingivaldiseasesoffungalorigin
a.Candidaspeciesinfections
1)generalizedgingivalcandidosis
b.lineargingivalerythema
c.histoplasmosis
d.other
4.Gingivallesionsofgeneticorigin
a.hereditarygingivalfibromatosis
b.other
5.Gingivalmanifestationsofsystemicconditions
a.mucocutaneousdisorders
1)lichenplanus
2)pemphigoid
3)pemphigusvulgaris
4)erythemamultiforme
5)lupuserythematosus
6)druginduced
7)other
b.allergicreactions
1)dentalrestorativematerials
a)mercury
b)nickel
c)acrylic
d)other
2)reactionsattributableto
a)toothpastes/dentifrices
b)mouthrinses/mouthwashes
c)chewinggumadditives
d)foodsandadditives
3)other
6.Traumaticlesions(factitious,iatrogenic,
accidental)
a.chemicalinjury
b.physicalinjury
c.thermalinjury
7.Foreignbodyreactions
8.Nototherwisespecified(NOS)

Figure1.

Classificationofperiodontaldiseasesandconditions.

*Canoccuronaperiodontiumwithnoattachmentlossoronaperiodontiumwithattachmentlossthatisnotprogressing.

accuratetoadoptanonspecifictermsuchasChronic
Periodontitistocharacterizethisconstellationof
destructiveperiodontaldiseases.
Agreatdealofdiscussioncenteredaroundwhat
wordsshouldbeusedtoreplacetheAdultPeriodontitis
term.SubstituteterminologysuchasPeriodontitis
CommonFormandTypeIIPeriodontitiswerecon
sideredandeventuallyrejectedbythemajorityofthe
group.ThetermChronicPeriodontitiswascriticized
bysomeparticipants,sincechronicmightbeinter
pretedasnoncurablebysomepeople.Nevertheless,
ChronicPeriodontitiswaseventuallyagreeduponas
longasitwasunderstoodthatitdidnotimplythatthis
diseasewasnonresponsivetotreatment.
Traditionally,thisformofperiodontitishasbeen
characterizedasaslowlyprogressivedisease.5Indeed,
datafrommanysourcesconfirmthatpatientswiththis
formofperiodontitisusuallyexhibitslowratesofpro
gression.6,7However,therearealsodataindicating
thatsomepatientsmayexperienceshortperiodsof
rapidprogression.8,9Therefore,workshopparticipants
concludedthatratesofprogressionshouldnotbeused
toexcludepeoplefromreceivingthediagnosisof
ChronicPeriodontitis.
ReplacementofEarlyOnsetPeriodontitis
WithAggressivePeriodontitis
ThetermEarlyOnsetPeriodontitis(EOP)wasused
inthe1989AAPand1993Europeanclassificationsas
acollectivedesignationforagroupofdissimilar
destructiveperiodontaldiseasesthataffectedyoung
patients(i.e.,prepubertal,juvenile,andrapidlypro

Page 3
AnnPeriodontol
Armitage

gressiveperiodontitis).Itwaslogicallyassumedthat
thesediseasesallhadanearlyonsetbecausethey
affectedyoungpeople.Unfortunately,theearlyonset
designationimpliesthatonehastemporalknowledge
ofwhenthediseasestarted.However,inclinicalprac
ticeandmostothersituationsthisisrarelythecase.
Inaddition,thereisconsiderableuncertaintyabout
arbitrarilysettinganupperagelimitforpatientswith
socalledearlyonsetperiodontitis.Forexample,how
doesoneclassifythetypeofperiodontaldiseaseina
21yearoldpatientwiththeclassicalincisorfirstmolar
patternofLocalizedJuvenilePeriodontitis(LJP)?Since
thepatientisnotajuvenile,shouldtheageofthe
patientbeignoredandthediseaseclassifiedasLJP
anyway?Thistypeofproblemstemsfromtheage
dependentnatureofthe1989classificationsystem.A
similarproblemariseswhenthe1989classificationis
appliedtoa21yearoldpatientwithgeneralizedperi
odontaldestruction.DoessuchapatienthaveRapidly
ProgressingPeriodontitis(RPP)orGeneralizedJuve
nilePeriodontitis(GJP)?Itcanbearguedthatneither
designationisacceptable.ThediagnosisofRPPmay

