CLASSIFICATION OF

PERIODONTAL DISEASES 2017

 WHAT IS CLASSIFICATION

• Systematic collection of data or knowledge & its arrangement in

sequential manner in order to facilitate its understanding or knowledge

• Classification systems are necessary in order to provide a framework in
which to scientifically study the etiology, pathogenesis, and treatment of
diseases in an orderly fashion.

• In addition, such systems give clinicians a way to organize the health

care needs of their patients.
 USES

• Identification of the etiology & understanding of the pathology

• For diagnosis prognosis & treatment planning

• Facilitates communication among the clinician, researcher’s, educators,

student, epidemiologist & public health worker’s

• Predicting treatment outcomes

 WHY DO WE NEED A
CLASSIFICATION SYSTEM
• Simplify our understanding regarding different diseases in a particular
medical or dental field

• Helps us to communicate

• Help us to formulate a treatment plan, predict the outcome of

treatment as well as to educate the patient about the disease.
• Periodontal disease classification are useful to help establish diagnosis,
determining prognosis, and facilitate treatment planning.

• Different classifications of periodontal diseases have been used over years

and have been replaced.
 CURRENT CLASSIFICATION

• The world workshop 2017 classification for periodontal and peri-

implant disease and conditions
 GINGIVITIS DENTAL BIOFILM
INDUCED
• An inflammatory lesion resulting from interactions between the dental
plaque biofilm and the host’s immune – inflammatory response, which
remains contained withing the gingiva and does not extend to the
periodontal attachment.

• Such inflammation remains confined to the gingiva and does not extend
beyond the mucogingival junction and is reversible by reducing levels of
dental plaque at and apical to the gingival margin
• A) associated with dental biofilm only
• B) Potential modifying factors of plaque-induced gingivitis
1. Systemic conditions.
2. oral factors enhancing plaque accumulation.
• C) Drug influenced gingival enlargements.
• Universal feature of these gingival conditions include : clinical signs and
symptoms of inflammation.
• Redness, swelling, and bleeding upon probing, discomfort on gentle probing are
all signs of inflammation
• Radiographs cannot be used to diagnose
 A) ASSOCIATED WITH DENTAL
PLAQUE BIOFILM ONLY[
• Inflammatory response of the gingival tissues resulting from bactaerial
plaque accumulation located at and below the gingival margin.
GINGIVITIS ASSOCIATED WITH DENTAL
PLAQUE ONLY

•Result of interaction between the microorganism found in

the dental plaque biofilm and the tissues and
inflammatory cells of the host.

•This interaction can be altered by local (crowded teeth,

insufficient restorations etc)and systemic factors
(puberty,menstruation, pregnancy,diabetes etc) which can
influence the duration and severity of the response
 puberty

Menstrual cycle

sex steroid hormones

pregnancy

hyperglycemia

Oral
contraceptives

Systemic conditions leukemia

Smoking

Potential modifying
risk factors
malnutrition

Prominent
subgingival
restoration margins
Oral factors
enhancing plaque
accumulation
hyposalivation
•Systemic factors contributing to gingivitis, such as the endocrine
changes associated with puberty, menstrual cycle, pregnancy and
diabetes may be exacerbated because of alterations in the gingival
inflammatory response to plaque

•Blood dyscrasias such as leukemia may alter immune function by

disturbing the normal balance of immunologically competent white
blood cells supplying the periodontium.

•Gingival enlargement and bleeding are common findings and may

be associated with swollen, spongy tissues caused by excessive
infiltration of blood cells.
GINGIVAL DISEASES MODIFIED BY
MALNUTRITION

Nutritional deficiences affect immune function

and may affect the host;s ability to protect
itself against some of the detrimental effects of
cellular products, such as oxygen radicals.
Gingiva appears bright red, swollenand bleeding
with severe vitamin c deficiency.
 DRUG INFLUENCED GINGIVAL
ENLARGEMENT
• PHENYTOIN
• CYCLOSPORIN
• CALCIUM CHANNEL BLOCKERS
Development and severity of gingival enlargement in response
to medicatrions are patient specific and may be influenced by
uncontrolled plaque accumulation.

