The new classification system offers a framework for defining periodontal health, gingivitis, periodontitis, and peri-implant diseases and conditions. Oral health professionals have an opportunity to use this model to increase consistency in diagnosing periodontal conditions and educating patients on their periodontal treatment needs. REFERENCES
Full Answer
What's new in periodontal classifications?
As a review, the periodontal classifications were revised in 1999 and classified as chronic, aggressive (localized and generalized), necrotizing, and a manifestation of systemic disease. 1 New technology, research, and information has emerged in the past 18 years which led to the new revisions. The American Academy of Periodontology ...
What are the shortcomings of the 1999 classification for periodontitis?
What are the shortcomings of the current 1999 classification with regards to periodontitis? These include substantial overlap and lack of clear pathobiology‐based distinction between the stipulated categories, diagnostic imprecision, and implementation difficulties.
Is there a new classification for retrograde periodontal disease?
A new endodontic-periodontal interrelationship classification, based on the primary disease with its secondary effect, is suggested as follows: retrograde periodontal disease: primary endodontic lesion with drainage through the periodontal ligament, primary endodontic lesion with secondary periodontal involvement; primary periodontal lesion;
What is the most widely used classification of endodontic periodontal lesions?
Based on these classifications, the most widely used classification of endodontic-periodontal lesions is the one that has been classified by Simon et al. [ 20 ], according to the primary cause of disease. One of the main classification items was primary endodontic disease, which we believe should be modified,...
What is the new periodontal classification?
The new classification, which introduces the concept of staging, supports a multidimensional view of periodontitis, incorporating severity, tooth loss due to periodontitis, and complexity of management of the patient's periodontal and overall oral rehabilitation needs.
What are the classifications of periodontal disease?
Periodontal disease can be grouped as periodontitis, necrotizing periodon- titis, and periodontitis as a manifestation of systemic conditions. An assessment of the periodontal status of pediatric patients should be part of a routine dental visit and oral examination.
What can be done about stage 4 periodontal disease?
There is no treatment that will keep a Stage 4 tooth healthy, and without extraction, these teeth will cause continued pain, inflammation, and can result in progressive periodontal disease of other teeth. Therefore, if any tooth has stage 4 periodontal disease, we recommend extraction as the only option.
What are the three categories of periodontal health?
Staging of periodontitis:Stage I (initial) ... Stage II (moderate) ... Stage III (severe with potential for additional tooth loss) ... Stage IV (severe with potential for loss of dentition)
What are the 5 stages of periodontal disease?
5 Stages of Gum Disease: Spotting the Signs to Get Treatment in...First Signs. In the very early stages of gum disease, your teeth will seem basically healthy. ... Gingivitis. ... Early Periodontitis. ... Moderate Periodontitis. ... Advanced Periodontitis.
How is the severity of periodontal disease determined?
Severity is based on the amount of clinical attachment loss (CAL) and is designated as slight (1-2 mm CAL), moderate (3-4 mm CAL) or severe (> 5 mm CAL). Refractory periodontitis refers to continued attachment loss in spite of adequate treatment and proper oral hygiene.
How is advanced periodontitis treated?
If you have advanced periodontitis, treatment may require dental surgery, such as: Flap surgery (pocket reduction surgery). Your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing.
What is advanced periodontitis?
Advanced Periodontal Disease: The final stage of periodontal disease is when the infection has evolved into disease-causing bacteria. It can cause redness, swollen gums that ooze pus, sensitivity, loosening of teeth, painful chewing, severe bad breath, and bone loss.
Can severe periodontitis be cured?
Periodontitis can be cured in some situations but it is more difficult than simply improving your oral hygiene routine. For some people, unfortunately, there is a point where a cure is not possible and the only option is to manage the symptoms.
Why is there a need for classification system for periodontal disease?
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.
What are the determinants of clinical periodontal health?
Determinants of periodontal health fall into 3 major categories, namely, microbiological, host, and environment (Table 1).
How do you classify reduced Periodontium?
Clinical gingival health on a reduced periodontium is characterized by an absence of bleeding on probing, erythema, edema and patient symptoms in the presence of reduced clinical attachment and bone levels....Reduced periodontiumNon-periodontitis patientHealthGingivitisRadiological bone lossPossiblePossible4 more rows•Jun 21, 2018
What is the new classification system for periodontal and periimplant health?
Last June at the EuroPerio9 congress in Brussels, a new global classification system for both periodontal and peri-implant health, diseases and conditions was announced. It is the result of a collaboration held between the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) where over 100 experts reviewed existing literature to create a consensus that should allow standardised care for patients around the world.
What is periodontal health?
The World Health Organisation defines health as 'A state of complete physical, mental and social wellbeing and not merely absence of disease of infirmity' and in accordance with this periodontal health would be defined as 'A state free from inflammatory periodontal disease that allows an individual to function normally and not suffer any consequences (mental or physical) as a result of past disease.' 1, 2 However, this is a little impractical and limiting in terms of clinical management so a more practical definition of periodontal health is 'A state free from inflammatory periodontal disease.' 2 This is the first time that clinical health has been defined in a periodontal classification system. 3, 4
What is periodontitis treatment?