notbeappropriatesincetherateofprogressionisnot
known,andtheGJPdesignationisunacceptable
becausethepatientisnolongerajuvenile.
Becauseoftheseproblems,workshopparticipants
decidedthatitwaswisetodiscardclassificationter
minologiesthatwereagedependentorrequiredknowl
edgeofratesofprogression.Accordingly,highly
destructiveformsofperiodontitisformerlyconsidered
undertheumbrellaofEarlyOnsetPeriodontitiswere
renamedusingthetermAggressivePeriodontitis.In
general,patientswhomeettheclinicalcriteriaforLJP
orGJParenowsaidtohaveLocalizedAggressive
PeriodontitisorGeneralizedAggressivePeriodonti
tis,respectively.IntheconsensusreportforAggres
3
II.ChronicPeriodontitis
A.Localized
B.Generalized
III.AggressivePeriodontitis
A.Localized
B.Generalized
IV.PeriodontitisasaManifestationofSystemic
Diseases
A.Associatedwithhematologicaldisorders
1.Acquiredneutropenia
2.Leukemias
3.Other
B.Associatedwithgeneticdisorders
1.Familialandcyclicneutropenia
2Downsyndrome
3.Leukocyteadhesiondeficiencysyndromes
4.PapillonLefvresyndrome
5.ChediakHigashisyndrome
6.Histiocytosissyndromes
7.Glycogenstoragedisease
8.Infantilegeneticagranulocytosis
9.Cohensyndrome
10.EhlersDanlossyndrome(TypesIVandVIII)
11.Hypophosphatasia
12.Other
C.Nototherwisespecified(NOS)
V.NecrotizingPeriodontalDiseases
A.Necrotizingulcerativegingivitis(NUG)
B.Necrotizingulcerativeperiodontitis(NUP)
VI.AbscessesofthePeriodontium
A.Gingivalabscess
B.Periodontalabscess
C.Pericoronalabscess
VII.PeriodontitisAssociatedWithEndodonticLesions
A.Combinedperiodonticendodonticlesions
VIII.DevelopmentalorAcquiredDeformitiesandConditions
A.Localizedtoothrelatedfactorsthatmodifyorpredispose
toplaqueinducedgingivaldiseases/periodontitis
1.Toothanatomicfactors
2.Dentalrestorations/appliances
3.Rootfractures
4.Cervicalrootresorptionandcementaltears
B.Mucogingivaldeformitiesandconditionsaroundteeth
1.Gingival/softtissuerecession
a.facialorlingualsurfaces
b.interproximal(papillary)
2.Lackofkeratinizedgingiva
3.Decreasedvestibulardepth
4.Aberrantfrenum/muscleposition
5.Gingivalexcess

a.pseudopocket
b.inconsistentgingivalmargin
c.excessivegingivaldisplay
d.gingivalenlargement(SeeI.A.3.andI.B.4.)
6.Abnormalcolor
C.Mucogingivaldeformitiesandconditionsonedentulous
ridges
1.Verticaland/orhorizontalridgedeficiency
2.Lackofgingiva/keratinizedtissue
3.Gingival/softtissueenlargement
4.Aberrantfrenum/muscleposition
5.Decreasedvestibulardepth
6.Abnormalcolor
D.Occlusaltrauma
1.Primaryocclusaltrauma
2.Secondaryocclusaltrauma

Figure1.(Continued)
Canbefurtherclassifiedonthebasisofextentandseverity.Asageneralguide,extentcanbecharacterizedasLocalized=30%ofsitesinvolvedand
Generalized=>30%ofsitesinvolved.Severitycanbecharacterizedonthebasisoftheamountofclinicalattachmentloss(CAL)asfollows:Slight=1or2
mmCAL,Moderate=3or4mmCAL,andSevere=5mmCAL.

