Classification of periodontal diseases

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The current classification of periodontal diseases is based on the resolutions of the “International Workshop for a Classification of Periodontal Diseases and Conditions” from 1999. After it was translated by the relevant specialist societies, it is gradually gaining acceptance in Europe.

A classification of periodontal diseases primarily makes sense to standardize international research into causes and therapy concepts and to enable quick and clear communication within the specialist group. It also gives outsiders an overview of the complex topic and thus simplifies the search for causes and treatment options for changes in the tooth support system.

Anatomical basics

The teeth are anchored in the oral cavity via the periodontium (tooth holding apparatus). This functional unit is made up of the gingiva (gums), cement , periodontal ( periodontal membrane) and alveolus (tooth socket). The periodontium is also closely related to the rest of the oral mucosa and the jawbone. All of these structures can be affected by pathological changes.

Types of Periodontal Diseases

All changes in the periodontium are classified according to whether they affect the mucous membrane alone (gingival diseases) or whether the remaining structures are also affected (periodontal diseases). A distinction is also made between inflammatory and non-inflammatory processes. Due to the close physiological relationships, the diseases can merge. Since many periodontal changes resemble other oral mucosal diseases in the clinical picture, these are also taken into account in a complete classification.

The long nomenclature dispute

The oldest reference to periodontal disease comes from Aulus Cornelius Celsus from the first century AD. But it was only Pierre Fauchard who first described the clinical symptoms of periodontal disease in 1746. In 1885 it was proposed to name the disease described "Maladie de Fauchard" after its author.

Inspired by various research work, but also by developments in basic medical subjects well into the 20th century, a lengthy discussion about nomenclature began. Often a new hypothesis on the etiology of periodontal disease was sufficient to demand a new terminology and classification. Until the 1970s, various names for the same clinical picture developed, although different synonyms were sometimes used at each teaching institution for mainly ideological reasons.

The German Society for Periodontology (DG PARO) tried in 1975 to settle this dispute through a uniform nomenclature. Although this was used consistently during the following years, criticism of this classification soon arose. The main criticism was that there was no term for non-inflammatory shrinkage processes on the tooth supporting apparatus. In addition, the continued use of the term "parodontosis" for inflammatory changes was bothered. In 1987 the DGP carried out a further revision.

1987 classification

Since the exact causes and reasons for most periodontal diseases were mostly still unknown at this point in time, this classification mainly tried to update the definitions of the respective clinical pictures. They were divided into 5 main groups according to the clinical picture.

  • Inflammatory forms
    • acute or chronic inflammation of the gingiva or periodontium
    • caused by bacterial deposits
    • divided according to the course and age at the onset of the disease
  • Gingivoparodontal manifestations of systemic diseases
    • not caused by plaque, but can be covered by inflammatory forms
  • Hyperplastic forms
    • primarily inflammation-free growths of the gums
    • localized or generalized occurrence
    • further distinctions according to the histological structure
  • Traumatogenic forms
    • mechanical, chemical or thermal injuries
    • Damage can affect the mucous membrane or the entire supporting tissue
  • Involutive forms
    • inflammation-free regression of the periodontium
    • localized or generalized occurrence
    • also related to the toothless jaw

Current classification from 1999

Many shortcomings were also soon discovered in the 1987 classification. The main point of criticism was that the age of the patients at the onset of the disease was overemphasized. In contrast, recent studies have shown that although there are clusters within the age groups, all forms of progression can still occur in both early and later life.

In addition, many changes in the periodontal area have been completely excluded. Gingivopathies in particular were not adequately recorded. Another problem was that for a long time there was no globally accepted, uniform nomenclature. That is why, in addition to the classification according to the German Society for Periodontology (DGP) from 1987, many scientists also used that of the American Academy of Periodontology (AAP) from 1977, or that of the World Health Organization (WHO) from 1978.

The current classification is particularly convincing in that it enables a clear assignment according to the causes for the many forms of disease that are not associated with plaque . It is used internationally by most specialist societies and thus enables simple scientific and clinical application.

Main groups

Periodontal diseases are divided into 8 main groups:

  1. Gingival Diseases (G)
  2. Chronic Periodontitis - Chronic Periodontitis (CP)
  3. Aggressive Periodontitis - Aggressive Periodontitis (AP)
  4. Periodontitis as a Manifestation of Systemic Diseases (PS)
  5. Necrotizing Periodontal Diseases (NP)
  6. Periodontal Abscesses - Abscesses of the Periodontium
  7. Periodontitis associated with endodontic lesions - periodontitis associated with Endodontic Lesions
  8. Developmental or acquired Deformities and Conditions

Subgroups

These main groups are divided into various subgroups. For the sake of clarity, only the most important are mentioned here.