It is defined as a state in which periodontitis has been successfully treated and clinical signs of the disease do not appear to worsen in extent or severity despite presence of a reduced periodontium. 2 This means that the disease has been treated through control of local and systemic modifying factors like cessation of smoking or good glycemic control of diabetes, which results in minimal bleeding on probing and improvements in periodontal probing depths although there will not be normal gingival sulcus depth nor normal bone heights. This is the ideal treatment outcome for a patient with periodontitis.
When was periimplant bone loss first defined?
It was first defined in 1993 at the 1st European Workshop on Periodontology and has been addressed numerous times since then. 8 It is inflammation of peri-implant tissues in the absence of continuous marginal peri-implant bone loss and is characterised by visual signs of inflammation like redness, swelling, bleeding on gentle probing and sometimes suppuration. 7, 8
Why is the periodontal classification system important?
The new periodontal classification system allows clinicians to better categorize patients’ oral health based on clinical and radiographic findings. Now that the oral-systemic link is part of the classification system, it will help patients become more involved in knowing the state of their diseases.
What is periodontal health?
Periodontal health is clearly defined by the absence of clinical detectable inflammation. Clinical gingival health can be found on a periodontium that is intact without clinical attachment loss (CAL) or bone loss, and on a reduced periodontium in either a patient without periodontitis or in a patient who has a history of periodontitis who is clinically stable.
What diseases affect the periodontium?
Other conditions affecting the periodontium. Systemic diseases associated with loss of periodontal-supporting tissues, such as neoplastic diseases, may affect the periodontium independent of dental plaque-induced periodontitis and should be categorized based on the primary systemic disease.
What is the staging system for periodontitis?
Periodontitis is then further characterized by a staging and grading system. Staging is based on the severity of the disease and the complexity of the disease management. When staging a patient, it is important to note that it takes only one complexity factor to shift the diagnosis to a higher stage.
Is periodontitis a systemic disease?
Periodontitis as a manifestation of systemic disease is a category developed to account for the systemic diseases and conditions that affect the periodontium. There are rare conditions that result in periodontitis, and these should be grouped in this category. 2.
What is the risk of periodontitis progression?
Risk of further periodontitis progression. Anticipated inferior treatment outcomes. Risk that the disease or its treatment may negatively affect the general health of the patient. One of the benefits of the new classification is that is accounts of risk factors / “grade modifiers”, specifically smoking and diabetes.
What is necrotising periodontal disease?
Necrotising periodontal diseases have a distinct pathophysiology. They are characterised by the presence of ulcers within the stratified squamous epithelium and the superficial layer of the gingival connective tissue, surrounded by a non‐specific acute inflammatory infiltrate.
What are the conditions that affect the periodontium?
Other Conditions Affecting the Periodontium: These conditions include systemic diseases affecting the periodontium, periodontal abscesses or endodontic-periodontal lesions, mucogingival deformities and conditions, traumatic occlusal forces, and tooth and prosthesis-related factors.
What are the different types of periodontal diseases?
As detailed in the Journal of Clinical Periodontology, the new classification system identifies three types of periodontal diseases and conditions along with several important subcategories: 1 Periodontal Health, Gingival Diseases and Conditions: This category includes periodontal and gingival health, gingivitis related to dental biofilm and gingival diseases/conditions not related to biofilm. 2 Periodontitis: This classification encompasses necrotizing periodontal diseases, periodontitis (no longer identified as chronic or aggressive) and periodontitis as a manifestation of systemic diseases. 3 Other Conditions Affecting the Periodontium: These conditions include systemic diseases affecting the periodontium, periodontal abscesses or endodontic-periodontal lesions, mucogingival deformities and conditions, traumatic occlusal forces, and tooth and prosthesis-related factors.
How many people have dental implants?
According to the American Academy of Implant Dentistry, 3 million people in the U.S. currently have dental implants and the number is increasing by 500,000 annually.
What is periimplant health?
Peri-implant health: A lack of visible inflammation and no bleeding upon probing. Peri-implant mucositis: Bleeding on probing and visible signs of inflammation. Peri-implantitis: Inflammation of peri-implant mucosa followed by progressive loss of surrounding bone.
What causes periodontal lesions?
It is known that the main cause of the periodontal lesions is the presence of the bacterial plaque, formed by aerobic and anaerobic microorganisms [9–12]. Pulp exposures, periodontitis, and caries lesions are of significant importance in the development of periodontal-endodontic lesions.
Why is it so hard to diagnose a pulpal lesion?
This makes it difficult to diagnose because a single lesion may present signs of both endodontic and periodontal involvement. There is a general agreement today that the vast majority of pulpal and periodontal lesions are the result of bacterial infection.
What does it mean when a tooth is symptomatic?
A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem.
Why do root canals get recontaminated?
Root canals may become recontaminated by microorganisms due to delay in placement of a coronal restoration and fracture of the coronal restoration and/or the tooth.
Does periodontal disease cause pulp necrosis?
Rubach and Mitchell [18] suggested that the periodontal disease may affect the pulp health when the accessory canal exposure occurs, allowing the periodontopathogenic bacteria to cause inflammatory reactions followed by pulp necrosis.
Is an endoperio lesion a complex disease?
An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult, but it is of vital importance to make a correct diagnosis for providing the appropriate treatment.