Page 4
DevelopmentofaClassificationSystemforPeriodontalDiseasesandConditions
Volume4Number1December1999

sivePeriodontitis(page53),workshopparticipants
havelistedsomecharacteristicsthatshouldbehelp
fulindistinguishingbetweenlocalizedandgeneralized
formsofthisgroupofperiodontaldiseases.Sincethese
featureshavenotbeenuniversallyusedintheolderlit
eraturetoplacepatientsintheLJPorGJPcategories,
itwouldbeinappropriatetoassumethattherewillbe
aconsistentonetoonerelationshipintransferring
informationfromtheoldclassificationsystemtothe
new.Forexample,somepatientsformerlyclassifiedas
havingGJPintheolderliteraturemightappropriately
beplacedineithertheChronicPeriodontitisorGen
eralizedAggressivePeriodontitiscategoriesinthenew
classificationsystem,dependingonavarietyofprimary
andsecondarycharacteristics.
TheRapidlyProgressivePeriodontitis(RPP)desig
nationhasbeendiscarded.Patientswhowereformerly
classifiedashavingRPPwill,dependingonavariety
ofotherclinicalcriteria,beassignedtoeithertheGen
eralizedAggressivePeriodontitisorChronicPeri
odontitiscategories.Itshouldbeemphasizedthat
patientswithrapidlyprogressiveformsofperiodonti
tisexist.Theydonot,however,representahomoge
neousgroup.
The1989classificationcontainedacategorytermed
PrepubertalPeriodontitiswhichhadlocalizedand
generalizedforms.Thecategorywasoriginallydevel
opedtoaccomodatethoseraresituationsinwhich
childrenwithprimaryteethhadsevereperiodontal
destruction.Itisnowknownthatmostofthepatients
whohavebeengiventhediagnosisofgeneralizedpre
pubertalperiodontitisactuallyhadoneofavarietyof
systemicconditionsthatinterferewithresistanceto
bacterialinfections.Suchconditionsincludeleukocyte
adherencedeficiency,10,11congenitalprimaryimmun
odeficiency,12hypophosphatasia,13chronicneutrophil
defects,14,15orcyclicneutropenia.16Underthenew

classificationsystem,suchpatientswouldbeplaced
undertheheadingofPeriodontitisasaManifestation
ofSystemicDiseases(page64).
Workshopparticipantsagreedthatprepubescentchil
drenwhohaveperiodontaldestructionwithoutanymod
ifyingsystemicconditionswould,dependingonavari
etyofsecondaryfeatures,fitunderthecategoriesof
ChronicPeriodontitisorAggressivePeriodontitisin
thenewclassification.Theideathatperiodontitishasits
beginningsinchildhoodissupportedbyretrospective
epidemiologicdatasuggestingthatlocalizedradiographic
bonelosscanbedetectedaroundtheprimarydentition
ofsomechildren.1719Inaddition,generalizedperi
odontitishasalsobeenreportedinyoungchildrenwith
outanydetectableunderlyingsystemicdisease. 20The
conceptthatperiodontitisdevelopsatanearlyageis
strengthenedbydatafrommanyepidemiologicstudies
demonstratingthatperiodontalattachmentlosscanbe
foundaroundthepermanentteethofadolescents.2131
EliminationofaSeparateDiseaseCategoryfor
RefractoryPeriodontitis
Inthe1989classification,aseparatediseasecategory
wasdevotedtoRefractoryPeriodontitis.Thishetero
geneousgroupofperiodontaldiseasesrefersto
instancesinwhichthereisacontinuingprogressionof
periodontitisinspiteofexcellentpatientcompliance
andtheprovisionofperiodontaltherapythatsucceeds
inmostpatients.Becauseofthediversityofclinical
conditionsandtreatmentsunderwhichperiodontal
therapyfailstoarresttheprogressionofperiodontitis,
workshopparticipantswereoftheopinionthatRefrac
toryPeriodontitisisnotasinglediseaseentity.Indeed,
itwasconsideredpossiblethatasmallpercentageof
casesofallformsofperiodontitismightbenonre
sponsivetotreatment.Thereforethegroupconcluded
that,ratherthanasinglediseasecategory,therefrac
torydesignationcouldbeappliedtoallformsofperi
odontitisinthenewclassificationsystem(e.g.,refrac
torychronicperiodontitis,refractoryaggressive
periodontitis,etc.).Itisrecommendedthatfuturestud
iesofthesepatientsdescribeasfullyaspossiblethe
populationunderinvestigationtominimizehetero
geneityofthestudysample.
ClarificationoftheDesignationPeriodontitisasa
ManifestationofSystemicDiseases
Inthe1989classification,oneofthediseasecategories
wasPeriodontitisAssociatedWithSystemicDisease.
Ingeneral,thiscategoryhasbeenretainedinthenew
classificationsinceitisclearthatdestructiveperi
odontaldiseasecanbeamanifestationofcertainsys
temicdiseases.TheConsensusReportforthisportion
oftheworkshop(page64)containsoflistofsystemic
diseasesinwhichperiodontitisisafrequentmanifes
tation.Itshouldbenotedthatdiabetesmellitusisnot
onthislist.Inthecollectiveviewofworkshoppartic
ipants,diabetescanbeasignificantmodifierofall
formsofperiodontitisbutthereareinsufficientdatato

