Periodontal diagnosis and classification

Last updated

In dentistry, numerous types of classification schemes have been developed to describe the teeth and gum tissue in a way that categorizes various defects. All of these classification schemes combine to provide the periodontal diagnosis of the aforementioned tissues in their various states of health and disease.

Contents

Alveolar ridge deficiency

In 1983, Seibert classified alveolar crestal defects: [1]

Class I: buccolingual loss of tissue with normal apicocoronal ridge height

Class II: apicocoronal loss of tissue with normal buccolingual ridge width

Class III: combination-type defects (loss of both height and width)

Furcation defect

Gingival recession

The magnitude of a receding gumline, commonly referred to as the measurement of gingival recession, is most often described using Miller's classification: [2]

Class I: Recession that does not extend to the mucogingival junction
Class II: Recession that extends to or beyond the mucogingival junction, but without loss of interproximal clinical attachment
Class III: Recession that extends to or beyond the mucogingival junction, with either loss of interproximal clinical attachment or tooth rotation
Class IV: Recession that extends to or beyond the mucogingival junction, with either loss of interproximal clinical attachment or tooth rotation that is severe

A new classification has been proposed to classify gingival and palatal recessions. The new classification system gives a comprehensive depiction of recession defect that can be used to include cases that cannot be classified according to earlier classifications. A separate classification system for palatal recessions (PR) is also proposed. The new classification system is more detailed, informative and tries to overcome the limitations of Miller's classification system. A wide array of cases which cannot be classified by application of Miller's classification, can be classified by application of Kumar & Masamatti's Classification. [3]

Tooth mobility

As a general rule, mobility is graded clinically by applying firm pressure with either two metal instruments or one metal instrument and a gloved finger. [4]

Normal mobility
Grade I: Slightly more than normal (<0.2mm horizontal movement)
Grade II: Moderately more than normal (1-2mm horizontal movement)
Grade III: Severe mobility (>2mm horizontal or any vertical movement)
Miller Classification
Tooth mobility can also be classified using the Miller Classification:
  • Class 1: < 1 mm(Horizontal)
  • Class 2: >1 mm(Horizontal)
  • Class 3: > 1 mm (Horizontal+vertical mobility)

Diagnosis of periodontal disease

The first step to a successful diagnosis is careful history-taking. Listen carefully to the patient. Ask key questions:

“Do your gums bleed upon brushing?”

“Are any of your teeth loose?”

“Do you smoke?”

"Have you been diagnosed with diabetes?"

Then, using a Williams probe with 1, 2, 3, 5, 7, 8, 9 and 10mm markings, measure the pocket depths around all the teeth. A six-point or a four-point pocket depth charting can be done. It should also be noted if any of the pockets bleed on probing. Bleeding will be a measure of inflammation; no bleeding on probing suggests health, except in smokers, who don't usually bleed on probing.

The probe will also help determine the distance from the base of the gingival sulcus to the cemento-enamel junction; this is attachment loss. This is the best way to monitor the patient's condition long-term but it is sometimes difficult to determine the position of the cemento-enamel junction.

If there is attachment loss, and no other systemic condition, then the diagnosis will be periodontitis.

Using the periodontal six/four point chart, if more than 30% of sites are involved then a diagnosis of generalised disease is given. If less than 30% of sites are involved, then the type of periodontitis is localized.

To complete the diagnosis, the extent of the disease must be assessed. This is defined as: mild (1-2mm), moderate (3-4mm) or severe (≥ 5mm) depending on the amount of attachment loss present.

Radiographs such as bitewings, intra-oral periapicals or a panoramic radiograph can be taken to help assess the bone loss and aid in diagnosis.

Periodontal classification 2018

Classification of Periodontal Diseases 2018

In 2018, a new classification system for Periodontal diseases was released. It has 3 main parts:

  1. Periodontal health, gingival diseases and conditions
  2. Periodontitis
  3. Other conditions affecting the periodontium.

In periodontal health, gingival diseases and conditions, there are 3 sub-types: [5]

I) Periodontal health and gingival health

  1. Gingival health on an intact periodontium
  2. Gingival health on a reduced periodontium
i.Stable periodontitis patient
ii.Non periodontitis patient

II) Gingivitis - dental biofilm induced

  1. Associated with the dental biofilm alone
  2. Mediated by systemic or local risk factors
  3. Drug influenced gingival enlargement

III) Gingival diseases - non dental biofilm induced

  1. Genetic/developmental disorders
  2. Specific infections
  3. Inflammatory and immune conditions
  4. Reactive processes
  5. Neoplasms
  6. Endocrine, nutritional and metabolic diseases
  7. Traumatic lesions
  8. Gingival pigmentation

In the second part of the new classification system, periodontitis, there are again three sub-types:

I) Necrotizing periodontal diseases

II) Periodontitis

III) Periodontitis as a manifestation of systemic disease

In the third division, Other conditions affecting the periodontium, there is again further breakdown.

