Dahanna Jasmine Joson

(1999 AAP Classification of Periodontal Diseases and Conditions)

CLASSIFICATION OF PERIODONTAL Definition/Symptoms SAMPLE CASE

DISEASES

1. Gingival Disease Signs and Symptoms includes redness

and swelling, bleeding, does not cause
loss of clinical attachment
This is caused by bacterial plaque,
local plaque or other retention factors

A. Dental Plaque-Induced Gingival Plaque‐induced gingivitis is

Disease inflammation of the gingiva resulting
from bacteria located at the gingival
margin.

These diseases may occur on a

periodontium with no attachment loss
or on one with attachment loss that is
stable and not progressing

a. Without local contributing factors-

B. Non-Plaque-Induced Gingival
Disease
b. With local contributing factors -
Associated with endocrine system
Puberty-associated gingivitis
Menstrual cycle-associated gingivitis
Pregnancy-associated
Diabetes mellitus-associated
gingivitis
Associated with blood dyscrasias
2. Chronic Periodontitis It is caused by bacterial plaque,
smoking, Plaque control, smoking, local
plaque retentive factors, such as
dental calculus and faulty restorations
Overall slow progression with
generalized periodontal pockets, bone
and clinical attachment loss, may be
generalized or localized
It was categorized to localized and
generalized. Generalized (> 30% of
sites are involved)

3. Aggressive Periodontitis Rapid loss of attachment and Clinical status of a 27‐year‐old female
supporting bone. It is significantly diagnosed with generalized aggressive
faster than chronic periodontitis periodontitis with furcation involvement
Patient is otherwise healthy, not
suffering from any systemic disease or
condition that could be responsible for
the present periodontitis
Cause by Bacterial plaque,
superinfection with specific periodontal
bacteria, possible impaired host
response, smoking
Signs and symptoms include severe
and rapid periodontal, by periods of
remission, may be generalized or
localized
It was categorized to localized and
generalized. Generalized (> 30% of
sites are involved)
This also can be a familiar aggregation
where there are similar cases within
the family
Classified into two:
Generalized aggressive periodontitis –
happens to people under the age of
30 , affecting more than fourteen
teeth, generalized to an entire arch or
an entire dentition
Localized aggressive periodontitis –
located in the 1st molars and incisors
with least destruction in the canine and
 premolar area, found in much younger
individual than GAP

4. Periodontitis as manifestation of Associated with disorders of the blood

systemic disease or blood forming organs such as
neutropenia, leukemia or genetic
disorders
Generalized and localized forms of
severe destruction of bone and
connective tissue tooth support

A. Associated with hematological Several hematologic and genetic

disorders disorders have been associated with
the development of periodontitis in
affected individuals
It is speculated that the major effect of
these disorder is through alterations in
immune response
The clinical manifestation of many of
these disorders appears at an early
age and may be confused with
aggressive forms of periodontitis
This was one of the drivers for the
transition from the term early-onset
periodontitis, which characterized a
heterogenous group of disease
B. Associated with genetic Systemic conditions that are
disorders associated with or that predispose and
individual to periodontal destruction
include genetic disorders that result in
an inadequate number or reduced
function of circulating neutrophils
In addition, severe periodontitis has
been observed in individuals who
exhibit secondary neutrophil
impairment, such as those with Down
syndrome, papillon-Lefevre syndrome
and inflammatory bowel disease
C. Not otherwise specified
5. Necrotizing periodontal diseases Acute necrotizing gingivitis – cause by
Bacterial plaque, may be associated
 with AIDS at any age
It presents as Pain, gingival redness,
swelling, bleeding, necrosis of
interproximal papilla
Necrotizing ulcerative gingivitis Sudden onset, bleeding on
toothbrushing
Pain and characteristic halitosis
The gingiva appears fiery-red and
swollen and yellow to grayish necrosis
is observed on the tip of the
interdental papilla and margins of the
gingiva.
Mostly anterior gingiva is affected and
normally limited to the soft tissue of
the periodontium.

Necrotizing ulcerative periodontitis Severe pain, localized soft tissue

necrosis, ulceration and interproximal
cratering
Not associated with deep pocket
formation but instead there is a loss of
crestal bone coinciding with soft tissue
destruction
Rapid horizontal bone loss in the
absence of severe gingival
inflammation has been reported
Tooth mobility is a common feature
Associated with severe immune
suppression with CD4+ cell count
below 200 cells/mm3