concludethatthereisaspecificdiabetesmellitusasso
ciatedformofperiodontitis.Forexample,thepres
enceofuncontrolleddiabetesmellituscanalterthe
clinicalcourseandexpressionofchronicandaggres
siveformsofperiodontitis.Similarly,thenewclassifi
cationdoesnotcontainaseparatediseasecategory
fortheeffectsofcigarettesmokingonperiodontitis.
Smokingwasconsideredtobeasignificantmodifier
ofmultipleformsofperiodontitis.
Oneoftheapparentinconsistenciesinthenewsys
temisinclusionintheDentalPlaqueInducedGingi
valDiseases(pages1819)portionoftheclassifica
tionalistofgingivaldiseasesthatcanbemodified
bysystemicfactors.Onthislistisdiabetesmellitus
associatedgingivitis.Howcanonejustifyinclusionof
adiabetesmellitusassociatedgingivitiscategoryand
purposelyexcludeaparallelperiodontitiscategory?
4

Page 5
AnnPeriodontol
Armitage

Thereasonforthisdecisionwasthatplaqueinduced
gingivitiswasconsideredasingleentitybythework
shopparticipants.Thisisnotthecaseforperiodonti
tis,wherethereareclearlydifferentclinicalforms.It
wouldhavebeenpossibletoincludeinthenewclas
sificationadditionalsubcategoriessuchasdiabetes
mellitusassociatedchronicperiodontitisanddia
betesmellitusassociatedaggressiveperiodontitis.
However,thegroupdecidedthatthiswouldbeunnec
essarilycomplicatedandnotyetjustifiedbysupport
ingdata.
ReplacementofNecrotizingUlcerative
PeriodontitisWithNecrotizingPeriodontal
Diseases
Workshopparticipantsacknowledgedthatnecrotizing
ulcerativegingivitis(NUG)andnecrotizingulcerative
periodontitis(NUP)areclinicallyidentifiablecondi
tions.However,thegroupwaslesscertainaboutthe
relationshipbetweenNUGandNUP.Aretheseclinical
conditionspartofasinglediseaseprocessorarethey
trulyseparatediseases?Sincethereareinsufficient
datatoresolvetheseissues,thegroupdecidedtoplace
bothclinicalconditionsunderthesinglecategoryof
NecrotizingPeriodontalDiseases.Iffuturestudies
showthatNUGandNUParefundamentallydifferent
diseases,thentheycanbeseparatedinsubsequent
revisionsoftheclassification.
Oneofthepotentialproblemswithinclusionof
NecrotizingPeriodontalDiseasesasaseparatecat
egoryisthatbothNUGandNUPmightbemanifesta
tionsofunderlyingsystemicproblemssuchasHIV
infection.Ifthisistrue,thenitmightbemoreappro
priatetoplacetheseconditionsundermanifestations
ofsystemicdiseases.Thereasonthatthiswasnot
doneisthattherearemanyfactors,otherthansystemic