Drugs which may affect gingival tissues are :

Anticunvulsants such as phenytoin, immunosuppressive drugs
such as cyclosporin A, calcium channel blockers as nifedipine,
verapamil, diltizem, sodium valproate, oral contraceptives.
NON PLAQUE INDUCED GINGIVAL
DISEASES AND CONDITIONS
GINGIVAL DISEASES OF SPECIFIC BACTERIAL
ORIGIN
•Increasing in
prevalence as a result
of sexually
transmitted diseases
as gonorrhea and
syphilis.
•Oral lesions may by
secondary to systemic
infection or may
occur through direct
infection
•Eg. Streptococcal
gingivitis or
gingivostomatitis
 22. SPECIFIC INFECTIONS
• 2.1) BACTERIAL ORIGIN:
• NECROTIZING PERIODONTAL DISEASE
• Necrotizing gingivitis, Necrotizing Periodontitis, and Necrotizing Stomatitis are severe inflammatory
periodontal diseases caused by bacterial infection in patiets with specific underlying risk factors
( poor oral hygiene, smoking, stress, poor nutrition, compromised immune status (e.g HIV)

• Acute streptococcal gingivitis

• Neisseria gonorrhoeae

• Treponema palladium

• Orofacial tumerculosis
GINGIVAL DISEASES OF VIRAL
ORIGIN

• Caused by a variety of
deoxyribonucleic acid and
ribonucleic acid viruses.
• Most common is herpes
virus infection
• Lesions are frequently
related to reactivation if
latent viruses.
 VIRAL ORIGIN
• COXSACKIE VIRUSES : HERPANGINA and hand-foot-mouth disease
• HERPES VIRUSES INCLUDING HERPES SIMPLEX VIRUS TYPES 1 AND 2
• Herpetic gingivostomatitis
• Recurrent ontraoral herpes simplex lesion
• VARICELLA ZOSTER VIRUS
• Primary infection causes chicken pox in children
• Reactivation causes unilateral distribution shingles
• MOLLUSCUM CONTAGIOSUM VIRUS : poxvirus family causes a contagious disease
with infrequent oral manifestations. It is seen in infants with immature immune system and
manifests as discrete umbilicated papules on the skin. In adults the disease appears on the
genital area and is often sexually transmitted.
• HUMAN PAPILLOMA VIRUS : benign lesioms : squamous cell papilloma, condyloma
aculomilatum, verruca vulgaris and focal epithelial hyperplasia.
• Usually asymptomatic a nd regress automatically.
GINGIVAL DISEASES OF FUNGAL ORIGIN

• Relatively uncommon in
immunocompetent individuals
but occur more frequently in
immunocomprised individuals.
• Also seen in those with normal
oral flora disturbed by long term
use of broad-spectrum
antibiotics.
• Most common oral fungal
infection if candiasis caused by
infection with Candida albicans.
• Also seen in individuals affected
ith HIV, condition known as
Linear gingival Erythema
 FUNGAL ORIGIN
• Candidosis
• caused by candida albicans , [Link], [Link]
• Oppertunistic pathogen
• Common finding : redness of the attached gingiva
 INFLAMMATORY AND IMMUNE
CONDITIONS AND LESIONS
• 3.1 : contact allergy: oral mucosal manifestations of hysensitivity are
very uncommon
• It can be due to dental restoratibe materials, dentrifices, mouthwashes
and food

• 3.2 : Plasma Cell gingivitis :

