Classification Of Periodental Lesions

Traditionally the periodontal lesion have been divided into two major categories: 1Gingival disease ( included that disease attack only the gingiva) 2Periodental disease ( involve the supporting structures of the teeth)

Classification of page and Schroeder 1982

1234prepubrtal periodontitis (generalized , localized) juvenile periodontotis. Rapidly progressing periodontitis. Adult periodontitis.

Classification of world workshop in clinical periodontics 1989

12Adult periodontitis. Early onset periodontitis. Prepubrtal (generalized , localized). Juvenile (generalized , localized). Rapidly progressing periodontitis 3Periodontitis associated with systemic diseases ( Down syndrome , Diabetes , AIDS ). 4Necrotizing ulcerative periodontitis . 5Refractory periodontitis.

Classification of American Academy of Periodontal Diseases ( AAP) 1999

12345678AGingival diseases . Chronic periodontitis. Aggressive periodontitis. Periodontitis as a manifestation of systemic diseases . Necrotizing periodontal diseases. Abscesses of periodontium . Periodontitis associated with Endodontic lesions . Developmental or acquired deformities and conditions .

-Gingival diseases :
1-

Dental Plaque-induced gingival diseases.

Gingivitis associated with dental plaque only: a- Without other local contributing factors. b- With local contributing factors ( Tooth anatomy and restorations or appliances and root fractures , cervical root resorption). 2Gingival diseases modified by systemic factors. * Associated with endocrine system 1- Prepuberty associated gingivitis. 2- Menstrual cycle associated gingivitis. 3- Pregnancy associated (a. gingivitis , b. pyogenic granuloma ) . 4- Diabetes mellitus associated gingivitis. * Associated with blood dyscrasias. 1- Leukemia-associated gingivitis .

2- others.

3- Gingival diseases modified by medication. * Drugs influenced gingival diseases. 1- Drug influence gingival enlargements . ( phynotin , Cyclosporin , Nifidipine). 2- Drug influenced gingivitis ( Oral Contraceptive Drugs). 4- Gingival diseases modified by malnutrition. - Ascorbic acid-deficiency ginigivtis. - Other.

B-

Non-plaque-induced gingival lesion.

Gingival diseases of specific bacterial origin. a- Neisseria gonormeo-associated lesions. b- Treponema pallidum-associated lesions. c- Streptococcal species-associated lesions. d- Other. 2Gingival diseases of viral origin. * Herpes Virus Infections. -Primary herpitic gingivostomatitis. -Recurrent oral herpes. -Varicella-zoster infections. *Other. 3- Gingival diseases of fungal origin. * Candida-species infections. (Generalized gingival candidiosis). * Linear gingival erythema. * Histoplasmosis. * Other. 4- Gingival lesions of genetic origin. * Hereditary gingival fibromatosis. * Other 5- Gingival manifestation of systemic condition. * Mucocutaneous disorder. 1- Lichen Planus . 2- Pemphigoid. 3- Pemphigus Vulgaris. 4- Erythema multiforme. 5- Lupus erythematosus. 6- Drug-induced. 7- Other * Allergic reactions. 1-Dental restorative materials. a-Mercury. c- Nickle. b-Acrylic. d- Others. 2- Reaction attributed to a- Toothpaste \ dentifrices. b- Mouth rinses \ mouth washes. 1-

c- Chewing gum additives. d- Food and addictives. 3- Others. 6- Traumatic lesions ( factitious ,iatrogenic, accidental). a- Chemical injury. b- Physical injury. c- Thermal injury. 7- Foreign body reactions. 8- Not otherwise specified.

- Chronic periodontitis. - Aggressive periodontitis. Chronic periodontitis Age Clinical presentation Familial tendency Affected area{site} Plaque accumulation Bacterial smear Extent
>30 years old, patients may be younger .

Aggressive periodontitis
<30 years old. Patients may be older. + (Incisors and first molars). + () Interproximal sites Inconsistent with the defects Aa, PG, TP, PI L.1st molar & incisor&at least two teeth. G. 1st molar & incisor & at least three teeth. Rapidly Most common vertical Usually advance

Any site may affected Consistent with the defect A community of bacteria Localized < 30

Generalized > 30

Progression Type of bone defect severity

Slowly Most common horizontal Slight-moderate sever

IV- Periodontits as a manifestation of systemic diseases.

* Associated with hematological disorders 1- Leukemia. 2 Other. * Associated with genetic disorder. 1- Familial and cyclic neutropenia 2- Down syndrome 3- Leukocyte adhesion deficiency syndrome 4- Chediak-Higashi syndrome 5- Histocytosis syndrome 6- Glycogen storage disease 7- Infantile genetic agranulocytosis 8- Cohen syndrome 9- Ehlers-Danlos syndrome 10- Hypophosphatasia 11- Other

V- Necrotizing periodental diseases.

* Necrotizing ulcerative gingivitis (gingival necrosis)

* Necrotizing ulcerative periodontitis (necrosis of gingival, periodontal ligament and alveolar bone). Main features Pain (usually rapid onset), interdental necrosis and bleeding. Secondary diagnostic features include fetid breath and pseudomembrane formation .

VI- Abscesses of periodontium. * Gingival Abscesses. * Periodontal Abscesses. * Periocoronal Abscesses. VII- Periodontitis associated with endodontic lesions. Perio-Endo lesion. Endo-perio lesion. Combined Perio-Endo lesion. VIII- Developmental or Acquired deformities and conditions. A- Localized tooth-related factors that modify or predispose to plaque-induced gingival disease/periodontitis. 1- Tooth anatomic factors. 2- Dental restoration or appliances . 3- Root fractures. 4- Cervical root resorption and cemental tears.

B- Mucogingival deformities and conditions around teeth. 1- Gingival\soft tissue recession. a-Facial or lingual surfaces. bInterproximally (papillary) 2- Lack of keratinized gingival. 3- Decreased vestibular depth. 4- Aberrant frenum\muscle position. 5- Gingival excess. a-Pseudopocket . bInconsistent gingival margin. c-Excessive gingival display. dGingival enlargement. e-Abnormal color. C- Mucugingival deformities and conditions on edentulous ridges. 1- Vertical and/or horizontal ridge deficiency. 2- Lack of gingival/keratinized tissue. 3- Gingival/soft tissue enlargement. 4- Aberrant frenum/muscle position. 5- Decrease vestibular depth. 6- Abnormal color. D- Occlusal trauma. 1- Primary occlusal trauma. 2- Secondary occlusal trauma.

Sana'a University Faculty Of Dentistry Fifth Level

Prepared by : supervised by: Fathi Noor Aldin Al-Salahi Mohammed Sultan Dhaif Allah Shara'abi

Dr. Dr. Issam Dr. Ali Al-