I) Systemic diseases or conditions affecting the periodontal supporting tissues

II) Periodontal abscesses and endodontic-periodontal lesions

III) Mucogingival deformities and conditions

IV) Traumatic occlusal forces

V) Tooth and prosthesis related factors

Related Research Articles

<span class="mw-page-title-main">Periodontal disease</span> Medical condition

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

<span class="mw-page-title-main">Necrotizing gingivitis</span> Non-contagious, painful bacterial infection of the gums

Necrotizing gingivitis (NG) is a common, non-contagious infection of the gums with sudden onset. The main features are painful, bleeding gums, and ulceration of inter-dental papillae. This disease, along with necrotizing periodontitis (NP) and necrotizing stomatitis, is classified as a necrotizing periodontal disease, one of the three general types of gum disease caused by inflammation of the gums (periodontitis).

<span class="mw-page-title-main">Gums</span> Soft tissue surrounding the roots of the teeth

The gums or gingiva consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

<span class="mw-page-title-main">Periodontal fiber</span> Group of specialized connective tissue fibers

The periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. It inserts into root cementum on one side and onto alveolar bone on the other.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Periodontal probe</span>

A periodontal probe is an instrument in dentistry commonly used in the dental armamentarium. It is usually long, thin, and blunted at the end. Its main function is to evaluate the depth of the pockets surrounding a tooth in order to determine the periodontium's overall health. For accuracy and readability, the instrument's head has markings written on it.

<span class="mw-page-title-main">Gingival sulcus</span> Space between tooth and gums

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

<span class="mw-page-title-main">Gingival and periodontal pocket</span>

Gingival and periodontal pockets are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth.

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

<span class="mw-page-title-main">Gingivitis</span> Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums; ulitis is an alternative term. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

<span class="mw-page-title-main">Debridement (dental)</span> Removal of plaque and calculus from teeth

In dentistry, debridement refers to the removal by dental cleaning of accumulations of plaque and calculus (tartar) in order to maintain dental health. Debridement may be performed using ultrasonic instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler and curettes, or through the use of chemicals such as hydrogen peroxide.

<span class="mw-page-title-main">Furcation defect</span>

In dentistry, a furcation defect is bone loss, usually a result of periodontal disease, affecting the base of the root trunk of a tooth where two or more roots meet. The extent and configuration of the defect are factors in both diagnosis and treatment planning.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)
<span class="mw-page-title-main">Necrotizing periodontal diseases</span> Bacterial infection of the oral mucosa and periodontium

Necrotizing periodontal diseases is one of the three categories of periodontitis as defined by the American Academy of Periodontology/European Federation of Periodontology 2017 World Workshop classification system.

<span class="mw-page-title-main">Peri-implantitis</span> Inflammatory disease

Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The soft tissues become inflamed whereas the alveolar bone, which surrounds the implant for the purposes of retention, is lost over time.

Peri-implant mucositis is defined as an inflammatory lesion of the peri-implant mucosa in the absence of continuing marginal bone loss.

Clinical attachment loss (CAL) is the predominant clinical manifestation and determinant of periodontal disease.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.

References

  1. ↑ Seibert, J. S. (1983). "Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Part I. Technique and wound healing". Compendium of Continuing Education in Dentistry. 4 (5): 437–53. PMID   6578906.
  2. ↑ Miller Jr, P. D. (1985). "A classification of marginal tissue recession". The International Journal of Periodontics & Restorative Dentistry. 5 (2): 8–13. PMID   3858267.
  3. ↑ Kumar, A.; Masamatti, S. S. (2013). "A new classification system for gingival and palatal recession". Journal of Indian Society of Periodontology. 17 (2): 175–81. doi: 10.4103/0972-124X.113065 . PMC   3713747 . PMID   23869122.
  4. ↑ Carranza, FA: Clinical Diagnosis. In Newman, MG; Takei, HH; Carrana FA, editors: Carranza's Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 439.
  5. ↑ Caton, Jack G.; Armitage, Gary; Berglundh, Tord; Chapple, Iain L. C.; Jepsen, Søren; Kornman, Kenneth S.; Mealey, Brian L.; Papapanou, Panos N.; Sanz, Mariano (2018). "A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification" (PDF). Journal of Clinical Periodontology. 45 (S20): S1–S8. doi: 10.1111/jcpe.12935 . ISSN   1600-051X. PMID   29926489.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.