Lecture 5

Question 1

Why have classifications of perio disease?

Answer 1

Communicate findings to other dental professionals

Help patients understand their disease: verbiage parallels oncology (stage and grade)

Formulate a diagnosis and treatment plan: relate to cdt code and procedure

Predict prognosis

Question 2

CDT what does it stand for?

Answer 2

Current dental terminology

Question 3

Why was there a transition from 1989 to 1999 classification?

Answer 3

1989 has shortcomings
• overlap in disease categories
•Absence of gingival disease component
•Inappropriate emphasis on age of onset disease and rates of progression
•Unclear classification criteria

Question 4

What were the attributes of the 1999 classification compared to the 1989 classification?

Answer 4

• Described distinct forms of periodontal diseases based on clinical, radiographic and historical data
• Age factor eliminated from criteria: Not based on age at the time of presentation Adult” & “Early-onset”
• Eliminated Refractory Periodontitis: Any periodontal case can be considered refractory (Unresponsive to periodontal treatment)
• Included NUG and NUP (necrotizing ulcerative gingivitis or periodontitis): ANUG was changed to NUG; Acute is a clinical descriptive term - not a diagnosis

Question 5

What were the shortcomings of the 1999 classification?

Answer 5

One dimensional view of periodontitis:
Graded according to severity: severe, moderate, slight; more than one severity level in various areas

Question 6

What are the attributes of the 2017 classification?

Answer 6

Attributes
First-time classification for:
• “Periodontal/Gingival Health”
• Acknowledged health vs only disease

Peri-implant diseases
• Acknowledged disease occurring with implants

Differentiate loss from other factors
• Uses “intact” vs “reduced”
• Previous - any loss was perio regardless of cause

Eliminates “chronic” and “aggressive” as different disease entities
• Regrouped under the single term “periodontitis”

Removed “ulcerative” from necrotizing conditions

New multidimensional view of periodontitis: Staging & Grading
• Full-mouth diagnosis: No subdivision into different severity levels
• Staging incorporates severity, tooth loss, and management complexity
• Grading incorporates progression, risk factors, and potential impact on general health
• Recategorization of various forms of periodontitis

Question 7

General Guidelines for AAP Classification

Intact Periodontium (Health or Gingivitis)

Answer 7

• There is NO radiographic bone loss.
• Healthy bone levels are measured as 1-2mm from CEJ to crest of bone; crestal lamina dura is intact (visibility varies based on tube head angulation and bone type).

Question 8

General Guidelines for AAP Classification

Reduced Periodontium (Health or Gingivitis) & (Perio or Non-Perio)

Answer 8

• Radiographic bone loss evident with no active signs of periodontitis.
• Bone loss from successfully treated stable periodontitis or due to non-periodontitis causes.
• Stage and Grade classification must be given.
• Non-periodontitis causes (classification) need to be acknowledged
• Radiographic bone loss is described as % of bone loss in relationship to the length of the tooth root.

Question 9

General Guidelines for AAP Classification

Periodontitis - Staging and Grading

Answer 9

• Periodontitis is microbially-associated, host-mediated inflammation resulting in loss of periodontal attachment.
• Radiographic bone loss evident with active signs of disease (bleeding, tissue appearance, halitosis, positive periodontal risks, etc.). If inactive, staging and grading is not given; use reduced periodontium classification.

Question 10

Criteria for Periodontal Case

Answer 10