• Uncommon inflammatory condition usually affecting the anterior
maxillary gingiva of uncertain etiology.
 ERYTHEMA MULTIFORME
• Uncommon, self-limiting , acute immune inflammatory disorder of oral mucosa. The
etiology is unclear in most of the patients.
• Immunologic hypersensitivity reactions.
 AUTOIMMUNE DISEASES OF SKIN
AND MUCOUS MEMBRANE
• 1. Pemphigus vulgaris (PV)
• Autoimmune vesiculo bullous disease of skin and mucous membrane
• Oral cavity is primary site of development.
• 2. Pemphigoid: group of mucocutaneous disorder caused by auto antibodies directed towards
antigen of the basement membrane, resulting in detachment of epithelium from the CT. any
area ca be involved but desquamative lesions of gingiva is main feature.
• 3. Lichen planus : common mucocutaneous disease with frequent manifestation in gingiva.
• Oral involvement alone is uncommon and concomitant skin lesions are also present.
• Lupus Erythematosus : group of autoimmune disorders
• 2 forms : 1 discoid LE
2. systemic LE
 GRANULOMATOUS
INFLAMMATORY CONDITIONS
• Orofacial granulomatosis
• Persistent enlargement of soft
tissues in the oral cavity as
well as the facial region with
various systemic condtions like
tuberculosis, Crohn’s disease
and sarcoidosis.
 REACTIVE PROCESSES
• 4.1 Epulides : epulis is a term often applied to exophytic processes originating from gingiva
• fibrous epulis : irritational fibroma – attached to gingiva
• Calcifying fibroblastic granuloma : exclusively on gingiva
• Pyogenic granuloma: pregnancy tumour, vascular epulis , predilection for gingiva
• Peripheral giant cell granuloma: usually develops from marginal gingiva.
 NEOPLASMS
• Premalignant :
• LEUKOPLAKIA
• ERYTHROPLAKIA
• MALIGNANT
• SQUAMOUS CELL CARCINOMA
• LEUKEMIA
• LYMPHOMA
 ENDOCRINE, NUTRITIONAL AND
METABOLIC DISORDES
• VITAMIN C DEFICIENCY
 Marginal gingivitis
 The gingiva appears bluish red,soft,friable, smooth
with shiny surface
 Hemorrhage on slight provocation and surface
necrosis with pseudomembrane formation
 TRAUMATIC LESIONS

• 1 . PHYSICAL INSULTS
• FRICTIONAL KERATOSIS
• TOOTHBRUSHING INDUCED GINGIVAL ULCERATION
• FACTITIOUS INJURY (SELF HARM)
• 2. CHEMICAL INSULTS (TOXINS)
• ETCHING
• SLOUGHING AND OR ULCERATIONS
• CHLORHEXIDINE, ACETYLSALICYCLIC ACID
• COCAINE
• HYDROGEN PEROXIDE
• BY DENTIST – INCORRECT USE OF ENDODONTIC SUBSTANCES
• 3. THERMAL INSULTS :
• THERMAL BURNS
• MICROWAVE FOOD, PIZZA, POTATO, BURN BY HOT TEA COFFEE
• SLOUGHIG , ULCERATIONS ,EROSIONS
 GINGIVAL PIGEMENTATION
• 1. GINGIVAL PIGEMENTATION/ MELANOPLAKIA
• ASSOCIATED WITH DRUGS, HEAVY METALS , GENETCS, ENDOCRINE
DISTURBANCES *ADDISON’S DISEASE) AND POST INFLAMMATORY
• 2. SMKERS MELANOSIS
• MANDIBULAR ANTERIOR FACIAL REGION
• 3. DRUG INDUCED PIGMENTATION
• QUININE , LONG TERM USE OF MINOCYCLINE
• 4. AMALGAM TATTOO
NECROTIZING GINGIVITIS
NECROTIZING PERIODONTITIS
NECROTIZING STOMATITIS
 PERIODONTITIS
• MICROBIALLY ASSOCIATED
• HOST MEDIATED INFLAMMATION THAT RESULTS IN ATTACHMENT LOSS
 PERIODONTITIS AS
MANIFESTATION OF SYSTEMIC
DISEASE
• GENETIC DISORDERS
• METABOLIC DISORDER / ENDOCRINE
DISORDRS
• Acquired immunodeficicency syndrome
• Inflammatory diseases
• Stress
• Hypertension
• Hyperparathyrodism
• malignancies
 PERIODONTAL ABSCESS
• PERICORONAL ABSCESS
• PERIODONTAL ABSCESS
• GINGIVAL ABSCESS
• PERIAPICAL ABSCESS
 GINGIVAL PHENOTYPE
• BIOTYPES:
• THIN SCALLOPED
• THICK FLAT
• THICK SCALLOPED
• Associated with or development /progression of mucogingival defect, recession in particular
 GINGIVAL RECESSION
• Apical shift of the gingival margin wrt CEJ
 LACK OF GINGIVA
• DEHISCENCE
• FENESTRATIONS