diseases,thatappeartopredisposetothedevelopment
ofNUGorNUPsuchasemotionalstressandcigarette
smoking.Sinceourunderstandingoftheseclinical
conditionsisfarfromcomplete,itwasconcludedthat
forthetimebeingtheyshouldbeincludedunderasin
gleandseparatecategoryinthenewclassification.
AdditionofaCategoryonPeriodontalAbscess
The1989classificationdidnotincludeasectionon
periodontalabscesses.Thishasbeenremediedbythe
additionofasimpleclassification(page83)primarily
basedonlocation(i.e.,gingival,periodontal,peri
coronal)ofthesecommonlyencounteredlesions.It
couldbearguedthatperiodontalabscessesarepartof
theclinicalcourseofmanyformsofperiodontitisand
formationofaseparatediseasecategoryisnotjusti
fied.However,intheviewofworkshopparticipants,
sinceperiodontalabscessespresentspecialdiagnos
ticandtreatmentchallengestheydeservetobeclas
sifiedapartfromotherperiodontaldiseases.
AdditionofaCategoryonPeriodonticEndodontic
Lesions
The1989classificationdidnotincludeasectiononthe
connectionbetweenperiodontitisandendodontic
lesions.Thereforeasimpleclassificationdealingwith
thisareahasbeenadded(page90).
AdditionofaCategoryonDevelopmentalor
AcquiredDeformitiesandConditions
Althoughthedeformitiesandconditionslistedinthis
sectionoftheclassificationarenotseparatediseases,
theyareimportantmodifiersofthesusceptibilityto
periodontaldiseasesorcandramaticallyinfluenceout
comesoftreatment.Inaddition,sinceperiodontists
areroutinelycalledupontotreatmanyofthesecon
ditionstheyhavebeengivenaplaceinthenewclas
sification(page101).
FUTUREREVISIONSTOTHECLASSIFICATION
Theclassificationofperiodontaldiseasesandcondi
tionsinthisvolumeshouldprovideaworkableframe
workuponwhichtostudyanddevelopeffectivetreat
mentsforthiscomplexgroupofinfections.Itis
anticipatedthataswelearnmoreabouttheetiology
andpathogenesisofperiodontaldiseases,futurerevi
sionstotheclassificationwillbeneeded.Allclassifi
cationsystemshaveinconsistenciesorinaccuracies.
Thepresenteffortisnoexception.Nevertheless,the
currentclassificationrepresentstheconsensusofan
internationalgroupofexpertsanditishopedthatthe
systemwillbeusefultotheprofessionandpublicwe
serve.
REFERENCES
1.TheAmericanAcademyofPeriodontology.Proceedings
oftheWorldWorkshopinClinicalPeriodontics.Chicago:
TheAmericanAcademyofPeriodontology;1989:I/23
I/24.
2.AttstrmR,vanderVeldenU.Consensusreport(epi
demiology).In:LangNP,KarringT,eds.Proceedingsof
the1stEuropeanWorkshoponPeriodontics,1993.Lon
don:Quintessence;1994;120126.

3.ArmitageGC.Periodontaldiseases:Diagnosis.AnnPeri
odontol1996;1:37215.
4.PapapanouPN.Periodontaldiseases:Epidemiology.Ann
Periodontol1996;1:136.
5.BrownLJ,LeH.Prevalence,extent,severityandpro
gressionofperiodontaldisease.Periodontol20001993;
2:5771.
6.LeH,AnerudA,BoysenH,MorrisonE.Naturalhistory
ofperiodontaldiseaseinman.Rapid,moderateandno
lossofattachmentinSriLankanlaborers14to46years
ofage.JClinPeriodontol1986;13:431440.
7.PapapanouPN,WennstrmJL,GrndahlK.A10year
retrospectivestudyofperiodontaldiseaseprogression.
JClinPeriodontol1989;16:403411.
8.SocranskySS,HaffajeeAD,GoodsonJM,LindheJ.New
conceptsofdestructiveperiodontaldisease.JClinPeri
odontol1984;11:2132.
9.JeffcoatMK,ReddyMS.Progressionofprobingattach
mentlossinadultperiodontitis.JPeriodontol1991;
5

Page 6
DevelopmentofaClassificationSystemforPeriodontalDiseasesandConditions
Volume4Number1December1999

