The objective of the workshop was to update the previous disease classification established at the 1999 International Workshop for Classification of Periodontal Diseases and Conditions.5 One of the major highlights included the recategorization of three forms of periodontitis, the development of a multidimensional staging and grading system for periodontitis, and the new classification for peri-implant diseases and conditions.6, The intent of this best practices document is to present an abbreviated overview of the new classification of periodontal and peri-implant diseases and conditions, including gingivitis. Lastly, the extent or the number of gingival sites exhibiting gingival inflammation can be described as either localized (<30 percent of the teeth are affected) or generalized (≥30 percent of the teeth are affected).22, As mentioned above, one revision from the 1999 classification system5 was the proposal to introduce the term incipient gingivitis…“where, by definition, only a few sites are affected by mild inflammation, expressed as mild redness and/or a delayed and broken line of bleeding rather than edema or an immediate unbroken line of bleeding on probing. Non-dental plaque-induced gingival diseasesThe gingiva and oral tissues may demonstrate a variety of gingival lesions that are not caused by plaque and usually do not resolve after plaque removal (Table 2 - see PDF).6 However, the severity of the clinical manifestations of these lesions often is dependent upon plaque accumulation and subsequent gingival inflammation. American Dental Association Classifications (based primarily on attachment loss) Case Type I: Gingivitis: no attachment loss, bleeding may or may not be present Case Type II: Early Periodontitis: pocket depths or attachment loss 3 - 4 mm BOP may be present localized areas of recession possible class I … Assessing periodontal health is important to establish a common reference point for diagnosing disease and determining therapy outcomes by practitioners.11,21 Four levels of periodontal health have been proposed, depending on whether (1) the periodontium (attachment and bone level) is structurally and clinically sound or reduced, (2) the ability to control local and systemic modifying factors, as well as (3) the relative treatment outcomes. Within each category there are specific types of diseases identified, Gingivitis Associated with Systemic Conditions or Medications, Gingival Manifestations of Systemic Diseases and Mucocutaneous Lesions, Blood Dyscrasias (for example Acute Monocytic Leukemia), Mucocutaneous Diseases (Lichen Planus, Cicatricial Pemphigoid), Periodontitis Associated with Systemic Diseases, Addition of a section on “Gingival Diseases”, Replacement of “Adult Periodontitis” with “Chronic Periodontitis“, Replacement of “Early-Onset Periodontitis” with “Aggressive Periodontitis”, Elimination of a separate disease category for “Refractory Periodontitis”, Replacement of “Necrotizing Ulcerative Periodontitis” with “Necrotizing Periodontal Diseases”, Addition of a category on “Periodontal Abscess”, Addition of a category on “Periodontic-Endodontic Lesions”, Addition of a category on “Developmental or Acquired Deformities & Conditions”, Gingival diseases of specific bacterial origin, Gingival manifestations of systemic conditions. Marty M, Palmieri J, Noirrit-Esclassan E, Vaysse F, Bailleul-Forestier I. Necrotizing periodontal diseases in children: A literature review and adjustment of treatment. Association among periodontitis and the use of crack cocaine and other illicit drugs. Helv Odontol Acta 1981;25(1):25-42.38. The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions was co-presented by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP). Other factors that predispose to gingivitis in both male and female adolescents are dental caries, mouth breathing, dental crowding, and eruption of teeth. 2 This system was widely used among practitioners although a gingival disease component was missing and there was an overlap of disease categories. Radiographs and probing attachment level analysis should not be used to diagnose gingivitis since they usually do not indicate loss of supporting structures. However, the role of vitamin C (ascorbic acid) in supporting periodontal tissues due to its essential function in collagen synthesis is well-documented.10,19 Vitamin C deficiency, or scurvy, compromises antioxidant micronutrient defenses to oxidative stress and collagen synthesis leading to weakened capillary blood vessels, consequently increasing the predisposition to gingival bleeding.48 Nevertheless, gingival inflammation due to vitamin C deficiency may be difficult to detect clinically and indistinguishable from plaque-induced gingivitis.22 Scurvy may occur in certain populations of pediatric interest such as infants and children from low socioeconomic families.22, One major change in the 2017 classification of dental plaque-induced gingival diseases was to simplify the system for the clinician and condense the catalog to include only conditions affecting the gingiva that could be clinically identified. In addition, health diseases/conditions such as Sjögren’s syndrome, anxiety, and poorly controlled diabetes may cause xerostomia due to hyposalivation.11,22, Systemic risk factors can modify the host immune inflammatory response in the presence of dental plaque biofilm resulting in exaggerated inflammatory response. The AAP updated its classification system for periodontal diseases in 2018 to create a common terminology compatible with scientific knowledge of periodontal diseases. Preshaw PM. This is because the inter-relationship between health, gingivitis, and periodontitis is highly dependent on the host’s susceptibility and immune-inflammatory response. Tooth-supported and/or tooth-retained restorationsand their design, fabrication, delivery, and materials often have been associated with plaque retention and loss of periodontal supporting tissues. Due to concerns from clinicians, researchers, educators, and epidemiologists regarding their ability to properly distinguish between chronic and aggressive periodontitis, the 2017 World Workshop members proposed grouping these two previously forms of periodontitis into a single category simply referred to as periodontitis.24,27 The clinical entity previously referred to as aggressive periodontitis due to its rapid rate of progression is now categorized as Grade C periodontitis and represents the extreme end of a continuum of disease rates. Pediatr Dent 2006;28(2):177-87.52. WHO: World Health Organization. Shourie V, Dwarakanath CD, Prashanth GV, Alampalli RV, Padmanabhan S, Bali S. The effect of menstrual cycle on periodontal health – A clinical and microbiological study. Abscesses of the Periodontium Copyright Am-Medicine.com © 2013-2020. Periodontitis Associated with Systemic Diseases Hyposalivation interferes with plaque removal, thereby increasing the risk of caries, halitosis, and gingival inflammation among other oral conditions. These disorders or conditions are grouped as periodontitis as a manifestation of systemic disease, and classification should be based on and follow the classification of the primary systemic disease according to the respective ICD codes.6 Moreover, they can be grouped into broad categories such as genetic disorders that affect the host immune response (e.g., Down syndrome, Papillon-Lefèvre,histiocytosis) or affect the connective tissues (e.g., Ehlers-Danlos syndrome, systemic lupus erythematosus); metabolic and endocrine disorders (e.g., hypophosphatasia, hypophosphatemic rickets); inflammatory conditions (e.g., epidermolysis bullosa acquisita, inflammatory bowel disease); as well as other systemic disorders (e.g., obesity, emotional stress and depression, diabetes mellitus, Langerhans cell histiocytosis, neoplasms). American Academy of Periodontology. J Periodontol 2016;87(12):1396-405.57. There are broadly two categories of gingival disease and conditions: dental plaque biofilminduced gingivitis and non-dental plaque-induced gingival disease. Oral manifestations include gingival enlargement/bleeding, petechiae, oral ulcerations/infections, and cervical lymphadenopathy. Albandar JM, Susin C, Hughes FJ. According to the American Academy of Periodontology, U.S.-trained periodontists are specialists in the prevention, diagnosis and treatment of periodontal diseases and oral inflammation, and in the placement and maintenance of dental implants. PPD: Periodontal probing depth. Case definitions and clinical criteria of these conditionsare presented below. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Periodontitis is a multifactorial, microbially-associated, host-mediated inflammatory disease characterized by progressive destruction of the periodontal attachment apparatus. The new periodontitis classification was further characterized based on a multi-dimensional staging and grading framework system. Heitz-Mayfield LJA, Salvi GE. Available at: “https://www.cancer.gov/about-cancer/diagnosis-staging/ staging”. J Periodontol 2018;89(Suppl 1):S9-S16.22. Albert DA, Severson HH, Andrews JA. Some highlights of the discussion at the meeting are provided below. In order to attain or maintain clinical periodontal health, clinicians should not underestimate predisposing and modifying factors for each patient and should recognize when these factors can be fully controlled or not. Jepsen S, Caton JG, Albandar JM, et al. The American Academy of Periodontology (AAP) has released a comprehensive update to the classification of periodontal and peri-implant diseases and conditions. There is either little or no evidence that traumatic occlusal forces can cause periodontal attachment loss, inflammation of the periodontal ligament, non-carious cervical lesions, abfraction, or gingival recession.14,20 Traumatic occlusal forces lead to adaptive mobility in teeth with normal support and are not progressive, while in teeth with reduced support, they lead to progressive mobility usually requiring splinting. Monitoring gingival health or inflammation is best documented by the parameter of BoP since it is considered the primary parameter to set thresholds for gingivitis and the most reliable for monitoring patients longitudinally in clinical practice.6,21 Clinicians are encouraged to start probing regularly when the first permanent molars are fully erupted and the child is able to cooperate for this procedure in order to establish a baseline, detect early signs of periodontal disease, and prevent its progression. A new classification scheme for periodontal and peri-implant diseases and conditions–Introduction and key changes from the 1999 classification. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. J Periodontol 2018;89(Suppl 1):S223-S236.14. Accessed June 22, 2018. root anatomy;iv. J Periodontol 2018;89(Suppl 1):S204-S213.13. systemic modifying factorsi. Early diagnosis ensures the greatest opportunity for successful treatment, primarily by reducing etiological factors, establishing appropriate therapeutic measures, and developing an effective periodic maintenance protocol.2, In 2017, the American Academy of Periodontology and the European Federation of Periodontology co-sponsored the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. J Periodontol 2018;89(Suppl 1):S237-S248.21. Peri-implant health can occur around implants with normal or reduced bone support.6,25, Peri-implant mucositisPeri-implant mucositis is characterized by visual signs of inflammation such as redness, swelling, and line or drop of bleeding within 30 seconds following probing, combined with no additional bone loss following initial healing. Peri-implant diseases and conditionsThe 2017 World Workshop members developed a new classification for peri-implant health, peri-implant mucositis and peri-implantitis. 66, No. Pediatric dentists are often the front line in diagnosing periodontal conditions in children and adolescents and in great position to treat or refer and coordinate, collaborate, and/or organize the patient care activities between two or more health care providers to ensure that the appropriatetreatment is delivered in a timely fashion. J Periodontol 2018;89(Suppl 1):S85-S102.19. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Billings M, Holtfreter B, Papapanou PN, Mitnik GL, Kocher T, Dye BA. Gusberti FA, Syed SA, Bacon G, Grossman N, Loesche WJ. 4. Traumatic occlusal forces and occlusal traumaTraumatic occlusal force is defined as “any occlusal force that causes an injury to the teeth and/or the periodontal attachment apparatus.”20 It may be indicated by one or more of the following: fremitus (visible tooth movement upon occlusal force), tooth mobility, thermal sensitivity, excessive occlusal wear, tooth migration, discomfort/pain on chewing, fractured teeth, radiographically widened periodontal ligament space, root resorption, and hypercementosis.20 Occlusal trauma is alesion in the periodontal ligament, cementum, and adjacent bone caused by traumatic occlusal forces. 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