Caused by Subgingival bacteria

6. Abscesses of the periodontium Painful, acute swelling of periodontal
tissues associated with deep
 periodontal pocket

A. Gingival abscess The gingival abscess is confined to the

marginal gingiva, and it often occurs in
previously disease-free areas. It is
usually an acute inflammatory
response to the forcing of foreign
material into the gingiva.
Gingival abscess is a localized, painful,
rapidly expanding lesion, that is
usually sudden in onset
Signs and Symptoms
a. It is a rapidly expanding lesion,
which is usually limited to marginal
gingiva or interdental papilla.
b. It appears as a red swelling with
smooth shiny surface which is painful
and the associated teeth are sensitive
to percussion.
c. The lesion becomes fluctuant and
pointed with a surface orifice from
which purulent exudate may be
expressed. If it is allowed to progress,
the lesion may rupture spontaneously.
Etiology: It occurs as a result of
bacteria, being carried deep into the
tissues when foreign substances such
as toothbrush bristle or fragments of
food substance are forcefully
embedded into the gingiva
B. Periodontal abscess The periodontal abscess involves the
supporting periodontal structures, and
it generally occurs during the course of
chronic destructive periodontitis.
A periodontal abscess is a localized
accumulation of exudate within the
gingival wall of a periodontal pocket
 C. Pericoronal abscess The pericoronal abscess results from
inflammation of the soft tissue
operculum, which covers a partially
erupted tooth. This situation is most
often observed around the mandibular
third molars. As with the gingival
abscess, the inflammatory lesion may
be caused by the retention of microbial
plaque biofilm, food impaction, or
trauma
The pericoronal abscess is associated
with the crown of a partially erupted
tooth.

Periodontitis Associated with The classification of lesions that affect

endodontic lesions the periodontium and the pulp is based
on the sequence of the disease process
A category of periodontal disease that
involves infection or death of the
tissues of the dental pulp.
A. Combined periodontic In endodontic periodontal lesions,
endodontic lesions pulpal necrosis precedes periodontal
changes. A periapical lesion that
originates with pulpal infection and
necrosis may drain to the oral cavity
through the periodontal ligament,
thereby resulting in the destruction of
the periodontal ligament and the
adjacent alveolar bone. This may
present clinically as a localized, deep,
periodontal probing depth that extends
to the apex of the tooth
Combined lesions occur when pulpal
necrosis and a periapical lesion
occur on a tooth that is also
periodontally involved. An intrabony
defect that communicates with a
periapical lesion of pulpal origin
results in a combined periodontal
endodontic lesion
In all cases of periodontitis associated
 with endodontic lesions, the
endodontic infection should be
controlled before the definitive
management of the periodontal lesion
is begun, especially when regenerative
or bone grafting techniques are
planned.

Developmental or acquired deformities

and conditions

A. Localized tooth-related factors In general, localized tooth-related

that modify or predispose to factors contribute to the initiation and
plaque-induced gingival progression of periodontal disease
diseases/periodontitis through the enhancement of plaque
accumulation or the prevention of
effective plaque removal via normal
oral hygiene measures. These factors
fall into the four subgroups:
i. Tooth anatomic factors:
Tooth anatomic factors are
associated with
malformations of tooth
development or tooth
location. Anatomic factors
e.g., cervical enamel
projections, palatal grooves,
enamel pearls, have been
associated with clinical
attachment loss, especially in
furcation areas
ii. Dental restorations or
appliances: Dental
restorations or appliances
are frequently associated
with the development of
gingival inflammation.
 Restorations placed deep in
the sulcus or within the
junctional epithelium may
impinge on the biologic width
resulting in inflammation and
the loss of clinical
attachment and bone.
Contour of a complete crown
restoration can affect plaque
retention with flat surfaces
being more hygienic as
compared to convex
restorations exhibiting
increased bulk of material at
the cervical region
iii. Root fracture: Root fractures
may be associated with
endodontic or restorative
procedures as well as
traumatic forces and may
lead to periodontal
involvement through the
apical migration of plaque
along the fracture line
iv. Cervical root resorption and
cemental tears: The
atraumatic removal of teeth
with progressed cervical
resorption lesions and the
reconstruction of resultant
ridge defects with bone
grafts, dental implants, and
prostheses are viable
solutions for such defects
Avulsed teeth that are
reimplanted frequently
develop ankylosis and
cervical root resorption many
years after reimplantation.
B. Mucogingival deformities and Mucogingival deformity is a generic
conditions around teeth term used to describe the
mucogingival junction and its
relationship to the gingiva the alveolar
mucosa, and frenula muscle
attachments.
A mucogingival deformity is a
significant departure from the normal
shape of the gingiva and the alveolar
mucosa, and it may involve the
underlying alveolar bone.
Mucogingival surgery and periodontal
plastic and aesthetic surgery correct
defects in the morphology, position, or
amount of gingiva.

i. Vertical and/or horizontal ridge

deficiency
ii. Lack of gingiva or keratinized
tissue
iii. Gingival or soft tissue
enlargements
iv. Aberrant frenum or muscle
position
v. Decreased vestibular depth
vi. Abnormal color
C. Mucogingival deformities and Mucogingival deformities, such as a
conditions on edentulous ridges lack of stable keratinized gingiva
between the vestibular fornices and
the floor of the mouth, may require
soft-tissue grafting and vestibular
deepening before prosthodontic
reconstruction
Alveolar bone defects in edentulous
ridges usually require corrective
surgery to restore form and function
before the placement of implants and
prostheses to replace missing teeth.
D. Occlusal trauma When an adequate quantity of
periodontal support is present to
withstand the normal forces of
occlusion, yet excessive parafunctional
forces exceed the adaptive capacity of
the attachment apparatus, the disease
process is referred to as primary
occlusal trauma.
When the quantity of the remaining
normal attachment apparatus has
been compromised by periodontal
disease and cannot withstand the
normal forces of occlusion, the disease
process is referred to as secondary
occlusal trauma.