62:185189.
10.WaldropTC,AndersonDC,HallmonWW,Schmalstieg
FC,JacobsRL.Periodontalmanifestationsoftheheri
tableMac1,LFA1,deficiencysyndrome.JPeriodontol
1987;58:400416.
11.MeyleJ.Leukocyteadhesiondeficiencyandprepuber
talperiodontitis.Periodontol20001994;6:2636.
12.BatistaELJr,NovaesABJr,CalvanoLM,etal.Necro
tizingulcerativeperiodontitisassociatedwithseverecon
genitalimmunodeficiencyinaprepubescentsubject:
clinicalfindingsandresponsetointravenousimmu
noglobulintreatment.JClinPeriodontol1999;26:499
504.
13.PlagmannHC,KocherT,KuhrauN,CaliebeA.Peri
odontalmanifestationofhypophosphatasia.Afamily
casereport.JClinPeriodontol1994;21:710716.
14.DoughertyN,GatalettoMA.Oralsequelaeofchronic
neutrophildefects:casereportofachildwithglycogen
storagediseasetype1b.PediatricDent1995;17:224
229.
15.KammaJJ,LygidakisNA,NakouM.Subgingival
microfloraandtreatmentinprepubertalperiodontitis
associatedwithchronicidiopathicneutropenia.JClin
Periodontol1998;25:759765.
16.PrichardJF,FergusonDM,WindmillerJ,HurtWC.Pre
pubertalperiodontitisaffectingthedeciduousdentition
andpermanentdentitioninapatientwithcyclicneu
tropenia.Acasereportanddiscussion.JPeriodontol
1984;55:114122.
17.SweeneyEA,AlcoforadoGAP,NymanS,SlotsJ.Preva
lenceandmicrobiologyoflocalizedprepubertalperi
odontitis.OralMicrobiolImmunol1987;2:6570.
18.BimsteinE,DelaneyJE,SweeneyEA.Radiographic
assessmentofthealevolarboneinchildrenandado
lescents.PediatricDent1988;10:199204.
19.SjdinB,MatssonL.Marginalbonelossintheprimary
dentition.Asurveyof79yearoldchildreninSweden.
JClinPeriodontol1994;21:313319.
20.BimsteinE,SelaMN,ShapiraL.Clinicalandmicrobial
considerationsforthetreatmentofanextendedkindred
withsevencasesofprepubertalperiodontitis:a2year
followup.PediatricDent1997;19:396403.
21.LennonMA,DaviesRM.Prevalenceanddistributionof

alveolarbonelossinapopulationof15yearoldschool
children.JClinPeriodontol1974;1:175182.
22.AassAM,AlbandarJ,AasendenR,TollefsenT,Gjermo
P.Variationinprevalenceofradiographicalveolarbone
lossinsubgroupsof14yearoldschoolchildreninOslo.
JClinPeriodontol1988;15:130133.
23.vanderVeldenU,AbbasF,vanSteenbergenTJM,etal.
Prevalenceofperiodontalbreakdowninadolescentsand
presenceofActinobacillusactinomycetemcomitansin
subjectswithattachmentloss.JPeriodontol1989;
60:604610.
24.KllestlC,MatssonL,HolmAK.Periodontalcondi
tionsinagroupofSwedishadolescents.(I).Adescrip
tiveepidemiologicstudy.JClinPeriodontol1990;17:601
608.
25.KllestlC,MatssonL.Marginalbonelossin16year
oldSwedishadolescentsin1975and1988.JClinPeri
odontol1991;18:740743.
26.BhatM.Periodontalhealthof1417yearoldUSschool
children.JPublicHealthDent1991;51:511.
27.CappelliDP,EbersoleJL,KornmanKS.Earlyonsetperi
odontitisinHispanicAmericanadolescentsassociated
withA.actinomycetemcomitans.CommunityDentOral
Epidemiol1994;22:116121.
28.AassAM,TollefsenT,GjermoP.Acohortstudyofradi
ographicalveolarbonelossduringadolescence.JClin
Periodontol1994;21:133138.
29.ClerehughV,WorthingtonHV,LennonMA,ChandlerR.
Siteprogressionoflossofattachmentover5yearsin
14to19yearoldadolescents.JClinPeriodontol1995;
22:1521.
30.AlbandarJM,BrownLJ,BrunelleJA,LeH.Gingival
stateanddentalcalculusinearlyonsetperiodontitis.J
Periodontol1996;67:953959.
31.TimmermanMF,vanderWeijdenGA,ArmandS,etal.
UntreatedperiodontaldiseaseinIndonesianadolescents.
Clinicalandmicrobiologicalbaselinedata.JClinPeri
odontol1998;25:215224.
Sendreprintrequeststo:Dr.GaryC.Armitage,University
ofCaliforniaSanFrancisco,SchoolofDentistry,521Par
nassusAve.,C628,Box0650,SanFrancisco,CA94143
0650.Fax:415/5024990;email:garmit@itsa.ucsf.edu
6