Classification of periodontal

diseases
 Periodontium
The periodontium consist of
the investing & supporting
tissues of the teeth which
include gingiva . periodontal
ligament ,cementum &
alveolar bone.
 DISEASE
A pathological condition of a part, organ, or
system of an organism resulting from
various causes, such as infection, genetic
defect, or environmental stress, and
characterized by an identifiable group of
signs or symptoms
 CLASSIFICATION
Systematic collection of data or
knowledge & its arrangement in
sequential manner in order to
facilitate its understanding or
knowledge
USES OF CLASSIFICATION
IDENTIFICATION OF THE ETIOLOGY &
UNDERSTANDING OF THE PATHOLOGY
FOR DIAGNOSIS PROGNOSIS & TREATMENT
PLANING
FACILITATES COMMUNICATION AMONG THE
CLINICIAN , RESEARCHER’S EDUCATORS ,
STUDENT, EPIDIMIOLOGIST & PUBLIC HEALTH
WORKER’S
PREDICTING TREATMENT OUTCOMES
HISTORICAL DEVLOPMENT OF
CLASSIFICATION SYSTEM

CLINICAL CHARACTERISTIC
PARADIGM
CLASSICAL PATHOLOGY PARADIGM
INFECTION / HOST RESPONSE
PARADIGM
CLINICAL CHARACTERISTIC
PARADIGM
Very little to know about the etiology & pathogenesis of
periodontal disease
C. G. DAVIS CLASSIFICATION(1879)
Gingival recession with minimum or no inflammation
Periodontal destruction secondary to time deposits
“ RIGG’S DISEASE” the hallmark of which was loss of
alveolus without loss of gums
 G. V. BLACK
CLASSIFICATION (1886)
CONSTITUTIONAL GINGIVITIS
PAINFULL FORM OF GINGIVITIS
SIMPLE GINGIVITIS
INFLAMMATION OF THE PERIODONTAL
MEMBRANE
PHAGEDENIC PERIODONTITIS
LITTLE OR NO EVIDENCE WAS USED TO
SUPPORT THE OPINION OF CLINICIAN OF
THE TIME
 CLASSICAL PATHOLOGY
PARADIGM
TWO FORMS OF DESTRUCTIVE PERIODONTAL
DISEASES
1. INFLAMMATORY
2. NON INFLAMMATORY

GOTTLIB CLASSIFICATION {1928}

1. INFLAMMATORY – SCHMUTZ PYORRHOEA [POOR
ORAL HYGINE ]
2. DEGENRATIVE OR ATROPHIC-
DIFFUSE ALVEOLAR ATROPHY

SYSTEMATIC METABOLIC
ORBAN CLASSIFICATION
(1942)
1. INFLAMMATORY
2. DYSTROPHIC
3. NEOPLASTIC
4. PATHOLOGIC REACTION PRODUCED
BY OCCLUSAL TRAUMA
 W.HO. EXPERT COMMITEE
ON DENTAL HEALTH IN 1961
SUGGESTED
ETIOLOGY PLAYS SECONDARY &
IMPORTANT PART IN CLASSIFICATION
CLINICAL ASSESMENT LACK
SUFFICIENT PRECISION TO SERVE AS
 INFECTION / HOST
RESPONSE PARADIGM

ROBERT KOCH IN 1876 – GERM

THEORY OF DISEASE
W. D. MILLER SUGGESTED THAT 3
FACTOR’S ARE CONSIDERRED FOR
PYRRHOEA
 PRITCHARD
CLASSIFICATION {1972}
INFLAMMATION WITH SURFACE
DESTRUCTION
DISEASE AFFECTING SURFACE OR
GINGIVA
DISEASE AFFECTING DEEPAR
STRUCTURE
 RAMFORD & ASH
CLASSIFICATION (1979)

