Session 9: Introduction to Classification of Periodontal Disease

Question 1

Identify the determinants of clinical periodontal health according to the 2017 AAP Periodontal Classification system

Answer 1

• Microbiological Determinants 
- Supragingival biofilm composition
- Subgingival biofilm composition
• Environmental Determinants
- Smoking, Medications, Stress, Nutrition
• Host Determinants
  1) Local predisposing factors
- Periodontal pockets
- Dental restorations
- Tooth morphology, root anatomy
- Tooth position, crowding, etc
  2) Systemic modifying factors
- Host immune function
- Systemic health
- Genetics

Question 2

Identify the general categories included in AAP ‘Periodontal and Gingival Diseases and Conditions’

Answer 2

• Stage 1-Mild, Stage 2-Moderate, Stage 3-Severe with the potential for tooth loss, and Stage 4-Severe with the potential for dentition loss.
• The AAP recommends starting by choosing either between Stages 1 and 2, or between Stages 3 and 4.

Question 3

Identify the general categories included in AAP ‘Periodontitis’

Question 4

Recognize the systemic diseases identified in the category of ‘Periodontitis as a Manifestation of Systemic Disease’

Answer 4

Systemic disorders that have a major impact on the loss of periodontal tissues by influencing periodontal inflammation
− Genetic disorders
− Diseases with immunologic disorders Eg. Down Syndrome
− Diseases affecting the oral mucosa and gingival tissue Eg. Epidermolysis bullosa
− Diseases affecting the connective tissues Eg. systemic lupus erythematous
− Metabolic and endocrine disorders Eg. Glycogen storage disease
− Acquired immunodeficiency diseases Eg. HIV infection
−Inflammatory diseases Eg. Inflammatory bowel disease
−Other systemic disorders that influence the pathogenesis of periodontal disease. Eg. diabetes mellitus, obesity, osteoporosis, arthritis, depression, smoking
−Neoplasms Eg. Squamous Cell Carcinoma, secondary metastatic neoplasms of perio tissues)

Question 5

Explain ‘staging’ of periodontitis and discuss how severity, complexity and extent/distribution assist in determining the 4 stages of periodontitis

Answer 5

Staging largely depends on severity of disease at presentation and complexity of disease management. Stage categories determined based on several variables e.g. clinical attachment loss, probing depth, etc…
- Severity is based on the amount of clinical attachment loss (CAL)

Question 6

Discuss the key characteristics of each Stage of periodontitis

Answer 6

Stage I: Initial Periodontitis
- Btw periodontitis and gingivitis. Early stages of LOA
Stage II: Moderate Periodontitis
- Established periodontitis with characteristic damage to tooth support.
- Monitoring to arrest disease progression. Evaluated carefully to determine if intensive management is required
Stage III: Severe Periodontitis with potential for tooth loss
- Significant LOA. No treatment = loss of tooth
- Complicated by intraboney defects, furcation involvement and history of periodontal tooth loss. No rehab needed
Stage IV: Severe Periodontitis with potential for loss of the dentition
- Characterized by presence of deep periodontal lesions that extend to apical portion of root and/or history of multiple tooth loss. Rehab needed

Question 7

Discuss the ‘primary criteria’ and how it assists in determining the grade of periodontitis