CLASSIFICATION OF DISEASES AND CONDITIONS AFFECTING

THE PERIODONTIUM

Melok Aris Wahyukundari, drg., M.Kes.

AAP (American Academy of Periodontology) International for Classification of Periodontal Workshop Disease 1999 : ------------------------------------------------------------A. Classification of Periodontal Disease : 1. Gingival Diseases* - Plaque-induced gingival diseases - Non-plaque-induced gingival lesions 2. Chronic Periodontitis** - Localized - Generalized

3. Aggressive Periodontitis - Localized - Generalized 4. Periodontitis as manifestation of systemic diseases 5. Necrotizing Periodontal Diseases - Necrotizing ulcerative gingivitis (NUG) - Necrotizing ulcerative Periodontitis (NUP) 6. Abscesses of the periodontium - Gingival Abscess

- Periodontal absces - Pericoronal abscess 7. Periodontitis associated with Endodontic Lesions - Endodontic-periodontal lesion - Periodontal-endodontic lesion - Combined lesion 8. Developmental or Acquired Deformities and Conditions - Localized tooth-related factors that predispose to plaque-induced gingival or periodontitis

- Mucogingival deformities and conditions around teeth - Mucogingival deformities and conditions on edentulous ridge - Occlusal trauma ______________________________________

* Penyakit yang terjadi hanya pada gingiva tanpa ada kehilangan perlekatan Or terjadi pada gingiva dengan kehilangan perlekatan yang stabil dan tidak berkembang. ** Dapat diklasifikasikan menurut : 1. Luas daerah : - Localized (< 30% terlibat) - Generalized (> 30% terlibat) 2. Keparahan CAL (clinical attachment loss): - Slight = 1 or 2 mm CAL - Moderate = 3 or 4 mm CAL - Severe > 5 mm CAL

B. Gingival Diseases Dental Plaque-Induced Gingival Diseases I. Gingivitis associated with dental plaque only A. Without local contributing factor B. With local contributing factors II. Gingival diseases modified by systemic factors A. Associated with the endocrine system : 1. Puberty-associated gingivitis 2. Menstrual cycle-associated gingivitis 3. Pregnancy associated a. Gingivitis b. Pyogenic granuloma

4. Diabetes mellitus-associated gingivitis B. Associated with blood dyscrasias 1. Leukemia-associated gingivitis 2. Other III. Gingival diseases modified by medications A. Drug-influences gingival diseases 1. Drug-influences gingival enlargement 2. Drug-influences gingivitis a. Oral contraceptive-associated. G. b. Other IV. Gingival diseases modified by malnutrition A. Ascorbic acid deficiency gingivitis B. Other ______________________

Non-Plaque-Induced Gingival Lesions I. Gingival diseases of spesific bacterial origin A. Neisseria gonorrhoe B. Treponema pallidum C. Streptococcal species D. Other II. Gingival diseases of viral origin A. Herpesvirus infections 1. Primary herpetic gingivostomatitic 2. Recurrent oral herpes 3. Vericella Zoster B.Other

III. Gingival diseases of fungal origin A. Candida-species infections: Generalized gingival candidosis B. Linier gingival erythema C. Histoplasmosis D. Other IV. Gingival lesions of genetic origin A. Hereditery gingival fibromatosis B. Other V. Gingival manifestations of systemic conditions

V. Gingival manifestations of systemic conditions A. Mucocutaneous lesions 1. Lichen planus 2. Pemphigoid 3. Pemphigus vulgaris 4. erythema multiforme 5. Lupus erythematosus 6. Drug induced 7. Other B. Allergic reactions 1. Dental restorative material: Mercury, nickel, acrylic, other

2. Reactions attributable to a. Toothpaste or dentrifices b. Mouthrinses or mouthwashes c. Chewing gum additive d. Food and additive 3. Other VI. Traumatic lesions (Factitious, iatrogenic, or accidental) A. Chemical injury B. Physical injury C. Thermal injury VII. Foreign body reactions VIII.Not otherwise specified

C. Periodontitis : - keradangan jaringan pendukung gigi - bakteri periodontopatogen - kerusakan periodontal ligamen dan tulang alveolar - terbentuk poket, resesi gingiva atau keduanya - kehilangan perlekatan klinis Klasifikasi Periodontitis: 1. Chronic Periodontitis 2. Aggressive Periodontitis 3. Periodontitis as a Manifestation of Systemic Diseases ________________________________________

1. Chronic Periodontitis - umumnya usia dewasa > 35 th (anak-anak bisa terjadi) - banyaknya kerusakan faktor lokal - mikrobial variable - Kalkulus subgingival sering ditemukan - perkembangan penyakit slow moderat kemungkinan bisa cepat - predisposisi: p. sistemik (DM, HIV), faktor lokal faktor lingkungan (merokok, stres)

2. Aggressive Periodontitis - 10 30 th - klinis: sehat t ada akumulasi yang besar dari plak dan kalkulus - kerusakan tulang dan loss attachment cepat - Jumlah deposit mikrobial keparahan - Genetik familial history - Actinobacillus actinomycetemcomitans

a. Localized Aggressive Periodontitis : - usia muda (pubertal) - molar pertama or insisive dengan proksimal loss attachment sedikitnya 2 gigi permanen (M1) - respon antibodi serum kuat b. Generalized Aggressive Periodontitis : - < 30 th (atau lebih ) - sedikitnya pada 3 gigi permanen lain selain dari molar pertama dan insisive - respon antibodi serum lemah