1. GINGIVITIS
2. GINGIVAL ATROPHY OR RECESSION
3. TRAUMA FROM OCCLUSION
4. PERIODONTITIS
 GRANT , STERN &
LISTGARTEN
CLASSIFICATION {1988}
BACTERIAL INDUCED DISEASES
GINGIVITIS
PERIODONTITIS
ADULT TYPE
POST JUVENILE
EARLY ONSET
JUVENILE
LOCALIZED
GENERALIZED
ACUTENECROTIZING ULCERATIVE GINGVITIS
ACUTE ABSCESS
PERICORONITIS
FUNTIONALLY INDUCED DISEASES
TRAUMATIC OCCLUSION
DISEASE ATROPHY

TRAUMA
ACCIDENTAL
HABITS
 Page & schroeder
classification (1982)
1)Prepubertal periodontitis
Generalized
Localized
2)Juvenile periodontitis
3)Rapidilly progressing periodontitis
4)Adult type periodontitis
Topic’s classification
(1986)
Acute
gingivitis
specific , non specific
Periodontitis
periodontal abscess
pericoronitis
Chronic
Gingivitis
plaque associated, symptomatic
Periodontits
recession
Periodontitis
localized
generalized
Periodontitis
simple
complex
Rapidlly progressive – type A
-- type B
Prepubertal
Juvenile
Post juvenile
symptomatic
Suzuki classification
(1988)
Adult periodontitis
Early onset periodontitis
Juvenile periodontitis
Post juvenile periodontitis
Prepubertal periodontitis
Genco classification
(1990)
Periodontitis in adult
Periodontitis in juvenile
localized
generalized
Periodontitis with systemic involvement
Primary neutrophil disorders
Secondary neutrophil impairment
Misellaneous condition
Weatherford classification
(1987)
Disease affecting surface of gingiva
Disease affecting deeper structure
Periodontal traumaties
Periodontal abscess
 CLASSIFICATION OF THE
WORLD WORKSHOP, 1989
PERIODONTITIS
a. Adult periodontitis.
b. Early-onset periodontitis:
i. Prepubertal periodontitis:
1.1. Localized
2.2. Generalized
ii. Juvenile periodontitis
1.1. Localized
2.2. Generalized
c. Periodontitis associated with systemic diseases
d. Necrotising ulcerative periodontitis
e. Refractory periodontitis
 EUROPEAN WORKSHOP,
CLASSIFICATION
1993
A. PRIMARY DESCRIPTORS
a. Adult periodontitis
b. Early-onset periodontitis
c. Necrotising ulcerative periodontitis
B. SECONDARY DESCRIPTORS
a. Tooth distribution.
b. Rate of progression.
c. Treatment response.
d. Associated with systemic diseases.
e. Microbiological characteristics.
f. Ethnicity.
g. Other factors.
 CURRENT
CLASSIFICATION
INTERNATIONAL WORKSHOP FOR A
CLASSIFICATION OF PERIODONTAL
DISEASES & CONDITION –(1999)
GOAL – “COURSE CORRECTION” OR
“FINE TUNING” OF 1989
CLASSIFICATION
I. Gingival Diseases
A. Dental plaque-induced gingival
diseases*
1. Gingivitis associated with dental plaque only
a. without other local contributing factors
b. with local contributing factors
2. 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
3. Gingival diseases modified by medications
a. drug-influenced gingival diseases
1) drug-influenced gingival enlargements
2) drug-influenced gingivitis
a) oral contraceptive-associated
gingivitis
4. Gingival diseases modified by malnutrition
a. ascorbic acid-deficiency
gingivitis
b. other
B. Non-plaque-induced gingival lesions

