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Lectures in periodontics – 4th stageClassification of Perio. diseases – Part 1Assist. Lec. Fahad M. al Dabbagh

PeriodontitisPeriodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession, or both.

Clinical feature:1- Clinical signs of inflammation, such as changes in color, contour, and

consistency and bleeding on probing2- Presence of clinically detectable attachment loss, often accompanied by

periodontal pocket formation and changes in the density and height of subjacent alveolar bone.

3- Recession of the marginal gingiva may occur in some cases.

Classification of periodontitis:1- Chronic periodontitis.2- Aggressive periodontitis3- Periodontitis as a manifestation of systemic diseases.

Chronic periodontitis is: The most common form of periodontitis. Most prevalent in adults but can be observed in children. Associated with the accumulation of plaque and calculus. The clinical features of chronic periodontitis include symptoms such as:

1- color, texture and volume alterations of the marginal gingiva, 2- bleeding on probing (BoP) from the gingival pocket area,3- reduced resistance of the soft marginal tissues to probing (increased

pocket depth or periodontal pocketing), 4- loss of probing attachment level, 5- recession of the gingival margin, 6- loss of alveolar bone (even or angular pattern), 7- root furcation exposure, 8- increased tooth mobility, 9- Drifting and eventually exfoliation of teeth.


Generally has a slow to moderate rate of disease progression, but periods of more rapid destruction may be observed.

Subgingival calculus if frequently found. Increases in the rate of disease progression may be caused by the impact of

local, systemic (such as diabetes mellitus and HIV infection), or environmental factors (such as cigarette smoking and stress) that may influence the normal host-bacterial interaction.

May occur as a localized disease where in <30% of evaluated sites demonstrate attachment and bone loss, or as a more generalized disease wherein >30% of sites are affected.

Described by the severity as slight (1-2mm of CAL), moderate (3-4mm of CAL), or severe (≥5mm of CAL) based on the amount of clinical attachment loss.


Aggressive periodontitis is:

Differs from the chronic form primarily by the rapid rate of disease progression.

Seen in an otherwise healthy individual, an absence of large accumulations of plaque and calculus.

Family history of aggressive disease suggestive of a genetic trait.

The following characteristics are common but not universal:1- Disease sites infected with Actinobacillus Actinomycetemcomitans

(recently renamed Aggregatibacter Actinomycetemcomitans) and, in some Far East populations, Porphyromonas gingivalis

2- Abnormalities in phagocyte function.

3- Hyper responsive macrophage producing increased prostaglandin 2 and Interleukin 1β.

4- In some cases self-arresting diseases progression. Classified into :

a- localized, which characterized by:1- circum pubertal onset of disease.2- Localized to first molar and incisor with proximal attachment loss of at

least two permanent teeth, first molar is one of them.3- Robust serum anti body response to infecting agents.

b- generalized, which characterized by:1- Usually affecting persons under 30 years of age (but it can affect older

patients).2- Generalized proximal loss of attachment affecting at least three teeth

other than first molars and incisors.3- Poor serum antibody response to infecting agents.4- Pronounced episodic nature of periodontal destruction.


Periodontitis as a manifestation of systemic diseases: Several hematologic and genetic disorders have been associated with the

development of periodontitis in affected individuals.1- Hematological disorders:

a- Acquired neutropenia.b- Leukemias.

2- Genetic disorders:a- Familial and cyclic neutropenia.b- Down syndrome.c- Papillon lefevre syndrome.d- Chediak higashi syndrome.e- Cohen syndrome.f- Hypophosphatasia.


g- Glycogen storage disease.h- Leukocyte adhesion deficiency syndrome.

It is speculated that the major effect of these disorders is through alterations in host defense mechanisms.

The clinical manifestation of many of these disorders appears at an early age and may be confused with aggressive forms of periodontitis with rapid attachment loss and the potential for early tooth loss.

Periodontitis as a manifestation of systemic disease is the diagnosis to be used when the systemic condition is the major predisposing factor and local factors such as large quantities of plaque and calculus are not clearly evident.

· web viewcolor, texture and volume alterations of the marginal gingiva, bleeding on probing...

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