  • Gingival diseases
    • Plaque induced gingival disease
      • Gingivitis caused by plaque alone
      • Gingival diseases modified by systemic factors
        • Hormonal influences (puberty, menstruation, pregnancy, diabetes mellitus)
        • Blood picture disorders (leukemia, etc.)
      • Gingival diseases modified by medications (phenytoin, oral contraceptives, etc.)
      • Gingival diseases modified by malnutrition (vitamin C deficiency, etc.)
    • Gingival disease not induced by plaque
      • Gingival diseases caused by specific bacteria (N. gonorrhoea, T. pallidum, streptococci, etc.)
      • Gingival diseases of viral origin (all forms of herpes infections)
      • Gingival fungal diseases (candida, histoplasmosis, etc.)
      • Gingival diseases of genetic origin
  • Chronic periodontal disease
    • Localized (up to 30% of all tooth surfaces are affected)
    • Generalized (more than 30% of all tooth surfaces are affected)

In addition, the severity of the disease is classified according to the attachment loss as light (1–2 mm), medium (3–4 mm) or severe (≥5 mm).

  • Aggressive periodontal disease
    • Localized
    • Generalized
  • Periodontitis as a manifestation of a systemic disease
    • Associated with blood formation disorders ( leukemia, etc.)
    • Associated with genetic disorders
      • Familial or cyclic neutropenia
      • Down syndrom
      • White blood cell adhesion deficiency syndrome
      • Papillon-Lefèvre syndrome, keratoma palmare et plantare
      • Chediak-Higashi Syndrome
      • Histiocytosis Syndrome or Eosinophilic Syndrome
      • Glycogen Storage Disease
      • Infantile genetic agranulocytosis
      • Cohen Syndrome
      • Ehlers-Danlos Syndrome (Type IV and VIII AD)
      • Hypophosphatasia
  • Necrotizing periodontal diseases
    • Necrotizing Ulcerative Gingivitis (NUG)
    • Necrotizing Ulcerative Periodontal Disease (NUP)
  • Abscess of the periodontium
    • Gingival abscess
    • Periodontal abscess
    • Pericoronal abscess
  • Combined periodontal-endodontal lesions
    • primarily of endodontic origin
    • primarily of periodontal origin
    • combined paro-endodontic origin
  • Developmental or acquired deviations and conditions
    • Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases / periodontitis
      • anatomical features of the tooth
      • Dental restorations
      • Root fractures
      • Tooth root resorption and cement demolition
    • Mucogingival deviations and conditions in the immediate vicinity of the tooth
      • Gingival recession
      • Lack of keratinized gingiva
      • Reduced vestibular depth, shallow oral vestibule
      • abnormal frenulum / muscle position
      • Gingival enlargement
      • Abnormal color
    • Mucogingival deviations and conditions on the edentulous ridge
      • Vertical and / or horizontal ridge deficiency
      • Lack of gingival / keratinized tissue
      • Gingival / soft tissue enlargement / growth
      • Abnormal frenulum / muscle position
      • Reduced vestibular depth, shallow oral vestibule
      • abnormal color
    • Occlusal trauma
      • Primary occlusal trauma
      • Secondary occlusal trauma

Criticism and preview

Although the current nomenclature has been in use since 1999 and has also become established in German-speaking countries since its translation at the latest, it is not yet used uniformly by all dentists. Various reasons can be found for this, some of which should also be understood as a criticism of the classification. For one thing, there is still no agreement with the WHO's International Statistical Classification of Diseases and Related Health Problems . This makes it unnecessarily difficult for dentists to use the ICD key for diagnosis, as is already required for general practitioners.

Furthermore, there is no clear assignment for the manifestations of HIV infection in the oral cavity. With this clinical picture in particular, there are often various symptoms that must be assigned separately to main groups 1, 5 and 8. In addition, many scientific papers have to fall back on older studies that were still using the old classification at the time of publication. Regardless of this, of course, every new classification is also a change for the user, which requires a certain willingness for further training. This willingness in the professional group is not high enough, which is why the older classification will probably continue to exist in parallel for some time.

Research in the field of periodontics is still far from being completed. It is of course only a matter of time before more recent results make a revision of the classification necessary. At the moment, however, one can only speculate about these innovations.

See also

Periodontics

Literature / sources

  • Klaus H. Rateitschak (Ed.): Periodontology. 3. Edition. Thieme, Stuttgart 2003, ISBN 3-13-655603-8 (color atlases in dentistry, vol. 1)
  • Detlef Heidemann (Ed.): Periodontology. 4th edition. Urban & Fischer, Munich 2005, ISBN 3-437-05490-2 (Dental Practice, Vol. 4)
  • Hans-Peter Müller: Periodontology. 3. Edition. Thieme, Stuttgart 2012 ISBN 3-13-126363-6

Web links