1. Gingival diseases of specific bacterial origin

a. Neisseria gonorrhea-associated lesions
b. Treponema pallidum-associated lesions
c. streptococcal species-associated
lesions
d. other
2. Gingival diseases of viral origin
a. herpesvirus infections
1) primary herpetic gingivostomatitis
2) recurrent oral herpes
3) varicella-zoster infections
b. other
3. Gingival diseases of fungal origin
a. Candida-species infections
1) generalized gingival
candidosis
b. linear gingival erythema
c. histoplasmosis
d. other
4. Gingival lesions of genetic origin
a. hereditary gingival fibromatosis
b. other
5. Gingival manifestations of
systemic conditions
a. mucocutaneous disorders
1) lichen planus
2) pemphigoid
3) pemphigus vulgaris
4) erythema multiforme
5) lupus erythematosus
6) drug-induced
b. allergic reactions
1) dental restorative materials
a) mercury
b) nickel
c) acrylic
d) other
2) Reaction attributable to
a)toothpastes/dentifrices
b)Mouthrinses / mouthwashes
c)Chewing bum additives
6. Traumatic lesions (factitious, iatrogenic,
accidental)
a. chemical injury
b. physical injury
c. thermal injury
7. Foreign body reaction
8. Not otherwise specified (NOS)
II. Chronic Periodontitis
A. Localized
B. Generalized
III. Aggressive Periodontitis
A. Localized
B. Generalized
IV. Periodontitis as a Manifestation of
Systemic Diseases
A. Associated with
hematological
disorders
1. Acquired neutropenia
2. Leukemias
3. Other
B. Associated with genetic disorders
1.Familial and cyclic neutropenia
2 Down syndrome
3. Leukocyte adhesion deficiency syndromes
4. Papillon-Lefèvre syndrome
5. Chediak-Higashi syndrome
6. Histiocytosis syndromes
7. Glycogen storage disease
8. Infantile genetic agranulocytosis
9. Cohen syndrome
10. Ehlers-Danlos syndrome (Types IV and VIII)
11. Hypophosphatasia
V. Necrotizing Periodontal Diseases
A. Necrotizing ulcerative gingivitis
(NUG)
B. Necrotizing ulcerative
periodontitis (NUP)
VI. Abscesses of the Periodontium
A. Gingival abscess
B. Periodontal abscess
C. Pericoronal abscess
VII. Periodontitis Associated With
Endodontic Lesions
A. Combined periodontic-endodontic lesions
VIII. Developmental or Acquired Deformities
and Conditions
A. Localized tooth-related factors that modify
or predispose to plaque-induced gingival
diseases/periodontitis
1. Tooth anatomic factors
2. Dental restorations/appliances
3. Root fractures and cemental tears
B. Mucogingival deformities and
conditions around teeth
1. Gingival/soft tissue recession
a. facial or lingual surfaces
b. interproximal (papillary)
2. Lack of keratinized gingiva
3. Decreased vestibular depth
4. Aberrant frenum/muscle position
5. Gingival excess
a. pseudopocket
b. inconsistent gingival margin
c. excessive gingival display
d. gingival enlargement
C. Mucogingival deformities and
conditions on edentulous ridges
1. Vertical and/or horizontal ridge deficiency
2. Lack of gingiva/keratinized tissue
3. Gingival/soft tissue enlargement
4. Aberrant frenum/muscle position
5. Decreased vestibular depth
6. Abnormal color

D. Occlusal trauma
1. Primary occlusal trauma
2. Secondary occlusal trauma
 Conclusion
The 1999 classification system has been
approved by the AAP, is now official
terminology for that organization, and will be
used in accredited graduate periodontal
programs and board examinations.
The Parameters of Care4 approved by the AAP
have adopted the new classification and future
publications will use it as their standard.
 Referances
Clinical periodontology Carranza,
Newman
8th edition & 9th edition
Periodontal therapy Nabers & Stalker
Foundation of periodontic for dental
hygienist Jill’s Nield – gehrig, Donald
E.william
www.uic.edu/classes/peri/peri323/syallbus/class/index.htm
www.perio.org/resources-products/classification.pdf
www.odont.lu.se/depts/par/eaop/currclas.html