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Periodontics Restorative Dentistry

Diagnosing periodontal disease: what is the periodontal classification system?

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This question was submitted by a general dentist: What are the latest thoughts on periodontal disease and the classification used for its diagnosis?

Dr. Sayed Mirbod, representing the Canadian Academy of Periodontology (CAP), provided this initial quick response

The benefit of a classification system is to provide a framework to study the etiology, progression and treatment for a disease. The system can also be used by clinicians to organize their patients’ health-care needs. Diagnosing periodontal disease is directly related to the classification system that is used by the clinician and the variations in the definition of periodontal health, gingivitis and periodontitis may affect treatment outcomes (1).

In 1999, the American Academy of Periodontology (AAP) published a revised classification of periodontal diseases. The major changes included the addition of a section on gingival diseases and the replacement of Adult Periodontitis with Chronic Periodontitis. Gingival diseases are classified as either plaque-induced or not primarily associated with dental plaque. It was acknowledged that the clinical expression of dental plaque-induced gingivitis can be modified by systemic factors, such as disturbances in endocrine system, by medications, and by malnutrition. Replacement of “Adult Periodontontis” with “Chronic Periodontitis” was the result of epidemiological data and clinical experience which suggested that this form of periodontitis, commonly found in adults, can also be seen in adolescents (2).

Chronic periodontitis is defined as an inflammation of the gingiva and the adjacent attachment apparatus and is characterized by loss of clinical attachment due to destruction of the periodontal ligament and loss of the supporting bone. Clinical features may include edema, erythema, gingival bleeding upon probing, and/or suppuration. It should be noted that no single parameter, such as probing depth can be used as an indicator of periodontal disease status. However, the presence of deeper pockets in conjunction with attachment loss, bleeding on probing, radiographic evidence of bone loss, and furcation involvement, can be used in diagnosing the periodontal disease and its severity (Table 1).

Chronic periodontitis is divided into three categories of slight (mild), moderate, and severe, based on probing depth, radiographic bone loss, furcation involvement and attachment loss. For instance, severe chronic periodontitis is generally characterized by periodontal probing depths greater than 6 mm with attachment loss greater than 4 mm with radiographic evidence of bone loss. Increased tooth mobility may also be present. Chronic periodontitis may be localized, involving one area of a tooth’s attachment, or more generalized, involving several teeth or the entire dentition (3).

Table 1. Common features used to define health, gingivitis and chronic periodontitis

(Patient may simultaneously have areas of health and chronic periodontitis with slight, moderate, and severe attachment loss)

 

Probing depth

Attachment loss

Bleeding on Probing

Radiographic  bone loss

Furcation involvement

Health

 

None

No

No loss

 

Gingivitis

 

None

Yes

No loss

 

Slight chronic periodontitis

<6mm

<4mm

Yes

May be seen

Up to Grade I (if present)

Moderate chronic periodontitis

<6mm

>4mm

Yes

May be seen

Up to Grade I (if present)

Severe chronic periodontitis

>6mm

>4mm

Yes

Apparent

More than Grade I (if present)

 

References

  1. Martin JA, Grill AC, Matthews AG, Vena D, Thompson VP, Craig RG, et al. Periodontal diagnosis affected by variation in terminology. J Periodontol. 2013;84(5):606-13.
  2. [No authors listed]. Parameter on chronic periodontitis with slight to moderate loss of periodontal support. American Academy of Periodontology. J Periodontol. 2000;71(5 Suppl):853-5.
  3. [No authors listed]. Parameter on chronic periodontitis with advanced loss of periodontal support. American Academy of Periodontology. J Periodontol. 2000;71(5 Suppl):856-8.

 

Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

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